The Care Quality Commission
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  • GP practice

Dr Jude's Practice - Riverside & Picton

Overall: Requires improvement read more about inspection ratings

Park Street, Liverpool, Merseyside, L8 6QP

Provided and run by:
Dr Don Jude Mahadanaarachchi

Important: The provider of this service changed. See old profile

All Inspections

13 December 2022

During a routine inspection

We carried out an announced comprehensive inspection at Dr Jude's Practice - Riverside & Picton on 8 and 13 December 2022. Overall, the practice is rated as requires improvement. The ratings for each key question are:

Safe - good

Effective - requires improvement

Caring - requires improvement

Responsive - requires improvement

Well-led - good

Following our previous inspection on 9 March 2022, the practice was rated requires improvement overall and for all key questions the practice was rated:

Safe - requires improvement

Effective - requires improvement

Caring - requires improvement

Responsive - requires improvement

Well-led - inadequate

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Jude's Practice - Riverside & Picton on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

We have rated this practice as requires improvement overall.

We rated the practice as good for providing safe services. This is because:

  • At this inspection, we found that those areas previously regarded as requiring improvement had been addressed and appropriate actions taken by the provider. The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.

We rated the practice as requires improvement for providing effective services. This is because:

  • The practice achievement in cervical cancer screening and childhood immunisations continued to be below nationally set targets.

We rated the practice as requires improvement for providing caring services services. This is because:

  • The provider had taken action to monitor patient views by monitoring the results of the GP national survey and actions plans were in place. However, the provider had not undertaken a practice patient survey and feedback from patients in the national GP patient survey were below local and national averages relating for questions about care and concern from staff.

We rated the practice as requires improvement for providing responsive services because:

  • Complaint records did not provide sufficient detail to demonstrate that all complaints were investigated thoroughly and without delay. The provider did not maintain a record of all complaints, outcomes and actions taken in response to complaints made to the practice.

We rated the practice as good for providing well led services because:

  • At this inspection, we found that those areas previously regarded as inadequate had been addressed and appropriate actions taken by the provider. Leaders demonstrated they understood the challenges to quality and sustainability. The practice had a culture which drove high quality sustainable care. There were clearer and improved processes for managing risks, issues and performance.

We found one breach of regulations. The provider must:

  • Ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or its investigation.

The provider should:

  • Take action to ensure all staff who may be exposed to blood, body fluids or tissues as part of their work activity should have pre-exposure immunisation against HBV.
  • Involve patients and the public in infection prevention and control by providing alcohol hand rub at the entrance to the building for the use of patients and visitors.
  • Undertake a risk assessment for the use of a shared automated external defibrillator (AED). Checks of emergency medicines should be carried out weekly.
  • Continue to monitor and provide evidence of effective medicines reviews for patients on repeat medicines.
  • Improve staff administration of prescription only medicines under a patient group directive to include appropriate authorisation.
  • Continue to take steps to improve the childhood immunisations and cervical screening rates for the practice.
  • GPs and practice staff should ensure that records relating to DNACPR decisions are available on patients record systems, particularly as they move between patient services such as hospital and primary care.
  • Continue to take steps to improve the results of the national GP patient survey.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

9 March 2022

During a routine inspection

We carried out an announced inspection at Dr Jude’s Practice – Riverside and Picton on 9 March 2022. Overall, the practice is rated as requires improvement.

Safe - Requires improvement

Effective - Requires improvement

Caring - Requires improvement

Responsive - Requires improvement

Well-led – Inadequate

Why we carried out this inspection

This inspection was a comprehensive inspection covering all key questions.

How we carried out the inspection

The inspection was carried out on site at the main location for Dr Jude’s practice at Riverside and Picton and included a visit to the branch surgery at Picton. The inspection included:

  • Conducting staff interviews
  • Completing clinical searches on the practice’s patient records system and discussing the findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Reviewing evidence from the provider

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Liverpool. To understand the experience of GP Providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

Our findings:

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

  • Improvements were required to the systems and procedures for ensuring care is provided in a way that keeps patients safe and protected from avoidable harm.
  • Staff had not completed the appropriate level of training in safeguarding children.
  • Recruitment was not always carried out according to the practice policy or Schedule 3 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
  • There was not an effective system in place for oversight of risks related to premises and equipment.
  • Staffing levels were not kept under review and the management of safety alerts and incidents were not well documented to include actions taken.

We rated the practice as requires improvement for providing effective services because:

We rated the service as requires improvement for providing effective services because:

  • Improvements were required to some aspects of the management of patients conditions and to health prevention.
  • The systems in place for supporting staff needed to be developed further.
  • Childhood immunisations and cervical cancer screening achievement was well below national averages.
  • The staff induction process was not tailored to specific roles.

We rated the practice as Requires Improvement for providing caring services because:

  • Patients were involved in decisions about their care and treatment but patient feedback with regards to feeling they were treated with kindness and respect was not always positive.
  • The provider had not acted upon patient feedback to improve patient experience.

We rated the practice as Requires Improvement for providing responsive services because:

  • Patients were not always satisfied with access to the practice and the provider did not act on feedback provided.

We rated the practice inadequate for providing well-led services because:

  • Some members of the leadership team had been recently appointed and their roles and responsibilities had not been clearly set out and were still being developed.
  • Practice staff were not always aware of the roles and responsibilities of members of the leadership team and the lines of accountability within the organisation.
  • The provider’s centralised governance function did not have clear systems and processes in place to support staff at practice level.
  • The provider did not have a documented overall strategy underpinned by detailed, realistic objectives and plans for high-quality and sustainable delivery.
  • The systems for identifying, managing and mitigating some risks were ineffective.
  • There was no leadership development programme in place.
  • The vision, values and strategy were not developed in collaboration with staff, patients and partners.

We found the following breaches of regulations. The provider must:

  • Ensure the care and treatment is provided in a safe way to patients.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Review the processes for adding alerts to the patient record system for vulnerable adults.
  • Confirm the arrangements for oversight of the emergency equipment.
  • Take action to increase childhood immunisation uptake to meet defined targets.
  • Take action to increase the number of patients taking up cancer screening.
  • Identify carers to enable this group of patients to access the care and support they need.
  • Ensure there is documented evidence of stock control and checks on vaccines stored at the branch practice (Picton).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care