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Bean Road Medical Practice Good

Reports


Inspection carried out on 8 January 2020

During a routine inspection

We carried out a comprehensive unannounced inspection of Bean Medical Practice on 8 January 2020. We inspected Bean Medical Practice due to concerns identified at an inspection of Clifton Medical Centre and it’s branch surgery, Victoria Road Surgery on 19 December 2019. As there were concerns identified at a provider level, highlighting a lack of effective leadership and clinical oversight, a decision was made to inspect each of the providers (Dr Devanna Manivasagam’s) services on 8 January 2020.

This inspection focused on the following key questions:

Are services at this location safe?

Are services at this location effective?

Are services at this location caring?

Are services at this location responsive?

Are services at this location well-led?

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations

We have rated this practice as good overall and requires improvement for effective and the population groups of families, children and young people and working age people (including those recently retired and students)).

We rated the practice as requires improvement for providing effective services because:

  • The practice’s uptake of childhood immunisations and cervical cancer screening rates were below the national averages and action taken had not yet demonstrated improved outcomes.

We rated the practice as good for providing safe, caring, responsive and well-led services because:

  • There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment that met their needs.
  • Patients needs were assessed and care and treatment was delivered in line with current legislation.
  • Risks to patients were assessed and well managed.
  • The practice used clinical audit as a method of identifying where improvements were required.
  • The practice organised and delivered services to meet patients’ needs.

The areas where the provider should make improvements:

  • Continue work to increase the uptake for cervical, breast and bowel screening.
  • Continue work to increase the uptake for immunisations.
  • Continue work on improved outcomes for patients where satisfaction levels are still low.
  • Continue work to increase care plans for patients with dementia.
  • Continue work to identify and support carers registered in the practice.
  • Review the designation of lead roles in the practice in the absence of the lead GP.
  • Continue to review the processes of checking vaccinations in the practice.
  • Review recruitment files to ensure these are in line with best practice.
  • Review the business continuity plan in the absence of the lead GP.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Review carried out on 16 August 2019

During an annual regulatory review

We reviewed the information available to us about Bean Road Medical Practice on 16 August 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 16 October 2018

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

We carried out an announced comprehensive inspection at Bean Road Medical Practice on 16 October 2017. Overall the practice was rated as good with requires improvement for providing well-led services. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Bean Road Medical Practice on our website at .

This inspection was a desk-based review carried out on 16 October 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 October 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

  • The practice had improved systems to highlight vulnerable adults to staff.
  • The practice had strengthened its medicines management arrangements. The ‘prescribing and medication review policy’ had been updated to include at least annual reviews for all patients on repeat medicines and there was a programme of reviews underway that prioritised those on the most medicines.
  • A physical and mental health check questionnaire had been completed by all staff.
  • The provider had updated its cold chain policy to include clear guidelines for transportation and administration of vaccines to patients in their home.
  • The national GP patient survey scores showed satisfaction rates remained below the national and local averages.
  • A structured programme of clinical and internal audit had been implemented.
  • Screening rates continue to be below national averages and although actions had been planned, although it was too early to see an impact since the last inspection.

There were areas where the practice should make improvements:

  • Continue to carry out regular medication reviews on all patients on repeat medication.
  • Continue to review the systems and processes in place to improve the uptake of cancer screening for patients.
  • Carry out regular reviews to explore how patient satisfaction rates regarding quality of care and access can be improved.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Inspection carried out on 16 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Bean Road Medical Practice on 7 July 2015 and rated the practice as good. The report for the inspection carried out on 7 July 2015 can be found by selecting the ‘all reports’ link for Bean Road Medical Practice on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Bean Road Medical Practice on 16 October 2017. This was because the practice had re-registered with the Care Quality Commission as a new provider having changed from a partnership to a single-handed GP practice. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • The practice had systems to promote the safety of patients, staff and visitors. We found gaps in the governance where improvements could further reduce the risks to staff and patients.
  • Staff were aware of current evidence based guidance and had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • The practice maintained appropriate standards of cleanliness and hygiene.
  • Appropriate recruitment checks had been undertaken prior to employment although satisfactory information about any physical or mental health conditions relevant to a person’s ability to carry out their role had not been obtained for all staff.
  • Results from the national GP patient survey published in July 2017 showed patients scored the practice below average for several aspects of care. The provider had taken action to address the low scores.
  • Support for carers included a carers’ corner in the patient waiting area and a carers’ newsletter.
  • Information about services and how to complain was available and the practice proactively acted on complaints posted on the national website, NHS Choices. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients found urgent appointments were normally available the same day but continuity of care was not always supported by the facility to make a pre-booked appointment with the same clinician.
  • 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 the management team.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

  • Review the vulnerable adults register to ensure that all are highlighted on the clinical system.
  • Review the processes for managing repeat medications to minimise any risk to patient safety.
  • Prior to employment, obtain satisfactory information about any physical or mental health conditions relevant to a person’s ability to carry out their role.
  • Update the cold chain policy to provide clear guidance to staff on the safe transportation and administration of vaccines to patients in their own homes.
  • Explore how the uptake rates for bowel and breast cancer screening could be improved.
  • Continue to engage with patients and explore ways in which the satisfaction scores can be improved for GP consultations, telephone access and availability of appointments.
  • Further strengthen the governance arrangements to minimise risks to the safety of staff and patients.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 7 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bean Road Medical Practice on 7 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for the care of older people, people with long term conditions, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It required improvement for providing safe, effective, caring, responsive and well-led services for families, children and young people.

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

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. There was a clear leadership structure and staff felt supported by management. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed.

  • The practice frequently met with other organisations including district nurses, health visitors, social services, school nurses and midwives to discuss patients with complex needs and to ensure that they meet people’s needs.

  • The practice had a complaints policy which was in line with recognised guidance. The practice informed us that they had not received any written complaints within the last 12 months. We did not see evidence that the practice monitored themes from the verbal complaints they had and that learning was shared.

  • We found that appraisals were overdue for the members of the reception team. The practice manager had recognised this prior to our inspection and had scheduled appraisals for these staff.

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

Importantly the provider must:

  • Ensure that young people who attend the service without a parent or guardian are involved in an assessment of their needs by a person with the required level of skill for this particular task. In order for the most appropriate cause of action to be decided; assessments must take into account current legislation and consider relevant nationally recognised evidence based guidance.

In addition the provider should:

  • Develop a proactive approach to identifying and targeting health promotion and preventative care services such as cervical screening, NHS health checks and a programme of flu vaccinations for patients who would benefit from them.

  • Establish a system for monitoring themes and trends with regards to verbal complaints received by the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice