Dr Hazem Lloyd Also known as Cedar House

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. (At the previous inspection undertaken in June 2016 the practice received a rating of Good overall, with a rating of requires improvement for being safe. A desktop review in October 2016 rated safe as Good.)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students) – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We carried out an announced comprehensive inspection at Dr Hazem Lloyd, Cedar House on 5 December 2017. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• Patients told us in the 46 returned comments cards that the GPs, reception and administration team were kind and caring. Patients said they could always get an appointment and believed they received good care and treatment.

• Recruitment checks were not undertaken for locum GPs that were used occasionally at the practice.

• Risk assessments for fire safety, infection control and Legionella were in place. General work place risk assessments were not adequate. General maintenance certificates such as a gas safety, electrical safety and portable appliance testing (PAT) were not available at the time of our inspection. However, the practice took action following our inspection visit and supplied copies of the gas maintenance certificate the week following the inspection, and confirmed PAT testing had been completed.

• The GP and nurses we spoke with knew how to identify and manage patients with severe infections. However, practice specific clinical pathways, procedures and protocols for care and treatment were not available, including one for responding to medical emergencies.

• The lack of defibrillator and protocol to follow in the event of a medical emergency potentially increased the risks to patients for not receiving safe effective care quickly.

• A system to routinely review the effectiveness and appropriateness of the care the practice provided was not well established for example a programme of clinical audit and re-audit and frailty assessments of older people were not in place.

• Nurses stated the GP was supportive. However, formal systems to support the nursing team were not established. For example, both nurses had not had an appraisal, did not attend staff meetings or clinical meetings, and a recorded process to audit decision making of the advanced nurse practitioner was not implemented.

• There was limited awareness of the accessible information standard; however, the practice confirmed they would implement this.

• A recorded strategy or business development plan to support the practice in meeting future challenges and priorities was not available. Governance arrangements to monitor and review the service provided were not supported by clear objectives and actions plans. This had resulted in gaps in service delivery and performance.

• The practice did not have systems in place to engage with patients. The practice had not undertaken any form of consultation with patients and did not have a patient participation or reference group. This compromised the practice’s ability to evaluate and improve the service it provided.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

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

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

Please refer to the requirement notice section at the end of the report for more detail.

The areas where the provider should make improvements are:

• The practice should keep copies of training certificates such as safeguarding for all staff including locum staff.

• The practice should establish a log to capture patients’ feedback, both positive and negative and use this feedback to support the governance of the practice.

• The practice should prioritise the security of the staff reception area and the consultation rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice