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Inspection Summary


Overall summary & rating

Updated 11 April 2017

We carried out an announced comprehensive inspection of the GP service at this location on 27 October and 14 November 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

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

Are services effective?

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

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

We found that this service was not 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 service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. We have not inspected the GP service before.

Marble Arch Dental Centre provides NHS and private dental treatment to patients of all ages. It also provides an appointment based private GP service and an opticians.

The practice staffing consists of three principal dentists, 11 associate dentists, six qualified dental nurses, six trainee dental nurses, two hygienists and eight receptionist/administration staff. Two doctors provide the GP service.

One of the principal dentists 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 practice is run, including the GP service.

The GP service is provided from one consultation room. There is a main reception for both the dental and GP services, and a waiting area. The GP service is provided predominantly on Saturdays, and only by appointment.

During this visit we were unable to obtain the views of patients as none were available.

Our key findings were:

  • The GPs were suitably qualified to meet the needs of patients.
  • The consultation room used for the GP service was visibly clean and tidy.
  • The service was accessible to patients who required non-emergency treatment and who were willing to pay private consultation fees.
  • The registered provider had not ensured that all the specified information relating to persons employed at the service was obtained and appropriately recorded.
  • The service had emergency equipment however it was not being regularly checked to ensure it functioned correctly. Emergency medicines were in place but not all were appropriately stored.
  • Refrigerator temperatures were not being checked daily or recorded. We noted on our second visit that records of checks were now being kept and a second thermometer had been purchased.
  • Patient records were incomplete in many cases, lacking adequate contact information.
  • Staff employed in the dental and optician service would act as chaperones when required but not all had undergone a disclosure and barring service check. Both GPs told us that they had not, to date, seen a patient who had requested a chaperone.
  • Governance systems were not effective. There were no systems to assess, monitor and improve the quality of the GP service or to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

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

  • Ensure equipment is regularly checked and calibrated where necessary.
  • Ensure emergency medicines are appropriately stored.
  • Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
  • Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
  • Ensure they maintain accurate, complete and contemporaneous records in respect of each service user.
  • Ensure systems are in place to assess, monitor and improve the quality of the service.
  • Ensure all staff who chaperone have undergone a disclosure and barring service check.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

  • Review and update the practice’s safeguarding policy.
  • Review the list of emergency medicines and amend stocked medicines where appropriate.
  • Remove the unused medicines kept in the GP consultation room.
Inspection areas

Safe

Improvements required

Updated 11 April 2017

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

We have told the provider to take action (see full details of this action in the Requirement Notices section at the end of this report).

We found that there had not been any significant events within the GP service, but that staff were aware what to do should one occur. The GPs had undergone safeguarding training however the safeguarding policy and procedure was out of date. Dental nurses or optician staff would chaperone medical patients if required but they had not all undergone a Disclosure and Barring Service (DBS) check. Following the inspection the provider informed us they had updated the safeguarding policy and put a chaperone policy,  specific to the GP service, into place. They also informed us that all staff who chaperoned had had a DBS check carried out.

The location had medical emergency equipment including a defibrillator but this was not being regularly checked to ensure it was in working order. Not all emergency medicines were being appropriately stored. Following the inspection the provider told us they had commenced monthly checks of the defibrillator.

We saw the recruitment file for the main GP contained most of the information required. However there were no recruitment details for the second GP. Following the inspection the provider informed us that all necessary recruitment documentation had been sought.

We found the GP consultation room to be visibly clean and tidy. The provider had not carried out any risk assessments or infection control audits specific to the GP service. There was a contract in place for the collection and disposal of clinical waste, including sharps bins.

Effective

No action required

Updated 11 April 2017

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

We found that both GPs were suitably trained and qualified for the service they provided. We reviewed all patient notes and found that the GPs had appropriately added their own hand written comments. We found however, that patient information, particularly their contact details, was poorly recorded on the provider’s patient note template. We noted that the secondary GP

We noted that because of the nature of the service, not least because appointments were usually at weekends, there was no direct interaction with other health care professionals and the GPs worked in an isolated fashion. However the GPs told us they would liaise with a patient’s own GP if they had one and had given permission for them to do so.

The GPs demonstrated a reasonable awareness of the Mental Capacity Act 2005. They told us they always obtained verbal consent for procedures. The main GP stated they felt written consent was unnecessary as no invasive procedures were carried out.

Caring

No action required

Updated 11 April 2017

We found that this service was providing caring services in accordance with the relevant regulations.

We were unable to talk to patients or observe how they were treated, however we did observe patients arriving for dentist appointments and noted reception staff were respectful, kind and helpful. These same staff would liaise with patients who wished to book a consultation with one of the GPs.

Responsive

No action required

Updated 11 April 2017

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

Appointment times met the needs of patients. We were informed that most patients chose to see the main GP because of her gender and ability to speak Arabic.

Staff stated that they could access language line if translation services were needed.

The practice had a procedure in place for dealing with complaints. Staff told us that there

had been no complaints made in relation to the GP service.

Well-led

Improvements required

Updated 11 April 2017

We found that this service was not providing well-led care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report).

The GPs commented that they felt supported by the registered manager. There were no systems of learning and improvement in place however the GPs had undergone training relevant to their role via alternative means. Following the inspection the provider informed us that the GPs had been made aware that their continuing professional development was their responsibility.

The provider did not have effective governance arrangements with regard to the GP service. Policies and procedures specific to the GP service were in place but there were no arrangements for identifying, recording and managing risks specific to the GP service; or for monitoring and improving the quality of that service through the use of monitoring tools and audits. The registered manager considered quality assurance was the responsibility of the GP, whilst the GPs understood that it was the provider’s responsibility.

The secondary GP thought there were systems to obtain feedback from patients, however the provider could not evidence this.