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Inspection carried out on 10 June 2019

During a routine inspection

We carried out an announced comprehensive inspection at Essex Lodge Surgery on 10 June 2019 to follow up on breaches of regulations. CQC inspected the service on 1 May 2018 and asked the provider to make improvements regarding a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We checked these areas as part of this comprehensive inspection and found this had been resolved.

The service is an independent health care provider that provides NHS contracted specialist musculoskeletal (MSK) care, chronic pain management, and private slimming clinic services.

Our key findings were :

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care but some systems or process needed to be reviewed and improved.

The areas where the provider should make improvements are:

  • Only supply unlicensed medicines against valid special clinical needs of an individual patient where there is no suitable licensed medicine available.
  • Review the policy for prescribing weight loss medicines to clarify the criteria and evidence base for initiating, reviewing and discontinuing treatment.
  • Review and improve arrangements for fire drills for staff working weekends to ensure staff and patient safety in the event of a fire.
  • Review and improve systems to ensure actions to improve safety following significant events, and to identify trends.
  • Review, improve and communicate an appropriate whistleblowing procedure to all staff to ensure its clarity and effectiveness.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 1 May 2018

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

We carried out a previous announced comprehensive inspection on 19 October 2017 to ask the service the following key questions: Are services safe, effective, caring, responsive and well-led?

We identified a breach of Regulation 17 HSCA (RA) Regulations 2014 Good governance and two areas the service should improve relating to safe, effective and well-led services. The full report on the 19 October 2017 inspection can be found by selecting the ‘all reports’ link for Essex Lodge Surgery on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 1 May 2018 in response to concerns that were reported to us, and to check whether the practice had carried out their plan to address requirements relating to the breach in regulations we identified in the previous October 2017 inspection.

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At the last inspection on 19 October 2017 there were breaches of legal requirements due to concerns regarding arrangements for clinicians medical indemnity insurance, a lack of clinical quality improvement activity, and best practice clinical guidelines were out of date. In addition, there were areas the provider should improve for patients requiring prescribed medicines, storing patient paper records electronically, and to ensure adequate clinical staff cover.

At this inspection 1 May 2018 most of these arrangements had improved.

Dr Hardip Nandra is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • Arrangements for patients requiring prescribed medicines had improved and were appropriate.
  • Effective recruitment processes were in place and clinicians were appropriately insured.
  • Clinical care was provided in line with best practice guidelines.
  • There was no clinical quality improvement activity to improve patient outcomes.
  • There were proper policies, procedures and activities that ensured safety and were accessible to all staff.
  • Storage arrangements for patient’s clinical records were appropriate.

We identified regulations that were not being met and the provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Inspection carried out on 19 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Essex Lodge Surgery on 19 October 2017. Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The service had systems to minimise risks to patient safety but policies were not always immediately accessible to staff and the recruitment procedure did not ensure clinical staff were appropriately insured.
  • Staff were generally aware of current evidence based guidance but the service did not carry out clinical quality improvement activity to improve patient outcomes.
  • Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Feedback from patients we spoke to, CQC patient comment cards and service survey results showed patients were satisfied with their care and treated with compassion, dignity and respect.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they did not have to wait too long to access the service and there was continuity of care; however systems for patient prescriptions entailed delays.
  • The service had good facilities and was equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the service complied with these requirements.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Monitor and review cover arrangements for the absence of a clinician.
  • Ensure completion of planned improvements for patients requiring prescribed medicines and storing patient paper records electronically.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice