Archived: West End Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 11 January 2016. Overall, the practice was rated as inadequate.

The practice was rated inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing caring and services. . The concerns that led to the overall inadequate rating applied to all of the population groups.

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

• Patients and staff were at risk of harm because systems and processes were not in place to keep them safe. Systems were not effective and did not enable the provider to identify, assess and mitigate against risks to patient safety.For example, Patient group directions were not authorised and completed for the practice nurse to administer medicines such as vaccinations and immunisations.

• Evidence could not be provided to demonstrate clinical staff had received recent safeguarding training to an appropriate level.

• Patients told us they were treated with compassion however they stated that poor continuity of care made it difficult to feel involved in decisions about their care and treatment, as well as finding it difficult to make appointments

• The provider could not, when requestedprovide evidence to demonstrate that patient specific directions were routinely used in line with legal frameworks.

• The management of significant events needed to be strengthened to ensure themes and trends were analysed. There was a lack of consistency in the format for reporting significant events.

• Recruitment processes were not effective. For example, the provider had not ensured that checks had been undertaken with the Disclosure and Barring Service (DBS) for clinical staff before they started working at the practice. Additionally staff files demonstrated that references had not been sought for all staff in line with the practice’s recruitment policy.

• Urgent appointments were usually available on the day they were requested but patients told us routine appointments were difficult to get with GPs and there was often a long wait when making the appointment. Patients said they often waited over 15 minutes of their allocated appointment times.

• Policies and procedures were in place to govern activity. However, not all of the practice’s policies had been completed and a number of policies lacked relevance to the services being provided by the practice.

• There were often delays in responding to complaints and some were refused a response as they had not been present to the practice in written form.There was no evidence of learning and development from the complaints received. The practice complaints policy was not in line with contractual obligations for GPs in England. The practice did not have mechanisms in place to record verbal concerns or complaints consequently the provider could not be assured opportunities for learning from patient feedback were maximised.

• Training, which the practice had deemed mandatory such as manual handling and infection control, had not been conducted on a regular basis in line with best practice. There was no system in place to regularly appraise staff and develop roles, with most staff last having an appraisal in 2011.

The areas of practice where the provider must make improvements are:

• The provider must ensure the systems to enable them to identify, assess and mitigate risks to patients, staff and others are effective

• Seek and act on feedback from relevant persons and other persons on the services provided, for the purposes of continually evaluating and improving such services, such as significant event monitoring and managing complaints appropriately.

• Recruitment procedures must be established and operated effectively to ensure persons employed are fit and proper for the role they are employed to undertake.

• Ensure risk assessments are in place so that the practice can be assured that care and treatment are being delivered in a safe manner such as health and safety assessments.

• Ensure persons providing care or treatment to patients have the qualifications, competence, skills and experience to do so safely, by supporting staff to work within their scope of qualifications and use relevant PGDs and PSDs.

The areas where the provider should make improvement are:

• Review the policies in place and consider whether these reflect the practice’s own arrangements and enable staff to carry out their roles in a safe and effective manner.

• Ensure there are effective systems and processes in place to assess and monitor their service to enable them to respond to the changing needs of patients

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice