The Care Quality Commission
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  • GP practice

Archived: The Laurels Medical Practice

Overall: Good read more about inspection ratings

256 St Ann's Road, Tottenham, London, N15 5AZ (020) 8800 4032

Provided and run by:
The Laurels Medical Practice

All Inspections

16 May 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 28 July 2015, when we found breaches of legal requirements and identified aspects of diabetes care and cancer screening that required improvement. We served two requirement notices relating to the breaches.

Following the inspection, the practice wrote to us to say what it would do to meet the legal requirements in relation to the breaches of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment, and regulation 14 of the Care Quality Commission (Registration) Regulations 2009, regarding notice of absence.

We undertook this focussed inspection on 16 May 2016 to check that it had implemented its action plan and to confirm that it now met the legal requirements. This report covers our findings in relation to those requirements and to the improvements needed to provide an effective service. We found that the practice had taken appropriate action to meet the requirements of the regulations. We also found that significant steps had been taken in relation to diabetes care. Data showed there had been some improvement in the effectiveness of the service, but results remained below average. We have revised the overall rating for the practice, which is now good. However, we have again rated the practice as requires improvement for providing an effective service, as we would like to see the progress sustained and for further improvement to be made.

The provider should -

  • Continue working to sustain improvement in relation to the care of patients with diabetes.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Laurels Medical Practice on our website at www.cqc.org.uk.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

28 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Laurels Medical Centre on 28 July 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed, with the exception of those relating to relating to the safe storage of vaccines and infection prevention and control.
  • There was evidence that clinical audits were being used to drive improvements in performance to improve patient outcomes. However, data also showed significant variation in patient outcomes above and below averages for the locality.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • Leadership arrangements did not support the delivery of high-quality person-centred care. Our registration records indicated that there were two partners working at the practice. However, on the day of our inspection we noted that there was only one full time GP working; supported by seven part time locums. We were told that the other partner was no longer practising and had been absent for more than 28 days. We had not received a statutory notification. Although the practising GP partner was clear about his role and accountability for quality, we could not be assured that they had the necessary capacity to lead effectively. For example, we noted that they had a range of responsibilities including safeguarding, clinical auditing and clinical and non clinical staff line management.

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

Importantly the provider must:

  • Ensure that vaccines are safely managed and stored.
  • Ensure Patient Specific Directions (PSDs) are in place for named patients whenever the health care assistant administers flu immunisations.
  • Undertake annual infection prevention and control audits in order to identify and act on infection risks.
  • Ensure that the Care Quality Commission is formally notified of the non practising partner’s absence and advised of the arrangements in place for managing the regulated activities during their absence.

In addition, the provider should:

  • Continue to implement and monitor improvements in patient outcomes for people with diabetes and for cervical screening uptake as these are significantly below CCG and national averages.
  • Review its clinical leadership arrangements to ensure they support the delivery of high-quality person-centred care.
  • Investigate an apparently high level of emergency admissions for patients with cancer.

We inspected The Laurels Medical Practice in 2013 using our old methodology and judged it to be compliant regarding the following outcomes: respecting and involving people, care and welfare, cleanliness and infection control, safety and suitability of premises and assessing quality of service provision. The location was not compliant regarding its safeguarding systems. We re-inspected in 2014 and judged that the location was compliant regarding this outcome.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

18 July 2014

During an inspection looking at part of the service

At our last inspection of this service on 30 October 2013 we found that staff were unfamiliar with the practice policy for safeguarding vulnerable adults. The provider had not taken reasonable steps to identify the possibility of abuse and prevent it from happening Regulation 11 (1)(a)Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take action.

At this inspection we found that staff had undertaken safeguarding training in October 2013 and could demonstrate knowledge of the provider's safeguarding policy and what to do if they suspected abuse. We found they were now compliant with the Regulation.

30 October 2013

During a routine inspection

The Laurels Medical Practice was a busy GP practice in shared premises. We found that patients were generally happy with the service they received. One patient told us, 'The doctors do a very good job under a lot of pressure.' The main concern expressed to us was the difficulty in getting an emergency appointment unless a patient turned up in person. One of the GPs we spoke to said that they knew it could be hard for people to get an urgent appointment, unless they came in at 8.30am.

We saw that the practice had recently increased the number of emergency appointments available and was trying to improve the situation.

We saw that the building was clean and well maintained and it had good access for people with mobility difficulties. One patient spoke highly of the current reception staff. However, due to the shared reception desk it was easy for patients to get confused by the system and staff spent a lot of time re-directing people to the correct service.

We had some concerns that staff were not as skilled and knowledgeable about safeguarding vulnerable adults as they were about safeguarding children. However we found that the team was good at learning from experience and it met regularly to discuss relevant issues.