Archived: Durdells Avenue Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Durdells Avenue Surgery on 7 February 2017 to assess the improvements made at the practice. Overall the practice is rated as inadequate.

We had previously inspected Durdells Avenue Surgery on 15 February 2016 when we rated the practice as requires improvement overall. Specifically, the practice was rated as requires improvement for safe and effective, good for caring and responsive and inadequate for well-led.

Areas which did not meet the regulations following our inspection in February 2016 were:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, risks from fire were assessed but actions to reduce risk were not implemented.
• There were no effective systems for clinical audits to promote learning and improvement to patient outcomes.
• There was no evidence of learning and communication with staff about reported safety incidents or clinical guidelines.
• The practice had limited leadership and limited formal governance arrangements. For example, they had failed to maintain accurate records relating to the requirements for staff training and development. Long-term plans to resolve low staffing were not in place.

On 7 February 2017, our key findings across all the areas we inspected are as follows:

• The practice had no clear leadership structure and limited formal governance arrangements.
• Staff were able to report incidents, near misses and concerns; however wider learning and effective communication across the team.
• Patients were at risk of harm because systems and processes were not being followed to keep them safe as a direct result of staff shortages. For example, not all staff had received training in infection control, chaperone duties for those staff undertaking this role, adult safeguarding and The Mental Capacity Act (2005).
• There remained a lack of effective systems for clinical audits or quality improvement exercises to promote learning and improvement to patient outcomes.
• Patients were generally positive about their interactions with staff and said they were treated with compassion and dignity. However, some patients reported there was limited continuity of care.
• The practice provided suitable support for patients who were also carers.
• The practice sought feedback from patients.
• Staff were not consistently well supported by management and the staffing arrangements.
• The practice had not displayed the rating of the previous inspection.

The areas where the provider must make improvements are:

• Introduce reliable processes for reporting, recording, acting on and monitoring significant events, complaints, incidents and near misses.
• Address identified concerns with infection prevention and control practice, including legionella.
• Carry out clinical audits, including re-audits and other activity to ensure improvements in patients care and outcomes have been achieved.
• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner and which are reflective of the requirements of the practice.
• Ensure patient complaints are investigated in an appropriate manner.
• Ensure sufficient staff are deployed to meet the needs for the safe running of the practice and patient’s needs.
• Ensure staff receive the training and support necessary for them to undertake their roles effectively, including regular communication and regular performance reviews.

In addition, there were areas where the practice should make improvement:

• Consider providing additional support to meet the needs of patients with impairments. For example, a hearing loop and improved disabled facilities.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

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 Durdells Avenue Surgery on 15 February 2016. Overall the practice is rated as requires improvement.

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. However, reviews and investigations were not robustly conducted to ensure that learning occurred and influenced practice.
• Risks to patients were not routinely assessed and findings of risk assessments where undertaken were not fully implemented.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Appointments were always available on the same day.
• The practice was understaffed for GPs and plans to resolve this were not in place.
• Information about services and how to complain was available and easy to understand.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review and/or were not implemented by the practice.
• The practice had sought feedback from patients.
• Staff were clear about reporting incidents, near misses and concerns however there was no evidence of learning and communication with staff.
• Staff felt supported by management.

The areas where the provider must make improvements are:

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

• Ensure staff receive regular formal appraisals and performance reviews.

• Establish governance arrangements to ensure the assessment of quality of care and delivery of improvements such as through practice meetings and clinical audit programmes.

• Ensure that staff receive the training and induction required to carry out their roles effectively and safely. Ensure this is monitored by the practice.

• Ensure that a programme of clinical audit that focuses on improving patient outcomes is established.

• Ensure that risks to patients from fire, legionella, infection control and electrical safety are routinely assessed and recommendations implemented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice