We carried out a review of the data available to us about Keats Surgery on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Keats Surgery, you can give feedback on this service.
We carried out an announced inspection at Keats Surgery on 27 May 2021. Overall, the practice is rated as Good.
Safe - Good
Effective - Good
Caring - Good
Responsive - Good
Well-led - Good
The Good ratings for Caring and Responsive are in respect of our previous inspection which took place on 16 December 2020.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Keats Surgery on our website at www.cqc.org.uk
Why we carried out this inspection
We had previously inspected the practice on 16 December 2020, when we rated it Good in respect of the Caring and Responsive questions but rated it as Requires Improvement in respect of the Safe, Effective And Well led key questions. We served a Requirement Notice for breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This inspection took place to confirm that the necessary actions had been taken to address the breach of regulation.
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included
Our findings
We based our judgement of the quality of care at this service on a combination of:
We have rated this practice as Good overall and Good for the following population groups: Older people, People with long-term conditions, Working age people (including those recently retired and students), People whose circumstances may make them vulnerable, People experiencing poor mental health (including people with dementia). We have rated the practice as Requires Improvement for the Families, children and young people population group.
We found that:
Whilst we found no breaches of regulations, the provider should:
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
We carried out an announced comprehensive inspection at Keats Surgery on 16 December 2020 as part of our inspection programme, to check on concerns noted at previous inspections. The reports of those inspections can be read on the CQC website at: https://www.cqc.org.uk/location/1-498006035/reports
We had inspected the practice on 12 February 2020, when we rated it inadequate overall and in respect of the safe, effective and well led questions; and requires improvement in respect of the caring and responsive questions. We served Requirement Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On 16 & 17 August 2020, we carried out a follow up, unrated, remote regulatory assessment, focussing on the breaches of Regulations 12 and 17 and found that the practice had made insufficient improvements. We therefore served Warning Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We did not revise the practice’s ratings at this stage.
We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering how we carried out this inspection. We therefore undertook some of the inspection processes remotely and spent less time on site. We conducted medical records searches on 3 and 9 December 2020 and carried out a site visit on 16 December 2020.
We have rated this practice as Requires Improvement overall.
We based our judgement of the quality of care at this service on a combination of:
We rated the practice as Requires Improvement for providing safe services because:
When we inspected in February 2020, we rated the practice as inadequate for providing safe services because arrangements for monitoring high risk medicines placed patients at risk and the practice lacked effective safety alerts systems. These issues continued to be of concern at our unrated August 2020 Remote Regulatory Assessment. We therefore served Warning Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; and asked the provider to take action.
At this inspection, arrangements for monitoring Warfarin continued to place some patients at elevated risk but monitoring arrangements for patients prescribed Methotrexate, Lithium and Azathioprine high risk medications had significantly improved. Appropriate arrangements were now also in place for acting on safety alerts.
We rated the practice as Requires Improvement for providing effective services:
When we inspected in February 2020, we rated the practice as inadequate for providing effective service. The practice’s performance was significantly below local and national averages on indicators relating to diabetes, hypertension and asthma. Childhood immunisations uptake was also significantly below the World Health Organisation 95% target.
Additional concerns were highlighted at our unrated August 2020 Remote Regulatory Assessment regarding missed diagnoses and a failure to deliver optimal patient care.
At this inspection, the practice’s performance was in line with local and national averages and monitoring arrangements for patients with diabetes and asthma now supported the delivery of optimal care and treatment. However, child immunisation uptake continued to be below local and national averages. We noted the practice had recruited an additional nurse and that unverified practice data indicated this was beginning to have a positive impact.
We rated the practice as Good for providing caring services:
When we inspected in February 2020, we rated the practice as requires improvement for providing caring services because patient satisfaction on involvement in care and treatment was below local and national averages.
At this inspection, although patient satisfaction on involvement in care and treatment was still below local and national averages, the gap had significantly narrowed. Patient satisfaction on the extent to which clinicians listened was now comparable to local and national averages. We also noted satisfaction on the overall patient experience at the practice was above local and national averages; as was satisfaction on the extent to which patients had confidence and trust in their clinician.
We rated the practice as Good for providing Responsive services:
When we inspected in February 2020, we rated the practice as requires improvement for providing responsive services because the practice continued to provide only limited nursing services. At this inspection, we noted that an additional part time practice nurse had been appointed to enhance flexibility, choice and continuity of care. National GP survey patient satisfaction scores were now also above local and national averages regarding phone access and appointment times.
We rated the practice as Requires Improvement for providing well-led services:
When we inspected in February 2020, we rated the practice as inadequate for providing well-led services because of concerns regarding leadership capacity, governance arrangements and systems for managing risks. Governance arrangements continued to be of concern at our unrated August 2020 Remote Regulatory Assessment. The provider was asked to take action.
At this inspection, governance arrangements regarding safety alerts had improved. However, we noted concerns regarding systems for managing infection risks.
The areas where the provider must make improvements are:
The areas where the provider should make improvements are:
I am taking the practice out of special measures in recognition of the improvements made since our previous inspection. However, further improvement is required in relation to providing safe, effective and well led services; and for the care provided to Families, children and young people and Working age people.
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
This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the Provider.
We carried out a GP Focused Inspection Pilot on 17 & 18 August 2020. We had previously carried out an announced comprehensive inspection at Keats Surgery on 12 February 2020 as part of our inspection programme. At that time, concerns were found in the key questions of Safe and Well led resulting in breaches of Regulation 12(1)- Safe care and treatment and Regulation 17 (1) – Good governance of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice was rated inadequate and placed into Special Measures.
The GP Focused Inspection Pilot undertaken on 17 & 18 August 2020 did not review the ratings for the key questions or for the practice overall as this was a Focused Inspection Pilot, undertaken to assess whether the provider had taken action to address the areas of immediate risk identified at the February 2020 inspection.
We will consider the practice’s ratings in all key questions and overall when we carry out a full comprehensive inspection at the end of the period of special measures.
We found that:
•Insufficient action had been taken since our February 2020 comprehensive inspection, such that arrangements for monitoring patients prescribed high risk medicines continued to place patients at risk.
•Insufficient action had been taken since our February 2020 comprehensive inspection, such that arrangements for acting on safety alerts continued to place patients at risk.
•Insufficient action had been taken since our February 2020 comprehensive inspection in that arrangements for monitoring the care of patients with diabetes, hypertension and asthma did not support the delivery of optimal care and treatment.
•Action had been taken since our February 2020 comprehensive inspection such that patient group directives (PGD’s) were now in date allowing specified health professionals such as nurses to supply and/or administer medicine without a prescription or an instruction from a prescriber such as a doctor.
•Systems were also now in place for disseminating learning from significant events and complaints; and for improving childhood immunisations.
The areas where the provider must make improvements are:
•Ensure that care and treatment is provided in a safe way.
•Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
This service will remain in Special Measures. Services placed in Special Measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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 service 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 by adopting our proposal to remove this location or cancel the provider’s registration.
Special Measures will give people who use the service the reassurance that the care they get should improve.
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
We previously carried out an announced comprehensive inspection at Keats Surgery on 4 February 2019, and rated the practice as requires improvement for safe, effective and well-led care and good for caring and responsive care. This gave the practice an overall rating of requires improvement. As a result of the concerns identified, we served requirement notices, as the provider was failing to comply with the relevant requirements of Regulation 12, Safe care and treatment and Regulation 17, Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This inspection was an announced follow-up comprehensive inspection, which took place on 12 February 2020. We found all the issues identified at the February 2019 inspection, with the exception clinical outcomes for patients with asthma, had been addressed to an appropriate standard.
However, during this inspection we found additional concerns .
We based our judgement of the quality of care at this service on a combination of:
We have rated this practice as inadequate improvement overall.
We rated the practice as inadequate for providing safe services because:
We rated the practice as inadequate for providing effective services because:
We rated the practice as requires improvement for providing caring services because:
We rated the practice as requires improvement for providing responsive services because:
We rated the practice as inadequate for providing well-led services because:
For the effective domain, we rated older people; people whose circumstances may make them vulnerable and people experiencing poor mental health as good. We rated people with long-term conditions as inadequate because performance indicators for Diabetes, Hypertension and Asthma were significantly below national and local averages. We rated families, children and young people as inadequate because performance in the uptake of childhood immunisations were significantly below the World Health Organisation targets. We rated working age people as requires improvement because the cervical screening uptake rate was below the national target.
For the responsive domain, we rated older people; people with long term conditions; people whose circumstances may make them vulnerable; and people experiencing poor mental health as good. We rated families, children and young people and working age people as requires improvement because there was limited nursing services, the majority of which was within of school and working hours.
The above ratings of the population groups across the effective and responsive domains resulted in:
The areas where the provider must make improvements are:
The areas where the provider should make improvements are:
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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 service 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 by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
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
We carried out an announced comprehensive inspection at Keats Surgery on 04 February 2019. The practice was previously rated in December 2016 and rated as good in all domains and population groups.
We based our judgement of the quality of care at this service on a combination of:
We have rated this practice as requires improvement overall.
We rated the practice as requires improvement for providing safe services because:
We rated the practice as requires improvement for providing effective services because:
We rated the practice as requires improvement for providing well-led services because:
We rated the practice as good for providing caring and responsive services because:
For the responsive domain, we rated all the population groups as good.
For the effective domain, we rated older people; working age people; people whose circumstances may make them vulnerable; and people experiencing poor mental health as good. We rated people with long-term conditions and families, children and young people as requires improvement. This was because performance in the uptake of childhood immunisations were below the World Health Organisation targets, and QOF scores for Asthma and Atrial Fibrillation were below local CCG and England averages. This gave an overall rating of requires improvement for long-term conditions and families, children and young people.
The areas where the provider must make improvements are:
The areas where the provider should make improvements are:
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
We carried out an announced comprehensive inspection at Keats Surgery on 3 June 2014. The inspection was part of a programme testing our new inspection methodology and was therefore not rated. However, concerns were identified regarding fire safety and recruitment checks and shortly thereafter the practice sent us an action plan detailing how they would make the required improvements. (The full comprehensive report on the June 2014 inspection can be found by selecting the ‘all reports’ link for Keats Surgery on our website at www.cqc.org.uk).
We carried out an announced comprehensive, follow up inspection on 1 December 2016. Overall the practice is rated as good (this rating takes account of our previously identified concerns).
Our key findings across all the areas we inspected were as follows:
The areas where the provider should make improvement are:
Continue to monitor recent activity to improve performance on diabetic care and childhood immunisations.
Consider undertaking “duty of candour” training to ensure that all staff are aware of its requirements.
Install a hearing loop in reception to improve access for patients with impaired hearing.
Chief Inspector of General Practice
Keats Surgery provides primary medical care and a range of services including maternity care, diabetes, and child health and baby immunisations clinics to 4,400 people in the Edmonton area of north London. It is open Mondays 8 am to 9pm and Tuesday to Friday 8am to 6.30pm. Outside of these times, an out of hour’s service is available.
Keats Surgery staff were a small and close-knit unit. Patients were happy with the service, found access to appointments was good, and staff were friendly and helpful. The surgery worked well with other services. There was good access to the practice for older people with mobility difficulties and staff took time with people when needed to discuss their care and treatment. A limited number of specialist clinics were provided by the practice for those with long term conditions. The appointments system was continually under review and changes had been implemented to improve the service for working people and those recently retired. Staff took time to listen to patients such as those with learning disabilities, and understood their needs.
However there was a lack of monitoring systems and clinical and staff meetings which meant that there were shortfalls in the management of the surgery and staff. Staff had not always undergone appropriate recruitment checks and did not always have appraisals. There were no fire safety procedures or checks so staff may not be able to respond appropriately in the event of a fire emergency.
We carried out an announced inspection on 3 June 2014. The inspection took place over one day and the inspection team comprised a lead inspector, a GP advisor and a practice management specialist. Before the inspection we talked to a range of health and social care professionals in the community who dealt with patients from Keats Surgery. These included pharmacists, care home manager and palliative care nurse. We talked to four patients. On the day of the inspection we observed staff talking to patients and spoke to the practice manager, two doctors including the clinical lead, practice nurse and two receptionists. We reviewed practice management and staff files, and comment cards which patients had posted on the reception desk.
The regulated activities we inspected were diagnostic and screening procedures, family planning, surgical procedures, treatment of disease and disorder or injury and maternity and midwifery services.