Archived: Dr Azmeena Nathu Also known as Pennygate Health Centre

We carried out a short notice, announced comprehensive inspection at Dr Azmeena Nathu, Pennygate Health Centre on 18 June 2018. This inspection was to see if the practice had made sufficient improvement for it to come out of Special Measures. This practice is rated as inadequate overall.

We carried out an announced comprehensive inspection at Pennygate Health Centre on 19 October 2017.

Breaches of legal requirements were found in relation to the governance arrangements within the practice.

We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in the warning notices by 12 January 2018.

The practice was placed into Special Measures on 28 December 2017.

At that inspection we found:

• Some systems and process were not effective in keeping patients safe. These concerned patient safety alerts, safeguarding, medicines reviews, monitoring patients on high risk medicines, cold chain monitoring, recruitment and retention of staff and NICE guidance.
• The practice could not demonstrate role specific training for staff.
• There was no effective system in place to monitor training and therefore we could not be assured that staff had the skills, knowledge and experience to deliver effective care and treatment.
• There was no evidence to show that staff were aware of current, evidence based guidance.
• Data from the 2017 national GP patient survey showed that patients rated the practice lower than others for most aspects of care.
• There was limited evidence that learning from complaints was shared with staff
• Feedback from the 2017 national GP patient survey showed that in 21 of the 23 areas surveyed results were below CCG and national averages.
• There was a lack of leadership and governance relating to the overall management of the practice.
• The practice was unable to demonstrate strong leadership in respect of safety
• There was a limited governance framework to support the delivery of good quality care for example in respect of safeguarding, patient safety alerts, medicine reviews the monitoring of patient on high risk medicines, recruitment and retention of staff, NICE guidance, training, learning form significant events and minutes of meetings.
• The arrangements for managing risks were not effective
• The practice could not demonstrate that they proactively sought feedback from patients and staff.
• There was little innovation or service development and minimal evidence of learning and reflective practice.

We undertook an unannounced focussed inspection on 19 April 2018 and a further announced inspection on 25 April 2018 to check that they now met the legal requirements. At the inspection on 19 and 25 April we found that not all the requirements of the warning notice had been met.

At this inspection carried out on 18 June 2018 we found that some improvements had been made. The key questions are now rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

At this inspection we found:

• Generally, the practice had clear systems to manage risk so that safety incidents were less likely to happen. However, there was no log kept of dispensary ‘near misses’.Following the inspection were provided with evidence that a ‘near miss’ log had been commenced.
• When incidents did happen, the practice learned from them and improved their processes.
• Records of consultations with patients were not always updated in a timely manner which put patients at risk.
• Clinicians were not always following evidenced based guidelines in respect of the assessment of unwell children, and the prescribing of antibiotics to children.This was addressed during the course of the inspection.
• Dispensary standard operating procedures had not always been signed by staff following update.
• Although the appointment system was easy to use and patients could access care when they needed it, access to extended hours appointments was limited. Patients were not able to book appointments directly through the reception staff and had to be referred to the GP before an appointment could be made.

• On the day of the inspection we were not provided with evidence of clinical audit being used as an aid to measure and improve performance. Following the inspection, we were provided with details of several such audits.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• There was a focus on equality and diversity and a culture that supported potentially vulnerable groups such as migrant workers and their families.
• The process for dealing with and responding to complaints was not embedded.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review and embed the complaints handling process.Following the inspection, we were informed that the complaints process had been reviewed.
• Review the process for updating and managing standard operating procedures to ensure they reflect current practice and to ensure staff have read and signed the most up-to-date version.
• Review monitoring and undertake an audit of prescribing, in particular antibiotic prescribing, to ensure high quality, safe, evidence-based practice.
• Review the process and provide clarity for booking extended hours appointments.

This service was placed in special measures on 28 December 2018. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe and well-led services. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by cancelling the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection at Pennygate Health Centre on 19 October 2017.

Breaches of legal requirements were found in relation to the governance arrangements within the practice. We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in the warning notices by 12 January 2018.

We undertook an unannounced focussed inspection on 19 April 2018 and a further announced inspection on 25 April 2018 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.

At the inspection on 19 and 25 April we found that not all the requirements of the warning notice had been met. The Care Quality Commission has written to the lead GP and asked for further information on how they will meet these requirements.

Our key findings across the areas we inspected for this focussed inspection were as follows:

• The practice had made improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe in relation to patient safety alerts, dispensary, monitoring of the cold chain, infection prevention and control, training requirements of staff, fire safety, management of legionella, portable appliance testing, Electrical Installation Condition report and actions, information technology systems and the documentation of discussion and actions from meetings that had taken place. Further work was required to ensure meeting minutes were detailed to include the discussion and actions taken, fire alarm and emergency lighting is carried out monthly, practice nurse received clinical supervision which is clearly documented and dispensary and locum staff undertake training identified relevant to their role,
• The practice did not have an effective system in place for the management of high risk medicines which included regular monitoring in accordance with national guidance.
• The practice did not have an effective process in place for medicines reviews.
• We could not establish if the practice had an effective system in place to safeguard service users from abuse and improper treatment.
• At this inspection we still had concerns in regard to the leadership capacity and clinical oversight of the practice.

The areas where the provider must make improvements are:

• Put in place an effective system for the management of patient on high risk medicines
• Improve the system in place for patients that require a medication review
• Improve the system in place for safeguarding service users from abuse and improper treatment.
• Ensure there is leadership capacity and clinical oversight in the practice.

In addition the provider should:

• Continue to embed the formalised process for the recording of meeting minutes and ensure they are detailed and evidence that learning is shared and actions are put in place. For example, in relation to significant events and complaints.
• Ensure there is monitoring for external training required by staff members relevant to their role.