The Care Quality Commission
  • Doctor
  • GP practice

Bruce Grove Primary Health Care Centre

Overall: Requires improvement read more about inspection ratings

461-463 High Road, Tottenham, London, N17 6QB (020) 8808 4710

Provided and run by:
Bruce Grove Primary Health Care Centre

All Inspections

11 August 2022

During an inspection looking at part of the service

We carried out an announced inspection of Bruce Grove Primary Health Care Centre on 10 and 11 August 2022. We have not revised the ratings from our previous inspection, which remain:

Overall, the practice is rated as Requires improvement.

The ratings for each key question are:

Safe – Inadequate

Effective - Requires improvement

Caring – Requires improvement

Responsive – Requires improvement

Well-led – Requires improvement

The full report of our previous inspection on 25 and 26 April 2022 can be found on our website at: https://www.cqc.org.uk/location/1-550196059

At our previous inspection, we identified concerns regarding appropriate monitoring of patients who were prescribed high-risk medicines. Additionally, patients who were prescribed medicines for long-terms conditions were not always monitored appropriately. We found a number of missing items from the practice’s supply of emergency medicines with no accompanying risk assessments to justify why these items were not stocked. We identified issues regarding fire safety and noted the practice did not have a fire alarm system installed. The practice premises were in a poor state of repair and facilities offered by the practice did not always allow for patient privacy and dignity to be maintained.

We served a warning notice under Section 29 of the Health and Social Care Act 2008 in relation to breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a requirement notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The practice told us it had taken immediate steps to address our concerns and subsequently sent us a plan of the actions taken.

Why we carried out this inspection

We carried out this focused inspection on 10 and 11 August 2022 looking at the identified breaches set out in the Regulation 12 warning notice, under the key question Safe, and to review the action taken by the practice. We found the practice had taken sufficient action to deem the warning notice met. We did not review the Regulation 17 requirement notice and have not revised ratings for the practice. We will consider those issues when we carry out a further follow up inspection in due course.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • A site visit on 11 August 2022 to consider the actions taken by the provider;
  • A remote clinical review of patients’ records and the clinical correspondence system on 10 August 2022, and discussion between the lead GP and a CQC GP specialist advisor (GP SpA) regarding actions taken in response to the warning notice.
  • A remote review of relevant policies, protocols and action plans developed or revised by the provider since our last visit.

Our findings

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.

We found that:

  • Since our previous inspection, the practice had improved the monitoring of patients prescribed angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
  • Additionally, we found that the practice had taken appropriate action to improve the monitoring of patients who were overprescribed short acting beta agonists (SABA) inhalers to patients with asthma.
  • The practice had improved the monitoring of thyroid function tests (TFTs) in patients prescribed medicines for hypothyroidism.
  • The practice had supplied spare pads to accompany the defibrillator, which were suitable for both adult and paediatric use. Also, the missing items from the emergency medicines supply that were identified in our previous inspection had either been added to the stock held by the practice, or a risk assessment was present to justify why any item was not stocked.
  • The practice had installed a fire alarm system.
  • The practice had undergone extensive refurbishment to its premises and had remedied the peeling paintwork noted at the previous inspection. Additionally, the practice had been deep cleaned and no signs of black mould or damp were seen during the site visit. The practice had created a designated private area to support breastfeeding mothers and provide baby changing facilities.

The areas where the provider should make improvements are:

  • Ensure thorough documentation is included in the clinical records of patients who refuse blood tests, stating that they have been fully informed regarded the risks and repercussions of refusing monitoring. In addition, patients’ capacity to make such a decision should be clearly recorded.
  • Ensure patients are given structured annual reviews to monitor their long-term conditions.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

26 April 2022

During a routine inspection

We carried out an announced inspection at Bruce Grove Primary Health Care Centre (the practice) on 25 and 26 April 2022. Overall, the practice is rated as “Requires improvement”.

The ratings for each key question were rated as:

Safe – Inadequate

Effective – Requires improvement

Caring – Requires improvement

Responsive – Requires improvement

Well-led – Requires improvement

Following our previous comprehensive inspection on 24 July 2017, the practice was rated “Requires improvement” overall and for the key questions “Caring”, “Responsive” and “Well-led”. The practice was rated “Good” for “Safe” and “Effective”. The practice was served a requirement notice under Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A follow-up focused inspection was completed on 21 March 2018, which looked at the “Caring”, “Responsive” and “Well-led” domains, and whether the requirement notice served had been met. At this follow-up inspection on 21 March 2018, the three key questions of “Caring”, “Responsive” and “Well-led” were all rated as “Good”, therefore giving the practice an overall rating of “Good”. Additionally, it was found that the items listed on the requirement notice had been actioned accordingly and therefore the requirement notice had been met.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Bruce Grove Primary Health Care Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This comprehensive inspection was carried out to follow up on the ratings issued at the previous inspection. The focus of the inspection included:

  • Inspecting at all five key questions (Safe, Effecting, Caring, Responsive and Well-led) to ensure current ratings are up to date.
  • Consideration of issues highlighted during previous inspections.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A site visit.

Our findings

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.

We have rated this practice as Requires improvement overall.

We found that:

  • We found that the practice was not always monitoring patients prescribed angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
  • Additionally, we found that the practice was not always monitoring the overprescribing of short acting beta agonists (SABAs) inhalers to patients with asthma.
  • We found that the practice was not always monitoring thyroid function tests (TFTs) in patients prescribed medicines for hypothyroidism.
  • We found that the practice had no paediatric or spare pads to accompany the defibrillator. Also, there were a number of missing items from the emergency medicines supply (antiemetics, dexamethasone, diclofenac, naloxone, opiates). There was no risk assessment to justify these missing items.
  • The practice had no fire alarm system in place, which was flagged as a high risk item which required immediate action. The fire risk assessment was completed by an external contractor on 18 April 2022.
  • We found that the practice premises were generally in a poor state of repair, and unclean in the toilet and general waiting areas. No privacy arrangements were in place to support breastfeeding mothers or baby changing facilities.
  • We found that the practice did not have complete staff personnel files. For example, there were missing Disclosure and Barring Service (DBS) certificates, appraisals and references, and one staff member’s proof of professional registration certificates had expired. Additionally, some staff training had expired, which included information governance training and basic life support training. The fire risk assessment completed by an external contractor also highlighted that not all staff were given fire safety training as standard.
  • Systems operated by the practice did not provide enough assurance that significant events and patient feedback, such as complaints, were used effectively to improve the quality of the service.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic, but some patient dissatisfaction was highlighted in data from the National GP Patient survey and online review platforms.
  • Whilst the practice has stated it aims to use feedback from complaints and the GP patient survey, patients’ feedback remains generally negative in nature. Additionally, the practice does not currently have an active Patient Participation Group (PPG).
  • Staff interviewed report a positive culture within the work place and a good working relationship with management.
  • All staff interviewed reported feeling staffing levels were sufficient and felt appropriate cover was provided in the event of staff absence.
  • Plans have been put in place to encourage uptake of cervical screening and childhood immunisations, with the practice proactively reaching out to such patient groups via both SMS and letters.

We found two breaches of regulations. The provider must:

  • 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).

In addition to the above, the practice should:

  • Identify and action learning needs that arise from significant events and complaints.
  • Establish a PPG and engage with it to help facilitate patient input regarding potential improvements to the practice.
  • Review and address findings from clinical audits to identify any changes which can be implemented to improve patient population outcomes.

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

21 March 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Bruce Grove Primary Healthcare Centre on 24 July 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Bruce Grove Primary Healthcare Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 March 2018 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 24 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • A practice survey had been undertaken in November 2017 to gauge the views of patients which showed positive results. The practice carried out a follow up survey in March 2018 and are awaiting the results of this.

  • Poor QOF scores had been reviewed and systems put in place to achieve improvement. This included clinical audit and a new system for recalling patients for review.

  • The practice had reinstated the Patient Participation Group (PPG) and was working with the group to improve service to patients.

In addition the provider should:

  • Continue to look at ways to improve QOF scores and patient outcomes especially in relation to patients with diabetes.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

24 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bruce Grove Primary Healthcare Centre on 5 December 2016. The practice was rated requires improvement for providing safe, effective, caring and well led services. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Bruce Grove Primary Healthcare Centre on our website at www.cqc.org.uk.

This inspection was undertaken to follow up on outstanding breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and was an announced comprehensive inspection on 24 July 2017. Overall the practice is rated as requires improvement.

Our key findings were as follows:

  • The practice did not have an active patient participation group (PPG). However the practice was working towards establishing this through a number of practice open days to attract patients to talk about the practice.
  • Low scores received from the national patient survey were being addressed by the practice. However this was having little impact.
  • the practice had low scores for QOF. an action plan had been developed to improve these scores but it was having little impact on patient outcomes.
  • An infection control audit had been undertaken and an action plan had been developed to address the issues identified.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Data showed patient outcomes were low compared to the national average. The practice had produced an action plan to address this and to improve scores and patient outcomes.
  • We saw evidence that audits were driving improvements to patient outcomes.
  • Information about services was available in a way patients could access.
  • The practice had a number of policies and procedures to govern activities.
  • Patients said they were treated with compassion, dignity and respect.

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

The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The provider should:

  • Continue to look at ways to improve QOF scores and patient outcomes especially in relation to patients with diabetes.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

5 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bruce Grove Medial Centre on 5 December 2016. Overall the practice is rated as requires improvement.

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

  • An infection control audit had been undertaken but an action plan had not been developed to address the issues identified. There was no schedule for the cleaning of hand held clinical equipment such as spirometer, nebuliser and ear irrigator.
  • Child size pads were not available for the defibrillator and staff had not been trained in its use.
  • The practice did not have an active patient participation group (PPG).
  • Low scores received from the national patient survey had not been addressed by the practice.
  • Care plans were not produced for patients that were discharged from hospital.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • The practice had a number of policies and procedures to govern activity, however not all staff were aware of their existence, for example infection control and adult safeguarding policies.
  • Data showed patients outcomes were low compared to the national average. Although some audits has been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
  • Patients said they were treated with compassion, dignity and respect.
  • Information about services was available in a way patients could access.

The areas where the provider must make improvements are:

  • Produce an action plan to address the concerns identified in the infection control audit.
  • Ensure child size pads are made available for the defibrillator and that staff are trained in its use.
  • Undertake clinical audits and re-audits to improve patient outcomes.
  • Ensure all staff are aware of policies used to govern the practice.
  • Produce a schedule for the cleaning of hand held clinical equipment.
  • Produce a plan of how the practice intended to improve QOF figures.

In addition the provider should:

  • Review how the practice takes account of patient feedback including the implementation of a PPG.
  • Review and address the low scores from the national patient survey.
  • Implement care plans for patients that are discharged from hospital.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

17 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bruce Grove Primary Healthcare Centre on 17 November 2014. Overall the practice is rated as good.

Specifically, we found the practice as good for providing effective, caring, responsive and well-led services. It required improvement for providing a safe service. It also required improvement for providing services for the care of older people, those with long term conditions, working age people (including those recently retired and students), families, children and young people and those whose circumstances make them vulnerable. The practice was rated as good for providing services to people experiencing poor mental health (including people with dementia).

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Data showed patient outcomes were average for the locality. Some audits had been carried out, and there was some evidence that audits were driving improvement in performance to improve patient outcomes.
  • Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
  • Information about services and how to make a complaint was available and easy to understand.
  • Urgent appointments were usually available on the day they were requested. However patients said they sometimes had to wait a long time for non-urgent appointments.
  • The practice had a number of policies and procedures to govern activity. These were over five years old and had not been reviewed.
  • The practice had not proactively sought feedback from patients.

The areas where the provider must make improvements are:

  • Ensure all staff acting as chaperones have a Disclosure and Barring Service (DBS) check.
  • Ensure that all necessary emergency medicines as per current guidance are available.
  • Ensure portable appliance testing (PAT) is undertaken immediately and periodically;

In addition the provider should:

  • Ensure an infection control audit is undertaken to monitor cleaning standards;
  • Ensure Legionella testing or a risk assessment is undertaken;
  • Ensure availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have one on-site.
  • Ensure multidisciplinary meetings are carried out on a more formal basis and a written record is taken;
  • Develop care plans for patients on the older persons register;
  • Improve service availability for the working age population;
  • Provide a system of patient feedback including the formation of a patient participation group (PPG);
  • Update all policies and procedures as necessary.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice