Archived: Dr B. Bekas

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At the previous assessment, we rated this key question as inadequate because: 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 people providing care or treatment to patients had the competence skills, qualifications and experience to do so safely, there was not an effective programme of audits in place. There was no 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 childhood immunisations was below the World Health Organisation (WHO) targets and the uptake for the 3 cancer indicators was below the local and national averages. At this inspection we found that these areas had not been adequately improved and we rated this key question inadequate.

The practice was in breach of legal regulation in relation to good governance and safe care and treatment.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were not established and effective systems and processes in place to assess, prioritise and review people’s care. Non clinical staff had not been trained and they did not have access to guidance or supervision to assist them to triage patients effectively. This meant there were no assurances that patients were directed to the most appropriate pathway for their health concerns.

We found some patient records were not appropriately coded and flagged to alert staff to individual clinical needs and preferences.

Patients did not always receive the required reviews for their care and treatment within the required timeframes.

We found people with long-term conditions were not always offered a structured annual review to check their health and medicines needs were being met. The remote clinical searches that we undertook of the practice’s clinical records system showed the monitoring of people with some long-term conditions was not always in line with National Institute for Health and Care Excellence (NICE) recommendations.

We found that patients with a long-term condition were not always monitored or followed up within an appropriate timescale or reviews did not always demonstrate best practice guidelines. For example, our clinical searches found there were 5 patients who had been prescribed 2 or more courses of rescue steroids for asthma in the previous 12 months, and we reviewed all of these patients. None of these patients had been offered a follow-up assessment, in line with national guidance and all of them were overdue an asthma review.

We found there were 13 patients with hypothyroidism who had not had a thyroid function blood test in the previous 18 months. We reviewed 5 of these patients and found that 4 out of these people were overdue the test and no reminders had been sent to them.

We Identified 18 patients with diabetes who’s latest HbA1c was greater than 75mmol/1. HbA1c is a measure of blood glucose levels. A high HbA1c means you have too much sugar in your blood. This means you’re more likely to developdiabetes complications, including serious problems with your eyes and feet.

We looked at 5 of these patients and 3 were overdue a medication review, blood test and diabetic review.

The service did not work well across teams and services to support people. They did not always share their assessment of people’s needs when moving between different services.

There were no established and effective systems in place to identify, share and embed best practice. The provider had not monitored individual clinicians’ work to ensure they were safe and effective. Clinical staff did not receive regular formal supervision to ensure their decisions were reflective of national legislation, evidence-based good practice and required standards. Regular management meetings were not held.

There were no staff from the PCN working at the practice due to lack of clinical support and oversight.

The service did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. The service did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

Due to inconsistencies of systems and processes we found some delays in carrying out annual reviews for patients. We were not assured that the practice was identifying patients who may need extra care or support and directing them to relevant services. This included patients at risk of developing a long-term condition, carers and those with a learning disability. We were therefore not assured that patients had access to appropriate health assessments and checks.

We were told by staff that there was no overall lead in managing patient recalls and this was managed between clinical and non-clinical staff.

Patients’ record systems did not always alert clinicians about patients who required ongoing monitoring. The recall system needed strengthening to ensure all people with complex health needs and long-term conditions were regularly reviewed and received support to manage their health needs. We found a lack of clinical oversight to ensure systems were effective to enable patients to be monitored and supported to live healthier lives where possible.

The practice had a website which outlined information and links for health promotion, health conditions and common health questions.

The service did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff we spoke with told us that they had competing priorities for their time at work and were not always able to implement systems to identify and manage patients who required monitoring.

We found inconsistent approaches to monitoring people’s care and treatment and found during the remote clinical reviews that not all patients had received an annual review and were not being appropriately monitored to ensure their high-risk medicines and long-term conditions were regularly reviewed.

We found no evidence to demonstrate that the practice had a programme of targeted quality improvement and monitoring and used information about care and treatment to make improvements.

We found the practice systems were not sufficient to ensure that those patients requiring medicine reviews and ongoing monitoring were actively being reviewed and recalled. Our clinical searches showed systems were ineffective to ensure patients were safely monitored.

Although leaders reported challenges with their patient population demographic, there was no plan in place to address this. The overall trend for child immunisation was below the required 90% for all 5 indicators and cervical screening uptake was significantly below the 80% target and this had been a trend since 2016.

The practice told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent.

There were no do not attempt cardiopulmonary resuscitation (DNACPR) decisions in place at the time of assessment.