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Archived: Dr Dissanayake Mudiyanselage Cyril Wijeratne Bandara Pattapola Good Also known as Anerley Surgery

Inspection Summary


Overall summary & rating

Good

Updated 29 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Dissanayake Mudiyanselage Cyril Wijeratne Bandara Pattapola on 2 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Dissanayake Mudiyanselage Cyril Wijeratne Bandara Pattapola on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 2 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good. Specifically, following the focused inspection we found the practice to be good for providing effective and well led services.

At our previous inspection on 2 November 2016, we rated the practice as requires improvement for providing effective services as the arrangements to ensure clinical staff were kept up to date needed improving. Clinical audits were carried out but not completed with a second cycle. Records showed that most staff had not undergone training in fire safety, infection prevention and control or information governance. Neither of the GPs had undergone training in the Mental Capacity Act 2005. Two week wait referrals were emailed however the practice did not have any process in place to check the emails had been received. Its systems for actioning test results and follow up action was not sufficiently robust. Sharing of information with other services was not as timely as it could be as the practice did not make use of electronic note sharing.

We rated the practice as requires improvement for providing well-led services as we found some weaknesses in governance systems which impacted on the services being provided, including: gaps in recruitment documentation; gaps in staff training and the lack of a robust system to manage referrals, test results, follow ups, Patient Group Directions and single use equipment.

We also highlighted other areas where the provider should take action:

  • Monitor Quality and Outcomes Framework (QOF) performance and take action if outcomes start to drop.

  • Take appropriate steps to identify patients who are also carers to allow the practice to provide support and suitable signposting.

  • Provide staff and patients with access to translation services.

Our key findings at this inspection were as follows:

We found that the provider had taken action to address the breaches of regulation identified at our previous inspection.

  • NICE and other guidelines were being stored on the practice’s computer system for ease of access.

  • Clinical audits had been competed with a second cycle.

  • Staff had undergone training in a number of areas including fire safety, infection control, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

  • A new referral and test result policy had been implemented.

  • The practice had signed up to the electronic shared care records scheme.

  • Gaps in recruitment documentation had been rectified.

  • Patient Group Directions and single use equipment was in date.

    The practice was rated as good for providing safe services at the inspection in November 2016, however at that time we had found out of date single use equipment and a Patient Group Direction. Gaps in recruitment documentation were also found. These issues were rectified during or just after the inspection. We reviewed these areas on this inspection and found that the practice had maintained these improvements.

We also found that the provider had taken the following action to address the areas where we suggested they should make improvements:

  • The GP and the practice manager regularly reviewed the practice’s QOF performance and told us they would take appropriate action if performance started to fall.

  • The practice had increased the number of identified patients who were also carers from 28 to 64 (up to 2% from 1%).

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

  • Provide staff and patients with access to translation services. This was raised at the previous inspection on 2 November 2016.

  • Put systems in place to ensure staff understand and retain learning undertaken.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • There was no clear system in place to receive and act on medicine alerts, medical devices alerts and other patient safety alerts. Following the inspection we were sent a new protocol for storing this information and for staff to record that they had seen it.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse. Not all staff had undergone safeguarding children training however they completed this shortly after the inspection.

  • At the time of the inspection staff had not undergone chaperone training and were unclear what acting as a chaperone required. Following the inspection we were sent evidence to show the practice manager and the senior receptionist had undergone online training.

  • Risks to patients were assessed and generally well managed. We found some out of date single use equipment (specimen pots and scissors). When pointed out, the practice immediately disposed of them.

  • We found two gaps in required recruitment documentation.

  • Patient Group Directions (PGD) had been adopted by the practice to allow nurses to administer medicines in line with legislation however we found that the one for influenza vaccination was out of date. An up to date PGD was sent to us subsequent to the inspection.

  • Some but not all staff had received annual basic life support training. This was rectified shortly after the inspection.

Effective

Good

Updated 29 June 2017

We found the practice had taken action to minimise risks to patients by improving how it actioned test results and referrals. The practice had signed up to the shared care records scheme which would enable them to share appropriate information with other care services.

Staff had undergone training in key areas including fire safety, information governance, infection prevention and control and basic life support. We noted, however, that some staff had undergone a wide range of e-learning over a very short period of time, several days before the inspection, but were unable to demonstrate the learning they had taken from it.

The practice could demonstrate quality improvement through clinical audit. It provided us with evidence of two completed audits.

We saw that guidelines from NICE were now all stored on the practice’s computer system for ease of access. Staff used this information to deliver care and treatment that met patients’ needs.

Caring

Good

Updated 28 December 2016

The practice is rated as good for providing caring services.

  • Data from the July 2016 national GP patient survey showed outcomes were comparable to England averages. For example:

  • The percentage of respondents to the GP patient survey who stated that the last time they saw or spoke to a nurse, the nurse was good or very good at treating them with care and concern. (01/07/2015 to 31/03/2016) was 85% compared to the England average of 91%.

  • The percentage of respondents to the GP patient survey who stated that the last time they saw or spoke to a nurse, the nurse was good or very good at involving them in decisions about their care (01/07/2015 to 31/03/2016) was 81% compared to the England average of 85%.

  • The percentage of respondents to the GP patient survey who stated that they always or almost always saw or spoke to the GP they preferred was 30% compared to the England average of 35%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • A poster advised patients who were also carers to identify themselves to staff so that they could offer support and advice, and there was also information on the practice website. The practice had identified just over 1% of patients were also carers.

Responsive

Good

Updated 28 December 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example it had increased appointment times for its elderly patients to 15 minutes and had engaged a permanent female GP.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was comparable to local and national averages.
  • 90% of patients were satisfied with the practice’s opening hours compared to the national average of 79%.
  • 64% of patients said they could get through easily to the practice by phone compared to the national average of 73%.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 29 June 2017

We found the practice had taken action to improve its governance systems, including introducing new policies and procedures; providing staff training and ensuring gaps in recruitment processes were filled.

It had established new systems and process to ensure Patient Group Directions and single use equipment were in date.

We saw the practice had put a new test result and follow up procedure into place; and they had also revised their two week wait referral process. We were told the new procedures were discussed with staff in a team meeting and we saw minutes to support this.

Checks on specific services

People with long term conditions

Good

Updated 29 June 2017

The provider had resolved the concerns for effective and well-led identified at our inspection on 2 November 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Families, children and young people

Good

Updated 29 June 2017

The provider had resolved the concerns for effective and well-led identified at our inspection on 2 November 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Older people

Good

Updated 29 June 2017

The provider had resolved the concerns for effective and well-led identified at our inspection on 2 November 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Working age people (including those recently retired and students)

Good

Updated 29 June 2017

The provider had resolved the concerns for effective and well-led identified at our inspection on 2 November 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 June 2017

The provider had resolved the concerns for effective and well-led identified at our inspection on 2 November 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People whose circumstances may make them vulnerable

Good

Updated 29 June 2017

The provider had resolved the concerns for effective and well-led identified at our inspection on 2 November 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.