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

Reports


Inspection carried out on 6 June 2017

During an inspection looking at part of the service

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 carried out on 2 November 2016

During a routine inspection

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. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and generally well managed. Risk assessments in relation to health and safety and fire were not available at the time of the inspection but were sent to the Commission shortly afterwards. Some emergency fire exit signage was missing but this was rectified during the inspection.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services was available. However the practice did not offer translation services. Patients who could not speak/understand English were advised to attend with a friend or relative who could translate. The practice had liaised with the local Somalia community and they had formed a group of members who could assist with translation for patients within their community.

  • Information about how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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. The practice did not offer electronic appointments or electronic repeat prescriptions.
  • The practice had good facilities and was well equipped to treat patients and meet their needs, however we found out of date single use equipment. This was disposed of immediately by the practice.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • Not all staff had attended safeguarding children training. This training was undertaken following the inspection. Some staff undertook chaperone duties but were not familiar with what that duty entailed. Following the inspection relevant staff completed chaperone training. Most staff had not undergone training in fire safety, infection prevention and control, information governance or basic life support. This was completed for all staff shortly after the inspection.
  • Clinical audits had been carried out but the cycle had not been completed with a second audit.
  • The recruitment processes were not robust. We found several gaps in documentation. Not all new staff had a recorded induction.
  • Medicine management was generally satisfactory however we found that not all Patient Group Directions were up to date. This was rectified post the inspection.
  • The system for referrals, actioning results and follow ups was not robust.
  • The practice had a governance framework to support the delivery of the strategy and good quality care however we found some weaknesses in governance systems which impacted on the services being provided.

The areas where the provider must make improvement are:

  • Establish governance systems and processes to enable the practice to operate effectively with regard to completed clinical audit cycles to demonstrate improvements in patient care, recruitment and staff training, and to ensure robust management of referrals, test results, follow ups, Patient Group Directions and single use equipment.

The areas where the provider should make improvement are:

  • 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.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice