Archived: Dr Bajen and Dr Blasco Also known as Rochford Medical Practice

Updated 4 June 2018

The provider for this service is Dr Bajen and Dr Blasco. There are two GP partners; however, at the time of the last three inspections in: June 2016, January 2017, October 2017, and in this inspection, only one of the GP partners could practice.

The practice is also known as Rochford Medical Practice and is located centrally in Rochford town. The website address is www.rochfordmedicalpractice.co.uk .

The practice is a purpose built building shared with another GP provider. There is a pay and display car park available and there are good public transport links with a train station nearby.

The practice holds a personal medical services contract and the list size is approximately 8,900 patients.

The patient demographics shows an average population age distribution profile and an average deprivation score compared with local and national practice averages.

Updated 4 June 2018

This practice is rated as requires improvement overall.

Previous inspections – We inspected this practice on 28 April 2016, the practice was rated as inadequate and placed into special measures. Further inspections were made on 31 January 2017 and 8 February 2017 and the practice remained rated inadequate overall and the period of special measures extended.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced inspection at Dr Bajen and Dr Blasco on 27 March 2018 to follow up on breaches of regulation identified at our previous inspections.

At this inspection we found:

• The practice had made improvements since the last inspection, including the employment of a new practice manager. They had strengthened their governance and leadership systems but further improvements were required.
• The practice had some systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• There were adequate systems in place for the management and review of patients prescribed high-risk medicines.
• Despite being identified on previous inspections, prescription pads were not logged and the prescription stationery was not kept securely.
• Although there were appropriate emergency medicines on site, a number of staff did not know where these were kept.
• There was no evidence of checks on the oxygen, no signage to alert to presence of a medical gas and some staff were unaware of where the oxygen was stored. Open single use masks were seen with the oxygen. There was no paediatric pulse oximeter.
• The GP responsible for home visits did not carry any medicines and there was no risk assessment as to why they were not required.
• There was no second thermometer on the vaccine fridge and no evidence that the primary thermometer was calibrated monthly to confirm accuracy. The plug on the medicines fridge could easily be removed.
• Although there were recruitment checks in place, there was little or no evidence that some checks, required by legislation, were taking place.
• The names of patients on old medical paper records were clearly visible from the reception area.
• Two-week wait cancer referrals did not contain all required information.
• There was no conflict of interest risk assessments for some members of staff who were also patients and these staff members had not signed a confidentiality agreement.
• There was a system in place to regularly monitor the non-collection of prescriptions. However, we found some prescriptions for non-high risk medicines that had been awaiting collection for over a month. These had not been reviewed to assess for the potential reasons and health risks of non collection.
• The practice delivered care and treatment according to evidence- based guidelines.
• The practice had reviewed their clinical performance and set up clinics to ensure that patients received appropriate reviews.
• Unverified data from the Quality and Outcomes Framework showed that there were improvements in performance from the previous year.
• Some clinicians understanding of consent and deprivation of liberties safeguards (DoLS) was lacking.
• Staff were not aware of how to use their IT system effectively to handover patient information to the out of hours providers.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had access to translation services however, several staff were unaware of how to access these services.
• Staff had not received appraisals since 2016.
• The practice had identified less than 1% of carers.
• Patients spoken with had mixed views on the ease of use of the appointments system and access to care, although data from the national GP survey reflected that satisfaction rates were in line with or higher than local and national averages.
• There was evidence that the practice had responded to comments/complaints about access and changed their telephone systems to reduce these issues. Evidence also showed that the patient participation group (PPG) had been consulted with on these changes.
• Staff spoken with felt that improvement had been made and there were more structures in place since our previous inspections.
• Staff told us they felt supported and able to raise concerns or suggestions.
• Policies and procedures were being reviewed and updated as ongoing work. Some were due review and some contained incorrect information.

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.
• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Review the storage of paper medical records to protect patient confidentiality.
• Implement a system to ensure that conflict of interest risk assessments take place where appropriate. Ensure all staff working at the premises with access to areas containing patient confidential information have signed a confidentiality agreement.
• Review medicines fridge plug security and consider need for additional thermometer.
• Prioritise the appraisal of staff.
• Review processes relating to patient information to out of hours services.
• Review systems for referrals.
• Review staff awareness of facilities to support patients to access services.
• Continue to review practice performance in relation to diabetes and mental health.
• Continue to identify and support carers.

This service was placed in special measures in April 2016. Further inspections were made in January 2017, and October 2017 and the practice remained in special measures. Insufficient improvements have been made such that there remains a rating of inadequate for safe. CQC is now taking further action against the provider Dr Bajen and Dr Blasco in line with its enforcement policy and will report further on this when it is completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 June 2018

Updated 4 June 2018

Updated 4 June 2018

Updated 4 June 2018

Updated 4 June 2018

Updated 4 June 2018