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Inspection carried out on 09 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We previously inspected the practice on 20 June 2016 and rated it then as Requires improvement overall. This was because it was not meeting legal requirements in relation to some aspects of patient safety, improving patient outcomes and governance arrangements. The June 2016 inspection report can be found at www.cqc.org.uk/location/1-539009738.

We carried out an announced comprehensive inspection at St Bartholomews Surgery on 09 November 2017 to follow up on breaches of regulations.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • National GP survey results showed patients did not always feel staff involved and treated them with care and concern. The practice took action and carried out a practice based survey which showed improvement.

  • National GP survey results showed patients found the appointment system easy to use and that they could access care when they needed it. Some feedback we received on the day of the inspection was less positive however. The patient participation group highlighted the need for more patient education on appointment booking.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

  • The practice had remedied the shortfalls identified at our previous inspection.

  • The provider had acted on recommendations we made at our previous inspection to improve the business continuity plan; the uptake of cervical screening; identifying and supporting carers; provisions for patients with hearing impairment and for patients for whom English is an additional language; and documenting meetings and following up agreed actions.

The areas where the provider should make improvements are:

  • Consider ways of improving patients’ understanding of the appointment booking system.

  • Include information about the role of the Health Services Ombudsman in its responses to complaints.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 20 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Bartholomew’s Surgery on 20 June 2016. Overall the practice is rated as requires improvement.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Not all safety systems and processes were in place such as fire safety, health and safety, medicines management and arrangements for the event of a medical emergency.
  • Systems to assess, monitor and improve safety were not effective for example infection control, monitoring use of prescriptions and cleaning of premises and equipment.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff had been trained to provide them with the knowledge and experience to deliver effective care and treatment.
  • 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 was not always easy to understand and improvements were not made to the quality of care as a result of complaints and concerns.
  • The majority of patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management.
  • The practice proactively sought 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:

  • Arrange to assess, monitor, manage and mitigate risks to the health and safety of service users including health and safety, fire safety and COSHH.
  • Ensure safe and effective management of medicines and prescriptions and for the event of a medical emergency.
  • Improve and evaluate systems or policies to improve quality and safety such as complaints and completed audits or other clinical quality improvement activity.

In addition the provider should:

  • Ensure all necessary information is held in the business continuity plan.
  • Seek to improve the uptake of patients attending for cervical screening.
  • Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
  • Review arrangements to support patients who are deaf or hard of hearing, and whose first language is not English.
  • Implement effective arrangements for meetings documentation and actions follow up.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 5 August 2014

During a routine inspection

St Bartholomew’s Surgery is located in East Ham in the London borough of Newham, East London and has a patient list of approximately 9,600. Newham’s health profile shows that it is worse than the England average and at or below the regional average on a range of indicators including substance misuse, recorded diabetes and incidence of tuberculosis (TB). The national index of multiple deprivation lists Newham as the second most deprived out of 326 local authorities in England.

The practice operates from one site. The staff team consists of five GP partners (one female, four male), one salaried GP (male), two practice nurses, one part time health care assistant, one practice manager and a team of reception and administration staff. During our inspection, we spoke with three GPs, two practice nurses, practice manager and reception staff.

All of the patients that we spoke with and those who completed comment cards were positive about the service they received at St Bartholomew’s Surgery. During our inspection we observed that patients were cared for in a respectful and compassionate manner. 

We noted that clinical staff met weekly to review patient progress. Meetings also routinely took place with other clinicians and the practice hosted or delivered a range of clinics which were relevant to the local health profile. These included ante natal and sexual health clinics.

The practice participated fully in Quality and Outcomes Framework (QOF) - a voluntary incentive scheme rewarding practices for how well they care for patients. The framework was used to improve services and benchmark (or compare) the practice with other practices in the borough.

The practice has an above average number of patients aged over sixty five relative to Newham and is slightly below average regarding patients aged under eighteen. Poor mental health, recorded sexual health infections and diabetes are overly represented in the borough; and this is also the case at the practice level. During our inspection, we noted that the practice was responsive to the needs of its population group. Examples included screening programmes for patients at risk of developing diabetes and weekly ante natal clinics. We also noted that the practice hosted an outpatient clinic delivered by the local community mental health team and provided a weekly sexual health clinic.

The provider was in breach of regulations related to:

Requirements relating to workers

Infection control and cleanliness

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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.