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Inspection carried out on 26 June 2019

During a routine inspection

CQC carried out an announced comprehensive inspection of Anerley Surgery on 31 October 2018 as part of our inspection programme under Section 60 of the Health and Social Care Act 2008. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The practice was rated as inadequate overall with ratings of inadequate for providing safe and well-led services, requires improvement for effective and caring services and good for providing responsive services. As a result of the findings on the day of the inspection, we issued the practice with warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) and placed the practice in special measures.

We carried out an unrated inspection on 29 January 2019 to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements as detailed in the warning notices.

This was an announced comprehensive inspection on 26 June 2019 to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements as detailed in the warning notices. The inspection report from our inspection on 31 October 2018 is available on our website.

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 good for all population groups

with the exception of

working age people (including those recently retired and students)

which we rated as requires improvement

.

At this inspection we found:

  • The system in place for high risk medicines had improved. We looked at records of patients taking high risk medicines and found they had all been monitored appropriately. The practice had introduced a protocol to monitor high risk drugs and staff followed the protocol for prescribing of high risk medicines. There was a written policy on warfarin prescribing.
  • Arrangements for managing safety alerts had improved. The practice had implemented a new process for managing safety alerts and we saw information was communicated and actions were followed up. We saw evidence that staff were able to perform searches.
  • The practice acted effectively on tasks raised on the clinical recording system. Staff actioned and completed tasks in a timely way.
  • There were improvements in the use of the computer system to support the delivery of safe care and treatment. The provider had arranged staff training on the electronic patient record system to ensure it was used effectively.
  • The practice had implemented monthly clinical and non-clinical meetings, which were minuted and distributed amongst all staff. The meetings allowed the discussion and review of patients on high risk drugs, prescribing and reviewing safety alerts to allow staff to provide feedback.
  • The practice had obtained a paediatric pulse oximeter. We saw the practice had paediatric defibrillator pads.

The areas where the provider should make improvements are:

  • Review and develop information contained within dementia care plans.
  • Take action to improve uptake of cancer screening.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

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

Inspection carried out on 29 January 2019

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

Inspection carried out on 31/10/2018

During a routine inspection

This practice is rated as inadequate overall

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Anerley Surgery on 31 October 2018. We inspected the practice at 224 Anerley Road London SE20 8TJ.

We carried out a comprehensive inspection as part of our inspection programme under Section 60 of the Health and Social Care Act 2008. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The provider did not ensure that care and treatment was delivered according to evidence-based guidelines; for example, patients on high risk medicines were not being monitored properly.

• There were ineffective arrangements for managing safety alerts.

• Information about services and how to complain was available.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• The leadership lacked the capacity and strategy to provide effective arrangements and systems, which led to governance, policy and procedural failures.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice was not acting effectively or in a timely fashion on tasks raised on the clinical recording system.

The areas where the provider must make improvements as

they are in breach of regulations are:

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements

• Risk review the need for a paediatric pulse oximeter.

• Explore ways to improve uptake of cervical screening and childhood immunisations.

• Explore ways to monitor and improve patient satisfaction with involvement in consultations.

I am placing this service in special measures. Services 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 service 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 remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice