Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Eamon McQuillan’s practice (also known as Bloomsbury Medical Centre) on 17 September 2015. Overall the practice is rated as inadequate.
Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.
Our key findings across all the areas we inspected were as follows:
- The practice did not have risk assessments in place to monitor safety of the premises such as control of substances hazardous to health and legionella. Other risks to patients such as fire safety were not assessed or well managed.
- The arrangements for managing emergency drugs and vaccinations in the practice kept patients safe. However, some of the medications kept in the GP bag were out of date and there was no monitoring process in place for these.
- There were some procedures in place to govern activity. However, some of these were generic, contained some information which was not relevant to the practice or was outdated.
- Staff had received training appropriate to their roles although some of the staff training was overdue such as annual basic life support training.
- A defibrillator was available on the premises, however, no oxygen was kept at the practice and no risk assessment had been carried out to determine if it was necessary to do so.
- Limited clinical audits were carried out to demonstrate quality improvement with minimal action taken to improve patient outcomes. None of the clinical audits undertaken in the last two years were completed audit cycles where any changes made had been reviewed.
- Evidence that care plans were routinely reviewed and updated was not available.
- Information was not available to help patients understand the complaints system, for example through poster displays or summary leaflets.
- Patients were highly positive about their interactions with staff and said they were treated with compassion and dignity.
- Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.
The areas where the provider must make improvements are:
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Ensure there formal governance arrangements are in place including systems for assessing and monitoring risks and the quality of the service provision.
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Ensure that all appropriate risk assessments are completed.
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Develop systems to ensure all necessary medicine reviews are completed when due
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Ensure an effective recall system of those patients who have abnormal test results
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Ensure clinical audits are regularly undertaken in the practice, including completed clinical audit or quality improvement cycles.
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Ensure arrangements for monitoring all emergency drugs are in place.
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Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
The areas where the provider should make improvement are:
- Consider a monitoring process for staff training in order to identify training which is overdue
- Ensure that the infection control action plans provide the necessary detail such as the name of the individual responsible for completing the actions and the timelines for completion.
- Review the information regarding the complaints process that is available for 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