Archived: Dr Leonard Jacob

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Leonard Jacob on 10 November 2015. 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.
• Not all risks to patients were assessed and well managed in relation to health and safety matters and recruitment.
• 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 how to complain was not readily available.
• Patients 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice was proactive in ensuring patients received vaccinations and health screening and demonstrated high rates of uptake. For example, the practice’s uptake for the cervical screening programme in 2014/15 was 96%, which was significantly higher than the local Clinical Commissioning Group (CCG) average of 82.5% and the national average of 81.8%. Childhood immunisation rates for the vaccinations given were significantly higher than CCG and national averages. For example, they had achieved 100% of childhood immunisation rates for the vaccinations given to under two and under five year olds. Flu vaccination rates for 2013/14 for the over 65s were 77.78% and at risk groups 70.12%. These were also above national averages. The practice had achieved a 98% response rate for health checks for patients aged 40 years plus compared to local CCG rates of 70%.

The areas where the provider must make improvement are:

• An infection prevention and control (IPC) risk assessment had not been completed and there were shortfalls in the management of IPC.
• Records of the vaccine storage fridge temperatures did not record reasons for the increase in temperature above the recommended limits and the actions taken to ensure the quality and effectiveness of medicines.
• The recruitment policy and procedure did not include requirements for references and DBS checks and appropriate recruitment checks had not been undertaken prior to employment.

• The fire risk assessment did not identify all areas of risk and fire escape routes were not fully marked with signs to indicate the exit route.

The areas where the provider should make improvement are:

• Procedures should be reviewed to ensure the GP has signed the Patient Group Directions (PGD) to allow nurses to administer medicines.
• The lack of provision of oxygen on the premises for use in an emergency situation should be reviewed.
• Records were not maintained to evidence all the training the staff had completed.
• Oxygen was not available for use in emergency situations.
• Curtains were not provided in all consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments.

• Information about the complaints procedure was not displayed in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice