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Dr N Essa & Dr M Harrold Good Also known as London Street Surgery

Reports


Inspection carried out on We commenced this inspection on 23 November 2016 and concluded with a visit on 25 November 2016

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

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr N Essa and Dr M Harrold in April 2016. At that time we found the practice had made improvements and removed them from special measures. However, a number of concerns were found and the practice was rated as requires improvement for the provision of safe, caring and well led services.

The practice sent us an action plan setting out how the changes they were making to address the issues that led to our concerns. We commenced reviewing data available to us about the practice on 23 November 2016 and returned to inspect the practice on 25 November 2016 to check that the practice had taken the actions they told us they would take in their action plan. We found significant improvement had been achieved. Specifically the practice had:

  • Introduced an effective system to record and deal with safety alerts.

  • A system in place to review and share learning from significant events.

  • Completed DBS checks for all relevant staff.

  • Effective systems in place to manage risk.

  • Surveyed patients to obtain feedback about the care they received. This resulted in an improved perception of care.

  • Taken action to promote the benefits of cancer screening programmes.

  • Encouraged patients with caring responsibilities to register their carer role and worked with other organisations to support carers.

  • Updated staff appraisals and taken action on the outcomes of appraisals.

The range of improvements made by the practice has resulted in the practice achieving a good rating for provision of safe, caring and well led services and an overall rating of good. This revised rating and the improvements the practice had undertaken were achieved at a time when the practice registered population had increased by approximately 200 in six months.

The area where the provider should make improvement is:

  • Ensuring information in different languages setting out the benefits of cancer screening programmes is made available at the earliest possible opportunity. Also ensuring the benefits of cancer screening programmes were promoted at every opportunity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 13 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr N Essa and Dr M Harrold (also known locally as London Street Surgery), on the 13 April 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in August 2015 found breaches of regulations relating to the safe, effective and responsive delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in August 2015 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At the inspection in April 2016, we found the practice had made significant improvements since our last inspection in August 2015. Specifically, we found the practice to require improvement for the provision of a safe, caring and well led services. It was good for providing effective and responsive services. However, the practice was required to make further improvements and rated as ‘requires improvement’ overall.

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

  • All the partners and staff worked hard to undertake a complete review of the service since the previous inspection and made sustainable improvements.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded. However, lessons learned from significant events and incidents were not always communicated widely enough to support improvement.
  • Risks to patients were assessed and well managed in some areas, with the exception of those relating to recruitment checks, safeguarding training and management of legionella. For example, Disclosure and Barring Scheme (DBS) checks or risk assessment were not carried out for a non-clinical staff undertaking chaperoning duties.
  • We found that completed clinical audits cycles were driving positive outcomes for patients.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Results from the national GP patient survey showed majority of patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment when compared to the local and national averages. The majority of patients we spoke with on the day of inspection confirmed this. However, not all felt cared for, supported and listened to.
  • Information about services and how to complain were available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care. Urgent and online appointments were 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 provider was aware of and complied with the requirements of the Duty of Candour.
  • The practice had improved their governance arrangements since previous CQC inspection. However, the practice was required to make further improvements to ensure continuous monitoring and assessment of the quality of the service.

The areas where the provider must make improvements are:

  • Review the process for implementing change following incidents and significant events to ensure actions are completed. Improve the recording of discussions and actions during practice meetings.
  • Ensure all actions required in response to national safety and medicines alerts are completed and disseminated within the practice.
  • Ensure all necessary recruitment checks are in place including systems for assessing and monitoring risks, carrying out Disclosure and Barring Scheme (DBS) checks or risk assessment.
  • Review patients feedback and address concerns regarding GPs listening, giving enough time, involving in decisions, explaining tests and treatments, and treating them with care and concern during consultations.
  • Further review and monitor the governance arrangements in place to ensure the delivery of safe and effective services. For example, monitoring of non-emergency medicines, accessibility of emergency equipment, management of legionella and awareness of emergency alert system during consultations.

In addition the provider should:

  • Ensure Patient Group Directions (PGDs) are renewed before they expire to allow nurses to administer medicines in line with legislation.
  • Ensure development areas identified during appraisals are followed up and monitored systematically.
  • Review the system in place to promote the benefits of cervical and bowel screening to increase patient uptake. Provide information in appropriate languages and formats.
  • Ensure routine health checks are undertaken for patients aged 40 to 74 years old.
  • Encourage carers to register as such to enable them to access the support available via the practice and external agencies.
  • Develop and implement clear action plans, to improve the outcomes for learning disabilities patients.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service. We will inspect this service again in future to check the practice has made further improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 05/08/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Essa and Dr M Harold on 5 August 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe services and being well led. Improvements were also required for providing responsive and effective services. It was also inadequate for providing services for the for all the population groups, except for people with long-term conditions which is rated as requires improvement. It was good for providing caring services.

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

  • Patients were at risk of harm because systems and processes were not always in place to keep them safe. For example medicines management systems and process for nurses to provide vaccinations did not reflect national guidelines.
  • Staff were not clear about how to report incidents, near misses and concerns. There was inconsistent recording of events and no evidence of learning or sharing information with staff.
  • There was limited assurance to demonstrate the practice had systems to drive improvement in care, treatment and patient outcomes. For example, clinical audits were not always effective, CCG prescribing targets had not been met and some areas of the quality and outcomes framework require improvement.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
  • Risk management was not a priority and patients and staff could be at risk. For example, in the event of an emergency or fire. Infection control audits had been completed but we saw limited evidence to demonstrate actions had been completed or when they should be completed by.

We saw one area of outstanding practice including:

  • Innovative approaches were evident to enable patients in vulnerable groups to access care services. The practice was engaged with the local community and presented health promotion sessions at local mosques and temples to help support patients live more healthy lifestyles.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure medicines management systems are reviewed and reflect national guidelines.
  • Develop a system of clinical audits and implement findings to drive improvement.
  • Implement a process to disseminate learning from significant events, clinical audits and complaints to practice staff members.
  • Undertake risk assessments and take timely action to address the concerns and identified risk.
  • Strengthen the leadership and management of the practice to ensure effective governance procedures are implemented, monitored and staff have the capacity to undertake the duties of their lead roles.
  • Ensure appropriate systems are in place to deal with emergencies and the maintenance of medical equipment is regularly undertaken.
  • Ensure all staff members have training and development plans which identifies training and updates that are appropriate to their role.

In addition the provider should:

  • Ensure all recruitment and employment information required by the regulations are documented in all staff personnel files.
  • Ensure all professional guidelines are kept on an internal system, which are easily accessible.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

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.