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Dr Hendrik Johan Beerstecher Requires improvement Also known as 13/10/2016

Reports


Inspection carried out on 11 April 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hendrik Johan Beerstecher on 8 March 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Hendrik Johan Beerstecher on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 11 April 2017. Overall the practice is now rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • There was an effective system for reporting, recording, investigating and learning from significant events.
  • Improvements to risk management had been made. However, some risks to patients, staff and visitors were not adequately assessed and well managed.
  • There had been improvements in arrangements to deal with emergencies and major incidents. However, some emergency equipment was not available in the practice.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Data from the Quality and Outcomes Framework (QOF) demonstrated a positive change in patient outcomes. However, further improvements were still required to benefit patients.
  • The practice followed up patients recently discharged from hospital and had worked with other health care professionals when necessary to understand and meet the range and complexity of patients’ needs.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to book appointments with a named GP and there was continuity of care, with urgent appointments available the same day.
  • Improvements to governance arrangements at the practice had taken place. However, further improvements to risk assessment and management were found to be required.
  • There was a clear leadership structure and staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are;

  • Ensure the health and safety law poster is displayed on the premises in line with the Health and Safety at Work etc. Act 1974.

  • Revise risk management and ensure that all risks to patients, staff and visitors, including fire safety risks and risks associated with the control of substances hazardous to health, are assessed and well managed.

  • Revise systems to ensure the practice is able to respond to a medical emergency in line with national guidance.

The areas where the provider should make improvements are;

  • Keep records of domestic cleaning carried out as well as any cleaning audits conducted at the practice.

  • Consider physically checking emergency equipment and emergency medicines at least on a weekly basis in line with Resuscitation Council (UK) guidance.

  • Continue to replace out of date emergency medicine as soon as replacement stocks become available and consider replacing the medical oxygen cylinders with ones that carry expiry dates.

  • Add emergency contact numbers for staff to the business continuation contingency plan.

  • Continue to improve patient outcomes, in particular for those patients with mental health problems.

  • Formalise and maintain records of all staff appraisals.

  • Improve coding activity to help ensure all childhood immunisation activities are captured in practice activity data.

  • Continue to identify patients who are also carers to help ensure they are offered appropriate support.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 8 March 2016

During a routine inspection

We carried out an announced comprehensive inspection at Dr Hendrik Johan Beerstecher on 8 March 2016. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, significant event investigation and patient communication was not always completed in a timely manner.
  • Governance arrangements were not robust or always effectively implemented.The practice had a number of policies and procedures to govern activity, but there was a lack of consistency in governance, for example, some policies required review and others did not contain sufficient detail.
  • There was an inconsistent approach to national and local clinical guidance.
  • Risks to patients were not always well assessed and well managed, for example, contingency planning in the event of an emergency or major incident or continuity planning in the event of unplanned absence of key members of staff.
  • The arrangements for managing medicines in the practice did not always keep patients safe. For example, the practice nurse was administering medicines, such as vaccines, without Patient Group Directions and the use of blank prescriptions were not being monitored.
  • The practice was unable to respond to a medical emergency in line with national guidance.
  • The practice did not always assess needs and deliver care in line with relevant and current evidence based guidance and standards.
  • Data showed patient outcomes were low compared to the local and national averages.
  • There was evidence of audit activity, but this had not significantly improved performance or patient outcomes.
  • Not all staff were up to date with mandatory training.
  • The practice did not have a system to follow up patients recently discharged from hospital.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
  • Some childhood immunisation rates were lower than the local clinical commissioning group averages.
  • Patients were offered health checks. However, newly registered patients did not routinely attend for health checks as part of their new patient assessments.
  • Data from the National GP Patient survey was consistently better than local and national averages.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care.
  • Practice staff had good local knowledge about their local patient population but did not actively engage with the NHS England Area Team and the local clinical commissioning group in order to secure improvements to services.
  • Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
  • Information was available to help patients understand the complaints system. However, this did not contain details of who to contact in order to raise a complaint and the practice was unable to demonstrate that all complaints, including verbal complaints, were investigated and replied to in a timely manner.
  • There was a structure of leadership and staff felt supported by management. However, there was a lack of clarity around responsibility and accountability between the GP and the practice manager who was also the practice nurse.

The areas where the provider must make improvements are:

  • Investigate safety incidents and complaints thoroughly and ensure that people affected receive reasonable support and a verbal and written apology in a timely way.
  • Revise risk assessment and management activities to ensure they include all risks to patients, staff and visitors.
  • Ensure the practice follows national guidance on infection prevention and control.
  • Revise medicines management to help ensure the practice is complying with relevant legislation and monitoring the use of blank prescriptions.
  • Ensure the practice is able to respond to a medical emergency in line with national guidance.
  • Ensure all staff have the necessary employment checks including a current Disclosure and Barring Service check in order to undertake roles such as chaperoning.
  • Ensure that patients’ needs are assessed and care delivered in line with relevant and current evidence based guidance and standards.
  • Implement a system for personalised care plans for vulnerable patients.
  • Ensure that all staff are up to date with attending mandatory training courses.
  • Ensure that patients discharged from hospital are followed up in a timely manner.
  • Revise governance arrangements and ensure that all governance documents are kept up to date and contain sufficient details for staff to follow.
  • Revise responsibility and accountability to ensure clarity between the GP and the practice manager/ practice nurse.

In addition the provider should:

  • Engage with the NHS England Area Team and the local clinical commissioning group in order to secure improvements to services.
  • Revise the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if required.
  • Review information available to patients about services provided to help ensure it is accurate and up to date.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If sufficient improvements have not been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the practice the reassurance that the care they receive should improve.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 28 November 2013

During an inspection to make sure that the improvements required had been made

We undertook this inspection visit to review infection control procedures in the practice. We reviewed records and systems and looked at the environment and how this impacted on the service delivery. We spoke with the GP and practice manager/practice nurse.

We found that the improvements needed to achieve compliance had been made. We found that the premises were suitable and safe, and risks associated with cross infection had been assessed.

Inspection carried out on 11 June 2013

During a routine inspection

This inspection visit was undertaken by two compliance inspectors. We used a number of different methods to understand the experiences of patients.

We spoke with five patients who had recently attended the practice. We spoke with the GP, practice manager who was also the practice nurse, and a receptionist.

Patients told us that they could access the GP as they needed to and that their privacy and dignity was respected. Patient’s care needs had been assessed, they had time to discuss their health care issues, and had been fully involved in making decisions about their care and treatment. Comments received included, ''I am fully satisfied with the care I receive.’’ Another patient said, ‘’The GP is very good my wife would be lost without him.’’

We looked at the processes that the practice had in place to ensure the people who used the service were protected from abuse. These ensured staff had an understanding of abuse and what to do if it was suspected.

Patients told us the practice was clean and that staff washed their hands regularly. We reviewed the facilities and practice in relation to infection control. We found that risks associated with cross infection had not been fully assessed.

We looked at the practice’s established processes. We found that these ensured all records were handled and stored appropriately.

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone.