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Jai Medical Centre (Brent) Inadequate

Reports


Inspection carried out on 1 October 2019

During an inspection to make sure that the improvements required had been made

We carried out an announced focused inspection at Jai Medical Centre (Brent) on 1 October 2019 as part of our inspection programme. We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection was planed to focus on the following key questions:

  • Is the service effective?
  • Is the service caring?
  • Is the service well-led?

During the inspection we decided to additionally include the following key question:

  • Is the service safe?

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

  • During our inspection, we visited one surgery, the Sheldon practice. But our findings relate to both sites.

  • Because of the assurance received from our review of information we carried forward the rating for the following key question: Is the service responsive? The practice is rated as Good for this key question.

We have rated this practice as inadequate overall.

We rated the practice as

inadequate

for providing safe services because:

  • The practice did not have clear systems and processes to keep patients safe.
  • The practice did not have appropriate systems in place for the safe management of medicines.
  • The practice did not have effective systems in place to follow-up urgent referrals.
  • The practice did not have an effective system to learn and make improvements when things went wrong.

We rated the practice as

inadequate

for providing well-led services because:

  • While there were some governance systems in place these were not comprehensive
  • The practice had not identified clear gaps in governance and was not managing risks effectively.
  • Systems and processes for sharing learning were weak.

We rated the practice as

good

for providing effective and caring services because:

  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The areas where the provider

must

make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider

should

make improvements are:

  • Review any further appropriate actions that could be taken to improve the cervical screening uptake rate and take action on related issues (such as read coding) which have already been identified

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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 13 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Stag Holyrood Surgery on 13 July 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Most patients said they found it easy to make an appointment with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice was creative in its approach to removing the barriers to care faced by individual patients.
  • There was a clear leadership structure and staff felt supported by the partners, the lead GP and management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

The practice had recently taken on a caretaking role for a nearby practice that had temporarily closed. However initially, the practice had been given no notice of the closure and was suddenly faced with patients from the closed practice arriving to consult with a doctor. The practice successfully set up a parallel reception, secured additional resources from its staff pool and started running the service the same day without cancelling patient appointments. 

The areas where the provider should make improvement are:

  • The practice should ensure its stock of emergency medicines is suitable to cover the needs of its patients, for example, including an injectable antibiotic.
  • The practice should put in place a written protocol for its use of patient specific directions (PSDs) and use PSDs more consistently to govern the administration of vaccines by the health care assistants.
  • The practice should increase the use of two-cycle audit to demonstrate that improvements to practice are well embedded and sustained.
  • The practice should consider ways to improve patient uptake of the national bowel cancer screening programme.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 29 April 2014

During an inspection to make sure that the improvements required had been made

At a previous scheduled inspection that took place on 31 October 2013 we found shortfalls in relation to the provider's staff recruitment processes. In particular we found that references had not been obtained for all staff prior to them commencing work at the surgery. The provider sent us an action plan on 09 december 2013 explaining how the shortfalls would be addressed.

During this inspection we spoke with the practice manager and looked at records relating to the recruitment of staff. We found that appropriate staff recruitment checks had taken place and recruitment procedures had been updated to ensure that more robust checks were completed before new staff were employed at the surgery.

Staff were encouraged to participate in on going learning and development to ensure they had the skills to carry out their role effectively.

Inspection carried out on 31 October 2013

During a routine inspection

During this inspection, we spoke with five patients. They confirmed that they had been treated with respect and dignity and were satisfied with the services provided. One patient told us, "I am satisfied with my GP. They explain my treatment and have referred me to the hospital specialist when needed�. Another patient said, �I have been coming here for many years. They are pleasant and respectful. They talk nicely to me�.

Patients said they had no problems getting an appointment to see a doctor and rarely had to wait long before being seen. Records indicated that patients were carefully assessed and their care and treatment had been carefully monitored. Reviews of care and treatment with the GP took place and these were recorded.

The practice had a recruitment policy. However, some essential checks had not been carried out prior to new staff being employed. Staff had been provided with essential training and updates. They were aware of action to take when responding to allegations or incidents of abuse.

The practice had an effective system to regularly assess and monitor the quality of service that patients received. A recent patient survey indicated that people were generally satisfied with the quality of services provided. Two members of the patients� participation group indicated that the views of patients were noted in the way the practice was run.