Dr B. Bekas

We carried out an unannounced focused inspection at Dr B. Bekas on 18 September 2023. Overall, the practice is rated as inadequate.

The ratings for each key question are:

Safe - inadequate

Effective - inadequate

Responsive - requires improvement

Well-led – inadequate

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection/review

This inspection was unannounced and was completed on site.

This included:

• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Reviewing evidence from the provider.

Our findings

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 inadequate overall.

We rated the provider inadequate for providing safe services:

• There was not an effective system for managing Disclosure and Barring System (DBS) checks.
• Recruitment checks were not carried out in line with the regulations.
• There was no induction process in place for new or temporary staff.
• Staff vaccinations were not maintained in line with UK Health and Security (UKHSA) guidance.
• The practice was not equipped to deal with medical emergencies.
• Blank prescriptions were not kept securely or monitored in line with national guidance.
• Vaccines were not appropriately stored to ensure they remained safe and effective.
• There were no health and safety risk assessments or a fire risk assessment in place.
• Medicines were not always prescribed safely and patients on repeat medication did not always receive the correct monitoring.
• The learning form significant events was not always shared with the practice team.
• There were no arrangements in place for the effective monitoring of infection, prevention and control.
• There was not an effective system in place to receive and action safety alerts.

We rated the provider inadequate for providing effective services:

• Patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidelines.
• There was not an effective system in place to demonstrate that persons providing care or treatment to service users had the qualifications, competence skills and experience to do so safely.
• The practice did not have evidence that staff had received clinical supervision to be assured that they were competent to carry out their roles.
• There was no system in place to ensure that all patients who required an annual health check, were offered one and there was a backlog of patients who had not been reviewed in the previous 12 months.
• The uptake for all childhood immunisations was below the World Health Organisation (WHO) targets.
• The uptake for the cancer indicators was below local and national averages.

We rated the provider requires improvement for providing responsive services:

• Patients reported difficulty getting through to the practice by telephone and accessing a GP appointment during the day.
• There was a lack of information available to patients via the telephone system and there was nowhere else for patients to access information, including any online information.
• Information of how to make a complaint was not readily available.
• There was no recording or oversight of verbal complaints and therefore complaints were not used to drive improvement.
• Learning form complaints was not always shared with staff.

We rated the provider inadequate for providing well-led services:

• There was a lack of leadership and oversight from the provider to ensure services were delivered in a safe and effective way to patients.
• The practice did not have a clear vision and credible strategy to provide high-quality sustainable care.
• The practice culture did not always effectively support the delivery of high-quality sustainable care.
• The overall governance arrangements and processes for managing risks, issues and performance were ineffective.
• The practice did not always act on appropriate and accurate information.
• Feedback from the public, staff, and external partners to sustain high quality and sustainable care was not sought or always acted upon.
• There was little evidence of systems and processes for learning, continuous improvement and innovation.

We found 2 breaches of regulation. The provider must:

• Provide care and treatment in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, provider should:

• Take steps to improve the uptake of childhood immunisations and cancer screening.

I am placing this service in special measures. Services placed in special measures will be inspected again within 6 months. If insufficient improvements have been made such that there remains a rating of inadequate for any 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 6 months if they do not improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care