The Care Quality Commission
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Archived: Dr Bajen and Dr Blasco Also known as Rochford Medical Practice

Overall: Requires improvement read more about inspection ratings

Rochford Medical Practice, Southwell Hse, Back Lane, Rochford, Essex, SS4 1AY 0845 408 1299

Provided and run by:
Dr Bajen and Dr Blasco

All Inspections

27 March 2018

During a routine inspection

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

06 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bajen and Dr Blasco on 28 April 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months.

A follow-up comprehensive inspection was undertaken following the period of special measures over two days on 31 January 2017 and a further visit on 08 February 2017. Overall, the practice was rated as inadequate. Specifically they were rated as inadequate for safe, effective and well-led, and requires improvement for caring and responsive. The practice was placed in a further period of special measures for six months.

The full comprehensive reports for the inspections in April 2016, January and February 2017 can be found by selecting the ‘all reports’ link for Dr Bajen and Dr Blasco on our website at www.cqc.org.uk.

As a result of the risks found at the most recent inspection, the practice sent us an action plan to address the concerns identified. This inspection was undertaken to focus on the areas of high risk identified at the last inspection and to assess the current level of risk to patients, to consider whether enforcement action was required. This inspection was unannounced and took place on 10 October 2017. We did not rate the practice on this occasion.

Our key findings across all the areas we inspected were as follows:

  • The way safety incidents were recorded had improved to show those responsible for actions. Incidents where discussed in practice meetings and revisited to check for trends.
  • A programme of work had been carried out to improve practice safety. However, regular premises walk-rounds to monitor practice safety had not been formally added to their risk assessments.
  • An effective system to manage medicine and patient safety alerts was seen.
  • Evidence seen showed that blood tests were checked before patients prescribed high-risk medicines received further medicine. However, we found prescriptions for medicine of high risk that had been waiting for collection over three months.
  • We saw an effective monitoring system to manage two-week wait referrals appointments.
  • Potential safeguarding issues were identified with an alert on the patient computer records system.
  • We saw responsibility for standardised coding of patients conditions, treatment, and monitoring requirements had be given to a delegated staff member that had undergone specific training. Although we were told random checks of this staff members work were made to check for appropriateness and consistency they had no evidence.
  • We found no plan to address the low number of annual reviews and recalls for dementia and learning disability patients.
  • Clinical audit was being used to monitor quality however; we found no evidence of two cycle audits undertaken or actions taken showing improvement.
  • Formalised deputising arrangements were in place to ensure care and treatment continuity for patients when the lead GP was away.
  • Some improvement to patient outcomes in the Quality Outcome Framework (QOF) data was seen on the practice computer system on the day of inspection.
  • The number of patients identified as carers was very low.
  • There was a new system to ensure all clinical staff were updated with National Institute for Health and Care Excellence (NICE) guidance.
  • The practice sought feedback from staff during monthly meetings and from patients during the quarterly Patient Participation Group (PPG) meetings.
  • We saw that all staff had received basic life support training.
  • The practice policies and procedures were in the process of being updated and reviewed to meet current guidance. Clinicians had provided clinical oversight of governance with policies signed and approved by them. The action plan showed policy updates and reviews were soon to be completed.
  • The practice business continuity plan contained the contact numbers for all staff and services.
  • There was a process to monitor patients that have not attended for breast and bowel cancer screening.
  • We were shown a new policy to support families suffering bereavement.
  • The practice action plan developed to manage the concerns found in the previous inspection showed many actions had been completed and the status of current work.

We were satisfied that the practice had taken sufficient action to mitigate the risks identified at our inspection in January 2017. The practice remains in special measures and we will continue to monitor risk throughout that period and if necessary, carry out a further inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

31 January 2017 & 08 February 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rochford Medical Practice on 28 April 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Bajen and Dr Blasco on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was a follow-up comprehensive inspection on 31 January 2017 and a further visit on 08 February 2017 to collect further evidence. Overall, the practice is now rated as inadequate.

Our key findings across all the areas were as follows:

  • Since the last inspection, the two GPs registered as partners with the Care Quality Commission were still in a legal and personal dispute. They were still not communicating with each other nor taking joint responsibility for the day-to-day running of the practice. Therefore, the practice had no clear leadership structure and insufficient improvement had been achieved since the last inspection.
  • Staff members knew how to raise concerns and report safety incidents. These were shared with staff members during practice meetings. When things went wrong, patients received reasonable support, truthful information, and a written apology if appropriate. However, the recorded safety incidents did not show; who had undertaken the actions, when the actions had been carried out, the benefits these actions had achieved, or performed any analysis to check for themes or trends.
  • The infection control policy met current guidance, and audits were carried out regularly to ensure infection control was effective at the practice.
  • A health and safety risk assessment of the premises had not been carried out to keep staff and patients safe. However, fire safety, and equipment risk assessments had been undertaken.
  • Patient safety and medicine alerts received at the practice were not reviewed or acted on and this presented a risk to patients.
  • The practice had a GP lead for safeguarding. However, there was no system to follow-up on children who did not attend for a hospital appointment and who might be at risk.
  • There was no system to track two-week wait referrals from the point of practice referral to specialist consultant’s appointment.
  • Staff members spoken with told us that when providing GP services on a Saturday morning with a locum GP, that the working environment did not provide them enough security and that there was a lack of support.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below average compared to local CCG and national practice averages.
  • There was no system to ensure clinical staff members were up to date with and following NICE guidance.
  • The coding of patients conditions, treatment, medicine, and review requirements showed inconsistencies on the patient record system.
  • Staff members, including the lead GP, could not utilise the patient record system to provide them with assurance that patients had received reviews of their condition in line with guidance.
  • There was no evidence of an effective system to ensure health reviews were being carried out in line with recommended guidance.
  • All staff members had received an appraisal and had a personal development plan.
  • Patients spoken with during the inspection said they were treated with compassion, dignity and respect and involved in decisions about their care and treatment. They also told us they could make an appointment with a GP and urgent appointments were available on the day requested.
  • We saw staff treated patients with kindness and respect, and maintained patient confidentiality at all times.
  • The practice identified carers registered at the practice and we saw information for carers on the practice website.
  • The practice with the NHS England Area Team or the local Clinical Commissioning Group (CCG) to secure improvements to local services for the benefit of their patients.
  • The rates for breast and bowel cancer screening were lower than other local and national practices.
  • Clinical and non-clinical staff members had received basic life support training within the last year. However, there was no evidence had received this training in the last 12 months.
  • There were contact numbers for utility services however there were no staff member’s contacts on the practice business continuity plan.
  • There were adequate facilities and equipment to treat patients and meet their needs.
  • Information about how to complain was available and evidence showed the practice responded to issues raised. Complaints were shared with staff members during practice team meetings to understand any lessons learned.
  • There was no policy to contact families suffering bereavement to offer support.
  • The lead GP was the named GP for all elderly and long-term condition patients registered. This GP was also responsible for checking, actioning, and recording all pathology results, correspondence and repeat prescriptions. We found no arrangements in place to provide these checks and actions if the GP was absent.
  • The administrative staff members told us they felt supported by the practice manager.
  • The practice policies and procedures were in the process of being reviewed by the practice manager at the time of our inspection.
  • We found no arrangements to monitor and improve service quality or patient outcomes.
  • The practice did seek the views of staff members or patients to gain feedback or understand their needs and opinions.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Include premises monitoring to practice safety risk assessments.
  • Implement an effective system to manage medicine and patient safety alerts.
  • Implement an effective system to monitor patients prescribed high-risk medicines.
  • Implement an effective system to manage and monitor two-week wait referrals appointments for patients.
  • Follow-up, identify, and investigate effectively any potential safeguarding issues.
  • Standardise coding of patients conditions, treatment, or monitoring requirements in patient records.
  • Implement a quality improvement process including the use of clinical audit.
  • Ensure formal deputising arrangements are in place when the lead GP is absent.
  • Record those responsible for the acting on safety incidents and analyse regularly to check for trends.
  • Improve patient outcomes and the Quality Outcome Framework (QOF) data.
  • Implement a system to ensure all clinical staff members are up to date with NICE guidance.
  • The practice should seek and act on feedback from staff members and patients.
  • Ensure all relevant staff members have received up to date basic life support training.
  • Ensure clinical leadership for an effective system of governance, and oversight of clinical performance.

In addition the provider should:

  • Contact numbers for staff members should be added to the practice business continuity plan.
  • All practice policies and procedures should all be updated, maintained and reviewed to meet current guidance.
  • Identify patients that qualify for breast and bowel cancer screening, to improve.
  • Produce a policy to support families suffering bereavement.

This service was placed in special measures in July 2016. Insufficient improvements have been made such that there remains an overall rating of inadequate. After an internal meeting at the care, quality commission to discuss our findings the following decision was made. The practice will remain in special measures while enforcement is still in place. The practice will be kept under review and if needed could be escalated to urgent enforcement action.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

28 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bajen and Dr Blasco, otherwise known as Rochford Medical Practice on 29 April 2016. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

  • The two GPs registered as a partnership with the Care Quality Commission were in a legal dispute, did not communicate with each other and were not taking joint responsibility for the management and leadership of the practice. This dispute pervaded through the practice and impacted on staff working at the practice, creating an unhappy working environment. One GP did not work every day and the other GP had been stopped from providing clinical care. Therefore the practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

  • Staff morale was extremely low, they did not feel supported and the disagreement between the partners had a negative impact on the management and performance of the practice at all levels.

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. There was no policy in place for the safe storage of vaccines and as a result there were inadequate systems in place to ensure vaccines were stored in line with recognised guidance.

  • Due to a lack of robust procedures, we could not be assured that patients on high-risk medicines were being monitored effectively.

  • Appropriate recruitment checks on staff had not consistently been undertaken prior to their employment. Infection control audits did not identify or address all concerns identified. There were no policies or risk assessments in place for the control of substances hazardous to health.

  • Staff were not clear about reporting incidents, near misses and concerns, records were brief and did not demonstrate learning outcomes.

  • There was a lack of audit activity or other quality improvement systems in place to identify where the practice could improve. The practice was aware of national data but had not taken action to address areas for improvement.

  • Staff training was ad-hoc and not being managed effectively. There was little support, especially for non-clinical staff and training records were disorganised. Some clinical staff had not received up to date basic life support training and not all staff were aware of safeguarding procedures.

  • There were no robust patient recall systems in place, due to a lack of leadership and staff structure, staff were not sure who was responsible for identifying or contacting patients who required health checks or reviews.

  • The nursing team attended multidisciplinary meetings. The GPs rarely attended and meetings were not documented in sufficient detail to ensure information could be shared or patient records could be updated. There was a lack of oversight by GPs at the practice of the care and treatment decisions made at the meetings.

  • There was no robust system in place to ensure all staff were aware of new national guidelines or patient safety alerts.

  • Prescriptions were not all stored securely and there was no system in place to monitor their use.

  • Most patients were positive about their interactions with staff and said they were treated with compassion and dignity, although some patients had experienced difficult situations with reception staff.

  • The system for managing complaints was not effective. Records were incomplete, some were missing and there was no evidence of analysing complaints or sharing learning outcomes.

  • The practice tried to identify carers but had limited engagement with these patients to offer them further support. There was no policy to actively contact families suffering bereavement to offer support.

  • National data showed patients were satisfied with access to appointments, although we were told on the day of our inspection of difficulties in getting appointments and access via the telephone.

  • The practice had a patient participation group; however this was now very small and met infrequently.

  • Staff did not feel supported and were overwhelmed by their workload; there was limited engagement with staff to understand how they were feeling and what support they needed.

The areas where the provider must make improvements are:

  • Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

  • Ensure that the system for managing complaints is reviewed so that they are recorded, analysed, learning identified and shared and that patients receive a suitable explanation and an apology where relevant.

  • Ensure there is an overarching governance framework including risk assessments, policies and procedures that are regularly reviewed and available to staff to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

  • Take action to address identified concerns with infection prevention and control practice and the safe storage of vaccines.

  • Provide staff with appropriate support, training and supervision to enable them to carry out their roles effectively and keep patients safe. Ensure that staff training is monitored and up to date, including basic life support and safeguarding training. Ensure recruitment arrangements include all necessary employment checks for all staff.

  • Put systems in place to ensure all clinicians are kept up to date with national guidance, guidelines and that they respond appropriately to patient safety alerts.

  • Implement a robust system for reviews for patients on high risk medicines.

  • Carry out clinical audits including re-audits to ensure that areas for improvements have been identified and actioned.

  • Ensure all prescriptions are stored securely and implement a system to monitor their use.

  • Significantly improve the leadership structure at the practice so that the governance systems and processes are effective. Ensure there is leadership capacity to deliver all improvements.

The areas where the provider should make improvement are:

  • Continue to identify patients who are carers and provide them and those patients suffering bereavement with appropriate support, advice and guidance.
  • Improve engagement with the patient participation group in order to seek patient feedback.
  • Implement a programme of regular staff meetings to seek feedback and engage staff with the future of the practice and ensure these are recorded.

At the time of publication enforcement action was being considered in line with the CQC’s enforcement policy.

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

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During a check to make sure that the improvements required had been made

During the inspection in February 2014 we found the practice was non-compliant in two areas. The practice submitted an action plan explaining how people would be protected from the risk of infection, and that staff were now properly supervised.

We reviewed the evidence sent by the practice and found improvements had been made and patients, staff and other visitors were protected from the risks of acquiring an infection by systems and standards of cleanliness.

Further evidence sent to us showed that staff supervision processes were in place to ensure staff members were supported.

5 February 2014

During a routine inspection

We found people received individualised care and treatment that was planned and agreed with them. Medical records were detailed and showed people received continuity of care between professionals and specialist services. The surgery was clean and tidy but had no systems in place to manage and monitor the prevention and control of infection. Staff did not receive individual supervision or regular peer support but did have regular appraisals and were provided with the opportunity to attend training and development.

People we spoke with told us that "staff are fantastic', friendly and easy to talk to. People found it easy to get an appointment by 'either ringing up or popping in.' People told us the nurses were very good, helpful and informative. The doctors explained options and supported people in the choices they made.