Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr G Celikkol’s Practice on 15 April 2016. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
- Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment, basic life support training had not been given to staff in a timely manner to recommended guidelines and there was no documentation of actions taken to address infection control audit findings.
- There had been no staff appraisals undertaken in the last 12 months and one staff member reported insufficient training for the role.
- Staff were not clear about reporting incidents, near misses and concerns and there was no formal training for staff in recognising emergency situations.
- There was no system to monitor clinical supplies in the practice and many were out of date.
- Emergency medicines were not easily accessible. There was no schedule for checking emergency equipment and emergency medicines had not been checked for over three months. There were no masks for children available for use with the emergency oxygen or children’s pads for the defibrillator.
- Not all practice policies were easily available to all staff and some policies had not been reviewed and updated following practice changes. Knowledge of and reference to national guidelines was inconsistent. There were no practice specific clinical protocols.
- Clinical staff were not seeing all items of communication coming into the practice from other services.
- The practice did not maintain some patient information securely.
- Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others, either locally or nationally. Where patient outcomes had been identified as low, the practice had not addressed this.
- There was a lack of coding of patient diagnoses on the computerised patient record which led to inadequate care and treatment of patients’ chronic conditions. Recorded patient consultations lacked detail.
- Staffing arrangements were not adequate to cover clinical staff long-term absence. There were no routine patient health checks and non-urgent reviews of patients’ chronic health conditions during this time.
- The practice had limited formal governance arrangements and no overview of patient complaints or significant events. There were no regular governance meetings and the practice did not record verbal complaints. There were no regular formal meetings with staff from other services.
- Patients’ views were mixed. Comments left on the CQC comment cards reported that staff were caring and treated patients with dignity and respect, however, data from the national GP patient survey showed that the number of patients who would recommend their surgery was significantly less than the national and CCG averages.
- There was little evidence to suggest that the practice was engaging with patients to seek their views of the service. They did not have a patient representative group.
- The practice did not have a clear vision for the future and did not have a succession plan.
The areas where the provider must make improvements are:
- Introduce and embed processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
- Ensure recruitment employment checks are undertaken for all staff.
- Put systems in place to ensure clinical practice reflects up to date national guidance and guidelines and develop practice specific clinical guidelines.
- Carry out clinical audits including re-audits or other quality improvement activities to ensure improvements in treatments have been achieved.
- Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
- Ensure that mechanisms are in place to seek feedback from patients and feedback is acted upon to ensure the practice improves services and the quality of care given to patients.
- Ensure policies and procedures are easily accessible to staff, are updated to reflect current guidelines and legislation and contain, where necessary referral pathways. For example, the safeguarding children and vulnerable adults reporting processes.
- Ensure that there are sufficient numbers of suitably qualified staff at all times, particularly in relation to practice nursing staff.
- Ensure all staff have timely basic life support training to recommended guidelines and that they receive regular appraisals.
- Ensure that all patients’ records are complete with history, medical examinations and diagnostic reasoning adequately recorded. This must include coding of conditions and illnesses.
- Ensure that processes are in place to regularly monitor emergency medicines, equipment and clinical supplies in the practice. Make emergency medicines easily available to all staff and update emergency equipment to allow for treatment of children.
- Ensure that all communications received by the practice are seen by clinical staff.
The areas where the provider should make improvement are:
- Ensure the practice is able to demonstrate effective management of complaints.
- Ensure that actions taken to address identified concerns with infection control are clearly documented.
- Take action to ensure that looped blind cords or chains are modified or secured out of reach in areas that could be accessed by children.
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