The Care Quality Commission
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Archived: Berwick Surgery

Overall: Inadequate read more about inspection ratings

17 Berwick Road, Rainham, Essex, RM13 9QU (01708) 520830

Provided and run by:
Berwick Surgery

Important: The provider of this service changed. See new profile

All Inspections

22 February 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berwick Surgery on 1 March 2016. The overall rating for the practice was Inadequate. The full comprehensive report on the 1 March 2016 inspection can be found by selecting the ‘all reports’ link for Berwick Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 1 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Inadequate.

Our key findings were as follows:

  • The practice had some systems in place to minimise risks to patient safety. However, these were not always clearly defined or embedded.

  • The arrangements for managing medicines, including vaccinations were adequate to ensure patient safety.

  • Staff were aware of current evidence based guidance. However not all patients had their needs assessed and treatment planned for effectively.

  • Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However they had not received training in Information Governance.

  • There was very limited or no monitoring of people’s outcomes of care and treatment. A higher than average number of patients with long term conditions were exception reported with limited/no efforts made to monitor this or ensure reasonable efforts were made to ensure these patients were reviewed.

  • A female locum GP was available for four sessions per week.

  • There was no evidence of quality improvement processes including clinical and non- clinical audits and local benchmarking.
  • There was an ostensive leadership structure in place however in practice this was unclear and unstable due to the imminent dissolution of the GP partnership which was responsible for the practice.

At the previous inspection we told the practice they should:

  • Review facilities for disabled people and people who are hard of hearing and advertise that translation services were available.

At this inspection we found a hearing loop had now been installed. The practice had an interpreting service and we saw a sign in reception informing patients about this. Facilities for people with mobility restrictions remained limited. We were told this was due to space limitations in the building and that this would remain under review.

However, there remained areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure appropriate steps are taken to ensure the outstanding issues identified in the most recent infection control audit are addressed.

  • Ensure an adequate business continuity plan was in place to be followed in the event of a major incident.

  • Improve care planning processes to ensure the health, safety and welfare of patients.

  • Ensure patients with long term conditions received appropriate care and treatment by taking all reasonable steps to ensure these patients were effectively identified and reviewed.

  • Ensure there is a programme of quality improvement including clinical audits to improve patient outcomes.

  • Ensure staff receive training on Information Governance.

  • Ensure systems and processes are in place at the practice, in particular regarding vision and strategy, governance, staffing, practice policies (specifically adult safeguarding), performance awareness, continuous improvement and leadership.

In addition the provider should:

  • Review and formalise the induction process.

On the basis of the ratings given to this practice at this inspection, and the concerns identified at the inspection on 1 March 2016, this practice will remain in special measures. This will be for a further period of six months. This will allow time for the new provider to address the concerns identified. We will inspect the practice again within the next 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

1 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berwick Surgery on Thursday 1 March 2016. Overall the practice is rated as inadequate.

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

  • Improvements to patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was limited evidence that the practice was comparing its performance to others.
  • Risks to patients were not assessed and managed. For example, there were no risk assessments for fire, COSHH, legionella or infection control.
  • We identified a number of gaps in the arrangements for identifying, recording and managing risks and we found many gaps in the record keeping for staff files.
  • The practice had a number of policies and procedures to govern activity, but some were overdue a review. For example, the safeguarding policy had not been reviewed since 2012.
  • The arrangements for managing medicines, including vaccinations, were not effective to ensure that patients were kept safe.
  • Data showed patient outcomes were comparable to the national average. However, exception reporting for patients with long term conditions was higher than CCG and national averages.
  • The practice did not have facilities for disabled people and there were no provisions for patients to see a female GP.
  • 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.

The areas where the provider must make improvements are:

  • Ensure there is a programme of quality improvement to include clinical audits and re-audits are carried out to improve patient outcomes and review exception-reporting data to improve the management of patients with long-term conditions.
  • Ensure risk assessments for fire, infection control, legionella and COSHH are carried out to keep people safe.
  • Ensure that recruitment checks comply with Schedule 3 requirements and risk assessments for DBS checks are carried out for staff who carry out chaperoning duties.
  • Ensure systems are in place to keep all staff up to date with role specific training, including training in safeguarding, fire safety, infection control, information governance, and Mental Capacity Act
  • Ensure effective systems are in place to manage medicines, including vaccines and emergency medicines and that there are systems in place to monitor blank prescriptions
  • Ensure formal governance arrangements are implemented, including systems for assessing and monitoring risks, the quality of the service provision and practice specific policies are up to date.

In addition the provider should:

  • Review facilities for disabled people and people who are hard of hearing and advertise that translation services were available.
  • Review systems to identify carers.

Since inspection, we have received additional information to show some action has been taken to address issues. We will investigate these in our next inspection in six months.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

9 September 2013

During a routine inspection

People we spoke with told us that the GP or nurse would take the time to listen to what they had to say. They told us that the staff had a good understanding of their individual needs, and offered them support in making decisions about their care. One person said, 'I like the doctor, he listens to you and has a good way of explaining things'.

People we spoke with were positive about the surgery. One person told us, 'I can't fault them, I have been coming here since it opened.' Another person said, 'I am happy with the doctor.' We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Care plans we looked at were person centred and were developed around individual needs.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us that they felt safe at the surgery and felt comfortable with reporting any concerns they had to staff.

There were effective recruitment and selection processes in place. Prospective staff were interviewed by the practice manager to ensure that they had the suitable skills and experience for the particular role. The practice carried out employment checks to verify qualifications, references and identity.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw that learning from incidents and investigations took place and appropriate changes were implemented. The practice took account of complaints to improve care for patients.