Archived: Dr George Duru Also known as The Duru Practice

We carried out an announced comprehensive inspection at Dr George Duru on 16 May 2023. Overall, the practice is rated as inadequate, with the following key question ratings:

Safe - inadequate

Effective - inadequate

Caring - requires improvement

Responsive - inadequate

Well-led - inadequate

Following our previous inspection on 11 November 2016, the practice was rated good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr George Duru on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities. The risk had increased due to concerns we received.

How we carried out the inspection/review

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:

• 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.
• Conducting an interview with the provider using video conferencing.
• Requesting evidence from the provider.
• A short site visit.
• Issuing questionnaires to staff

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 inadequate overall.

We rated the provider inadequate for providing safe services:

• Staff were not all trained in safeguarding.
• Recruitment systems were not effective and relevant legislation was not adhered to.
• Infection prevention and control systems were not effective.
• Safety procedures such as for fire and health and safety were not adequate.
• Significant events were not used for learning or to improve practice when things went wrong.
• Safety alerts were not appropriately actioned.

We rated the provider inadequate for providing effective services:

• Clinicians were not always up to date with current guidance.
• A Statement of Intent had been in place with no evidence of consultation.
• A delayed referral had not been actioned in a timely way.
• Blood tests were not always repeated at appropriate intervals.
• We saw 33 cases of potentially missed diabetes diagnoses.
• We saw over-prescribing of asthma inhalers.
• Childhood vaccinations were below target.
• There was no programme of targeted quality improvement.
• Training was not well-managed.
• Staff appraisals were not routinely carried out.

We rated the practice requires improvement for providing caring services:

• A patient had been asked to register with a new practice when they made a complaint.
• There were no internal patient surveys, and the NHS website was not checked for patient comments. This was a missed opportunity to identify where improvements could be made.
• The website did not contain information about support groups, including for carers of the bereaved.

We rated the practice inadequate for providing responsive services:

• Appointments were difficult to access unless patients could get through on the telephone or attend the practice.
• Only on the day appointments were available
• Complaints were not handled appropriately and there was a lack of transparency in complaints’ handling.

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

• Leaders had not identified the risks we found during the inspection.
• Poor performance had not been identified and acted on.
• Policies were not followed and did not contain enough information to provide relevant guidance.
• There were no formal systems for managing risks.
• Information, such as from complaints, was not recorded and acted on.
• Staff were unsure about raising concerns about patient care and did not know of improvements made following patient feedback.

We found 5 breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying out of the regulated activity.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

In addition, the provider should:

• Improve their take-up for childhood immunisations.
• Give staff protected time for training.
• Keep a log of rejected referrals.
• Have a full record of Do Not Attempt Cardiopulmonary Resusitation decisions in order for reviews to be carried out.

Due to the breaches of regulation identified we will be carrying out further enforcement action against the provider.

I am placing this service in special measures. The Care Quality Commission will refer to and follow its enforcement processes in taking action reflecting these circumstances.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted.

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