Chadwell Heath Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chadwell Heath Surgery on 11 August 2016. Overall, the practice is rated as requires improvement.

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

• We saw evidence of significant events being identified but the records were incomplete and did not demonstrate actions taken to prevent the incident happening again. There was limited evidence of patients receiving a verbal or written apology.

• There were poor arrangements for identifying, recording and managing risks, issues and implementing mitigating actions. The practice was not meeting its responsibilities in ensuring the safety of its patients and this included significant event analysis, prescription management, risk assessment, fire safety and infection prevention and control.

• Staffing arrangements did not always ensure enough staff were on duty to meet patient needs.

• The practice had a number of policies and procedures to govern activity, but some of these were not effectively implemented or monitored. For example, the safeguarding policies did not highlight who the child safeguarding leads were and did not contain contact details.Staff were not familiar with key policies such as the duty of candour.

• The practice had limited information regarding chaperones on display, and four patients told us they had never been offered a chaperone. Not all staff who chaperoned had undergone a Disclosure and Barring service (DBS) check; however, the practice had carried out an assessment of risk in relation to this.

• The practice did not hold regular governance or team meetings.

• Staff training was not well monitored and there were gaps in training for staff of all levels including in basic life support and safeguarding.
• Multidisciplinary working was taking place but was generally informal and record keeping was absent.
• Data showed patient outcomes were low when compared to the local and national average. Exception reporting for the percentage of patients (2014/15) diagnosed with dementia who had received a face to face review in the last 12 months was 17%, higher than the Clinical Commissioning Group (CCG) average of 10% and national average of 8%. Data for 2015/16 showed exception reporting for this indicator had improved to 4.5% compared to the CCG average of 8% and England average of 7%.
• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was similar to local and national averages. Feedback from patients reported that telephone and appointment access were an issue despite the extended hours opening.

• Governance arrangements had systemic weaknesses and did not ensure the practice operated safely and effectively. Performance was not being monitored in all areas, although three completed clinical audits had been carried out.

• The practice had taken action to improve patient outcomes in some disease areas such as diabetes, which included reducing the age for NHS health checks from 40 to 30 years in order to improve detection of the disease.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Patients rated the practice higher than others for some aspects of care.

• Information about services was available but not everybody would be able to understand or access it. For example, access to translation services was not advertised in the practice. The practice did not have a hearing loop.

• The practice had only identified 0.2% of their practice list as carers.

The areas where the provider must make improvements are:

• Ensure systems and processes are established and operated effectively to safeguard children and vulnerable adults from abuse.

• Assess, monitor and mitigate the risks to the health and safety of service users in respect of the proper and safe management of prescriptions; infection prevention and control and health and safety risk assessments.

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to deliver a safe service.

• Ensure effective and sustainable governance systems and processes are implemented to assess, monitor and improve the quality and safety of the services provided including; reporting, recording, acting on and monitoring significant events, incidents and near misses and ensuring that patients affected receive reasonable support and a verbal and written apology; monitoring and responding to patient satisfaction levels in relation to access to appointments; addressing areas of poor performance relating to patient outcomes highlighted through the Quality and Outcomes Framework, discussing and acting upon safety alerts; promoting shared learning from significant events and complaints; reviewing the frequency of staff meetings to ensure all staff are aware of decisions or changes in the practice and regularly reviewing and updating procedures and guidance, ensuring staff are aware of these.

• Ensure patients are made aware that a chaperone can be requested and provided.

In addition the provider should:

• Consider improving communication options for patients who have a hearing impairment. Raise awareness amongst the patient list of the availability of translation service.

• 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 advertised appointment times to ensure that patients are being given correct information.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice