The Lordship Lane Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Lordship Lane Surgery (then named Dr SAKM Doha) on 23 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for The Lordship Lane Surgery on our website at www.cqc.org.uk.

This inspection was undertaken five months following the publication of the report of the inspection in January 2017, and was an announced comprehensive inspection on 12 September 2017. Overall the practice has improved and is now rated as good overall.

Our key findings were as follows:

• The systems and processes to address risks to patients were not as comprehensive as they needed to be. For example, the fire log indicated the fire alarms were usually tested on a monthly basis, but we saw that if the designated fire marshal was absent when the test was due, no-one else undertook it. There was a health and safety risk assessment which had been completed in June 2017. It was minimal and did not adequately review all potential areas of risk.
• The security of medicines and blank prescriptions had been improved.
• We saw staff were recording the temperature of the vaccine refrigerator each day the practice was open; however, there was only one thermometer rather than the two recommended as good practice. The vaccines we checked were all in date.
• Although the practice had a policy of checking uncollected prescriptions every three months, we found a number waiting to be collected that were older than this.
• Patients prescribed high risk medicines received regular monitoring.
• The premises were clean and a comprehensive infection prevention and control (IPC) audit had been carried out by the local clinical commissioning IPC lead. Staff at the practice had begun to take action to rectify areas identified for improvement.
• There had been a number of clinical audits undertaken in the last two years, including two completed audits where the improvements made were implemented and monitored.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes overall were comparable to the Clinical Commissioning Group (CCG) and national average.
• Staff had access to guidelines from NICE and told us they used this information to deliver care and treatment that met patients’ needs. Clinical staff were aware of recently issued guidelines.
• Meetings took place with other health care professionals on a monthly basis; however, we found that most of the multi-disciplinary meetings were not minuted, albeit the GP in attendance updated patient notes where appropriate.
• The practice maintained a palliative care register and held regular multi-disciplinary meetings with, for example, the palliative care consultant and the health visitors. We noted the practice did not maintain a register of patient deaths.
• Staff had the skills, knowledge, support and experience to deliver effective care and treatment.
• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
• The practice had identified 101 patients as carers (just over 2% of the practice list).
• The Patient Participation Group felt that the practice listened to what they had to say, and tried to act upon suggestions.
• All but one of the 46 patient Care Quality Commission comment cards we received were positive about the service experienced. Data from the national GP patient survey showed the practice was comparable to others for most aspects of care.
• In the week preceding this inspection the practice had employed a locum female GP, with a view to them becoming a permanent salaried GP. Patient feedback had been very positive.
• A complaint leaflet was available and since the last inspection the practice has set up a designated complaints information notice board in the reception area.
• Staff told us there was an open culture within the practice and they had the opportunity to raise any issues at team meetings and felt confident and supported in doing so.

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

Importantly, the provider must:

• Strengthen arrangements for identifying, recording and managing risks, issues and implementing mitigating actions, including an appropriate health and safety risk assessment, accurate electrical testing records and regular fire alarm tests.
• Review the process for dealing with uncollected repeat prescriptions so that they are dealt with in a timely manner.

In addition the provider should:

• Consider acquiring an additional thermometer for the vaccine fridge.
• Consider implementing a register of patients who have died.
• Make arrangements to minute multi-disciplinary meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Lordship Lane Surgery (then named Dr SAKM Doha) on 19 May 2016. The overall rating for the practice was requires improvement, with a rating of inadequate for providing safe care. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for The Lordship Lane Surgery on our website at www.cqc.org.uk.

This inspection was undertaken six months following the publication of the report of the inspection in May 2016, and was an announced comprehensive inspection on 23 January 2017. Overall the practice remains rated as requires improvement.

Our key findings were as follows:

• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. The practice did not have a health and safety risk assessment, for example.

• The security of some medicines and blank prescriptions needed to be improved.

• Not all patients prescribed high risk medicines had received regular monitoring.

• The premises were clean however there were several areas where infection prevention and control processes required improvement.

• There had been a number of clinical audits undertaken in the last two years; however, with the exception of the CCG led prescribing audit, none of these were completed audits where the improvements made were implemented and monitored.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes overall were comparative to the Clinical Commissioning Group (CCG) and national average. However, the practice was an outlier for two QOF clinical indicators relating to atrial fibrillation and cervical screening.

• Staff had access to guidelines from NICE and told us they used this information to deliver care and treatment that met patients’ needs. The practice did not, however, have systems in place to monitor that these guidelines were followed through risk assessments, audits and random sample checks of patient records.

• In most areas staff had the skills, knowledge, support and experience to deliver effective care and treatment. Not all staff had undergone appropriate training or received an annual appraisal.

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

• The practice had identified just 15 patients as carers (less than half a percent of the practice list).

• The Patient Participation Group felt that the practice listened to what they had to say, and tried to act upon suggestions but did not share information, such as complaints and the learning taken from them.

• All of the 31 patient Care Quality Commission comment cards we received were positive about the service experienced. Data from the national GP patient survey showed the practice was comparable to others for most aspects of care.

• The practice had not considered how the lack of a female GP may have affected patients; or reviewed whether or not patients’ needs were being met by being referred elsewhere.

• The practice had a complaints leaflet but this was not on display and had to be specifically requested. The practice maintained a complaints log which detailed the learning taken but we found limited evidence to show this had been discussed with staff.

• Staff told us there was an open culture within the practice and they had the opportunity to raise any issues at team meetings and felt confident and supported in doing so.

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

Importantly, the provider must:

• Ensure patients who are prescribed high risk medicines are appropriately monitored.

• Improve the security of medicines and blank prescription pads.

• Improve patient outcomes by implementing a clinical quality improvement programme and continue to monitor performance against the Quality and Outcomes Framework and clinical audit.

• Strengthen arrangements to prevent and control the spread of infections.

• Strengthen arrangements for identifying, recording and managing risks, issues and implementing mitigating actions, including a health and safety risk assessment.

• Ensure that staff have access to appropriate training including, for example, cervical screening refresher training; and receive annual apprisals.

In addition the provider should:

• Review how patients with caring responsibilities are identified to ensure information, advice and support is made available to them.

• Introduce systems to ensure all clinicians are kept up to date with national guidance and safety alerts.

• Consider how to ensure patients have access to practice information in the reception area, including the practice leaflet and the complaints procedure, and ensure that complaints are handled in line with the policy and shared with staff.

• Record the action taken when the vaccine refrigerator temperature exceeds the maximum temperature.

• Review how the needs of patients who wish to see a female GP are being met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice