Braithwell Road Surgery

We carried out an announced comprehensive inspection at Braithwell Road surgery on 1 August 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 17 December 2018.

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 requires improvement overall.

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

• The practice did not have clear systems and processes to keep patients safe.

There were some areas that had been addressed since the last inspection and improvements were seen in the following areas:

• The safe management of medicines requiring refrigeration.
• The safeguarding policy and procedure was updated.
• Safeguarding training
• The children at risk register had been reviewed.
• Systems to check clinical staff registration.
• Systems for checking immunisation status for all staff including GPs.
• Systems for monitoring patients on high risk medicines.
• Systems to support the requirements of the duty of candour.
• Systems for monitoring curtains in consultation rooms are cleaned in line with current national guidance.

We rated the practice as requires improvement for providing well-led services because:

• Whilst the practice had a clear vision and strategy there was a lack of monitoring by the provider to ensure objectives were achieved.
• The overall governance arrangements were not always effective.
• The practice did not have effective processes for managing risks.

There were some areas that had been addressed since the last inspection and improvements were seen in the following areas:

• Management of health and safety, staff training, recruitment and storage of medicines.
• Systems and processes for learning and continuous improvement.

We rated the practice as good for providing effective and caring and responsive services because:

• Improvements were seen in the monitoring of the outcomes of care and treatment.
• Improvements were seen in the provision and monitoring of training and the practice was able to show that staff had the skills, knowledge and experience to carry out their roles.
• 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. Patients could access care and treatment in a timely way.
• There were high levels of patient satisfaction with the service.

These areas affected all population groups, so we rated all population groups as good, with the exception of people whose circumstances make them vulnerable, which was rated as requires improvement for provision of effective services and overall.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Implement plans for reception staff training for their role in the management of patients with severe infections such as sepsis.
• Review and improve systems for GP involvement in monitoring prescribing in the practice.
• Review and improve provision of annual reviews for patients with a learning disability..
• Review and develop a practice specific duty of candour policy.
• Review and improve the whistle blowing procedure incorporating the NHS Improvement Raising Concerns (Whistleblowing) Policy and identify a Freedom to Speak Up Guardian in relation to this policy.
• Review and improve patient engagement.
• Review and improve provider involvement in the monitoring and oversight of the practice.

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

We carried out an announced comprehensive inspection at Braithwell Road surgery on 17 December 2018.

At this inspection we followed up on breaches of regulations identified at a previous inspection in April 2018.

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 requires improvement overall.

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

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have appropriate systems in place for the safe management of medicines requiring refrigeration.
• Recruitment procedures had not been followed in the recruitment of non-clinical staff.

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

• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

We rated the practice as requires improvement for providing well-led services because:

• While the practice had made some improvements since our inspection in April 2018, it had not appropriately addressed the Requirement Notice in relation to health and safety and staff training. At this inspection we also identified additional concerns that may put patients at risk in relation to recruitment and storage of medicines requiring refrigeration.
• Whilst the practice had a clear vision and strategy there was a lack of monitoring to ensure objectives were achieved.
• The overall governance arrangements were not always effective.
• The practice did not have clear and effective processes for managing risks.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring and responsive services because:

• 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. Patients could access care and treatment in a timely way.
• There were high levels of patient satisfaction with the service.

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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. Ensure specified information is available regarding each person employed.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and update the safeguarding policy and procedure with the new practice manager's details.
• Review and update the children at risk register.
• Review and update systems to check clinical staff registration is up to date.
• Review and improve reception staff training for their role in the management of patients with severe infections such as sepsis.
• Review systems for checking immunisation status for all staff including GPs in line with the Department of Health Immunisation against infectious disease guidance (the Green Book).
• Review and improve systems for monitoring patients on high risk medicines so the information is accessible to all clinicians.
• Review and improve systems for involvement in monitoring prescribing in the practice.
• Review and improve the complaints procedure to include information about how to escalate complaints.
• Review and improve systems to support the requirements of the duty of candour.
• Review and improve patient engagement.
• Review and improve systems for monitoring curtains in consultation rooms are cleaned in line with current national guidance.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice