20 October 2014
During a routine inspection
Letter from the Chief Inspector of General Practice
Deanhill Surgery is a small sized GP practice based in Richmond. The practice provides primary care services to around 2050 patients.
We carried out an announced comprehensive inspection on 20 October 2014.
Overall the practice is rated as inadequate.
We found numerous issues in relation to the safety and there were inadequate systems in place to monitor and respond to risks. The extent of the issues identified indicated that there was a lack of managerial oversight. As a result, safe, effective and well-led were rated as inadequate. We rated effective and responsive as requires improvement and caring as good.
Due to inadequate ratings in safe,effective and well led .The concerns which led to these ratings apply to all population groups using the practice.
Our key findings across all the areas we inspected were as follows:
The leadership of the practice was inadequate. There was no clear leadership structure and staff did not feel supported by management. The provider had two practices, which were registered separately with the Care Quality Commission. We were told that the same management team were responsible for the running of both practices, but they rarely attended Deanhill Surgery and policies and procedures had not been adapted to ensure they were relevant and fit for purpose.
The practice did not hold regular governance meetings and issues were discussed at ad-hoc meetings. Staff did not feel involved or engaged and learning from incidents or complaints was not disseminated to support improvement.
Safety was not sufficiently prioritised and there were inadequate systems in place to monitor and manage risks. Staff understood their responsibilities to raise concerns, and report incidents and near misses. However, when things went wrong, reviews and investigations were not sufficiently thorough. Not all staff demonstrated the necessary competencies in relation to safeguarding and the nurse had not undergone a criminal records check prior to commencing work. The practice was visibly unclean on the day of our inspection and there were insufficient systems in place to protect patients from the risk of infection.
Staff had knowledge of and reference to National Guidelines but there were no systems to ensure this was consistent. There were no completed audit cycles for patient outcomes. Multidisciplinary working was not taking place.
Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions.
Importantly, the provider must:
Ensure there are appropriate systems, governance arrangements and effective leadership in place to monitor the quality of the service being provided.
Ensure that all clinical staff have full Disclosure and Barring Checks and there is a clearly documented rationale for not undertaking a DBS check on other staff to demonstrate that any risks have been assessed.
The practice must ensure all staff are sufficiently competent in child protection and safeguarding vulnerable adults so they are able to identify and respond appropriately to potential concerns.
The practice must ensure they maintain appropriate standards of cleanliness and hygiene in relation to premises occupied for the purpose of carrying on the regulated activity.
The practice must ensure that all clinical and administrative staff are properly trained, supervised and appraised.
In addition the provider should:
Ensure that clinical audit cycles are completed to demonstrate improved outcomes for patients. The practice should also work with other professionals and organisations involved in patients’ care to ensure they receive care that is well co-ordinated and effective.
Actively seek to involve patients in developing and improving the service.
Ensure staff are engaged and involved in developing and improving the service and ensure that learning from incidents and complaints are disseminated.
Provide a practice website, and offer online repeat prescription and appointments booking to enable patients to have flexibility.
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