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Inspection Summary


Overall summary & rating

Good

Updated 31 October 2018

We carried out an announced focused inspection at East End Medical Centre on 15 February 2018. The overall rating for the practice was good but we rated it as requires improvement for providing effective services. We issued a warning notice for breach of Regulation 17 (Good governance) and a requirement notice of for a breach relating to nursing staff of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We then undertook a focused inspection on 11 June 2018 to follow up the warning notice and found the provider had complied requirements under Regulation 17 (Good governance), but that it should introduce a programme of care record reviews for all clinical staff. The full comprehensive report on the 15 February 2018 and 11 June 2018 inspections can be found by selecting the ‘all reports’ link for East End Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 October 2018 to assess whether the provider was meeting legal requirements, particularly regarding Regulation 18 of the Health and Social Care Act (HCSA) (staffing), and arrangements for care record reviews for clinical staff. This report covers our findings in relation to improvements made since our 15 February 2018 and 11 June 2018 inspections.

Overall the practice is now rated as good.

Our key findings were as follows:

  • Nursing staff were appropriately trained and undertook duties in accordance with their remit.
  • Arrangements were in place to monitor clinical staff to provide of safe and effective patient care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.
  • The practice maintained appropriate standards of cleanliness and hygiene. We observed the premises to be clean and tidy.
  • We reviewed two personnel files and found appropriate recruitment checks had been undertaken prior to employment.
  • The practice had adequate arrangements in place to respond to emergencies and major incidents.

Effective

Good

Updated 31 October 2018

We rated the practice as good for providing effective services overall and across all population groups.

At our 15 February 2018 inspection we rated the practice as requires improvement for providing effective services because nursing staff were working outside appropriate clinical boundaries and leadership and management staff were not aware of this. Nursing staff did not have the required level of understanding or training for duties they were undertaking including under the Mental Capacity Act 2005, and there were weaknesses in the process for practice nurse’s appraisal. At the 11 June 2018 inspection concerns around nursing staff had been addressed, but we found the practice should introduce a programme of care record reviews for all clinical staff.

At this inspection 22 October 2018, the practice had embedded appropriate arrangements for nursing staff and there was effective oversight of all clinicians care.

Effective staffing

Staff had the skills, knowledge and experience to carry out their roles.

  • Nursing staff were working within appropriate clinical boundaries.
  • A lead GP had reviewed nursing appointments retrospectively where needed, to ensure patient safety and care in line with best practice and requirements.
  • The practice had ensured role-specific training and updating for nursing staff.
  • Leaders and managers had sufficient understanding of clinical staff learning needs and related levels of competence through appraisal and clinical staff care record reviews.

Please refer to the evidence tables for further information.

Caring

Good

Updated 15 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed the practice was comparable to others in most areas of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • All of the 44 patient Care Quality Commission comment cards we received were positive about the service experienced.

  • The practice provided facilities to help patients be involved in decisions about their care, including translation services and a mobile induction loop for patients who were hard of hearing.
  • We noted that the practice offered carers an annual flu jab but did not provide any other specific support.
  • If families suffered a bereavement the practice sent a sympathy card but did not call or visit.

Responsive

Good

Updated 15 March 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice met with the local CCG every three months, and also attended monthly cluster meetings.
  • Patients said they found it easy to make an appointment, albeit not always with their preferred GP. Urgent appointments were available the same day.
  • Patients could access alternative GPs, at this practice, on Monday evenings and Saturday mornings via the local GP co-operative.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 15 March 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. However, arrangements to monitor and improve quality were not always effective.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Families, children and young people

Good

Working age people (including those recently retired and students)

Good

People experiencing poor mental health (including people with dementia)

Good

People whose circumstances may make them vulnerable

Good