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Drs Masterton, Thomson, Bolade & Otuguor Good Also known as Dr Masterton & Partners

Reports


Inspection carried out on 22 May 2019

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

We carried out an announced comprehensive inspection on 22 May 2019 as part of our inspection programme. We had previously carried out announced comprehensive inspections on 26 July 2016 and 15 March 2018. At the time of the inspection of 15 March 2018 the service was rated as good. It was rated as requires improvement for the well led domain and good in all other areas.

The areas where we said that the provider must make improvement were:

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

At the inspection on 2 May 2019 we found that these areas had been addressed by the practice which is now rated as good in all areas.

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 good overall and good for the well led key question.

We found that:

  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

Review carried out on 21 May 2019

During an annual regulatory review

We reviewed the information available to us about Drs Masterton, Thomson, Bolade & Otuguor on 21 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 15 March 2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection December 2016 – Requires improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Requires improvement

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

We carried out an announced comprehensive inspection at Drs Masterton, Thomson, Bolade & Otuguor on 15 March 2018, because we had previously identified areas where the practice was failing to meet the legal requirements in delivering care.

This was the practice’s third inspection. We first inspected on 26 July 2016 when we found significant concerns relating to safe recruitment of staff, management of medicines, arrangements for emergencies, infection control, managing test results, learning from significant events, staffing levels and support for staff (including induction, training and appraisal) and overall governance, including maintenance of appropriate policies. We rated the practice as inadequate.

Before the report of the July 2016 was published, we carried out a focused inspection on 1 December 2016, because of the delay in producing a finalised report and the safety concerns identified. Despite not having had a copy of the report from the previous inspection, we found that the practice had made substantial improvements, fully addressing most concerns and with actions underway to address those that remained. There remained some issues with how medicines were managed, with infection control, training and appraisal. We therefore rated the practice as requires improvement.

More details of the findings of the previous inspections are given under the key questions, below. You can read the report from the previous inspections by selecting the ‘all reports’ link for Drs Masterton, Thomson, Bolade & Otuguor on our website at www.cqc.org.uk.

At this inspection we found:

  • In general, the practice had maintained the improvements made previously. Although there were issues in some of the same areas, these were not the same as previously identified (so the issues did not reflect a failure to act by the practice).
  • There were systems to assess, monitor and manage risks to patient safety, although there were aspects that needed to be strengthened, particularly related to documentation of recruitment checks.
  • There was an effective system for staff training and appraisal, but the practice policy did not include all of the training recommended by national guidance.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes, although formal documentation sometimes followed later.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Measures of the effectiveness of care showed the practice was performing in line with local and national averages (although not always up to the national target). Exception rates (patients excluded from performance data) for chronic obstructive pulmonary disease were above average, but this appeared to be linked to the practice’s older population.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients told us that they found the appointment system easy to use and reported that they were usually able to access care when they needed it, although some patients reported that it could be difficult to get appointments with particular GPs and sometimes with a female GP. Patients reported that they sometimes had to wait too long after their appointment time.
  • There was continuous learning and improvement at all levels of the organisation. This had after the first inspection focused on patient safety, but was extending to other aspects of the practice’s care and services.

The areas where the provider must make improvements:

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

(Please go to the requirement notice section at the end of the report for more detail.)

The areas where the provider should make improvements are:

  • Review the causes of long waiting times and the below 80% cervical screening rate and consider actions.
  • Consider if there are ways to improve accessibility to consulting rooms for patients with impaired mobility, and ways to support patients’ understanding, for example by using easy read materials.
  • Review staff training in consent, including the mental capacity act.
  • Continue to monitor high exception rates for chronic obstructive pulmonary disease to ensure exceptions remain clinically appropriate.
  • Review whether there is sufficient access to female GP appointments and nurse appointments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 1 December 2016

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Masterton, Thomson, Bolade & Otuguor on 26 July 2016. During the inspection we identified breaches of regulation 12 (Safe Care and Treatment), regulation 17 (Good governance) and regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches resulted in the practice being rated as inadequate for being safe, effective and well-led and good for being caring and responsive. Consequently the practice was rated as inadequate overall.

The specific concerns identified were:

  • There was not always evidence of learning from significant events and not all staff were involved in significant event discussion.

  • Satisfactory recruitment checks had not been undertaken for all staff prior to employment.

  • The practice’s supply of oxygen had expired.

  • Systems and processes did not operate effectively to ensure that patients were safeguarded from abuse.

  • Infection control risks were not adequately assessed or addressed.

  • Medicines were not always managed safely in that high risk medicines were not always monitored appropriately, two of the practice’s Patient Group Directions had expired, emergency medicines and prescriptions were not stored securely and vaccines were not being monitored appropriately.

  • The practice had not complied with the recommendations in their last fire risk assessment.

  • Partners in the practice had failed to ensure that effective systems were in place for the management of test results and to ensure a failsafe system for referrals for urgent tests and assessments.

  • Some practice policies were incorrectly dated, did not contain all requisite information, were not regularly reviewed and were not easily accessible to staff.

  • There was no system to ensure all staff were regularly appraised.

  • Training had not been completed by all staff.

  • There were insufficient numbers of clinical staff.

The practice provided the Care Quality Commission (CQC) with an action plan within 48 hours of the inspection which detailed the action the practice intended to rectify some of the concerns identified on the day of the inspection.

Due to delay on the part of CQC in producing a finalised report from the inspection undertaken on 26 July 2016 and the significant patient safety concerns identified, we undertook a focused inspection of the practice in order to ascertain whether or not the provider had taken the necessary action to address the concerns raised. The current overall rating for this practice is an aggregation of the ratings for caring and responsive in the report from the inspection undertaken on 26 July 2016 and the rating for safe, effective and well led in this inspection report which focused on these key questions. You can read the report from the first comprehensive inspection by selecting the ‘all reports’ link for Drs Masterton, Thomson, Bolade & Otuguor on our website at www.cqc.org.uk.

Had CQC found that the practice were still inadequate for any key question during this inspection the service would have been placed in special measures for a period of six months after which time a further inspection would have been undertaken to see if sufficient improvement had been made.

An announced focused inspection was undertaken on 1 December 2016. This report focuses on the action that the practice has taken to address the concerns identified during our initial inspection.

Overall the practice is rated as requires improvement. Specifically, following the focussed inspection we found the practice to be requires improvement for providing safe, effective and well led services. This recognises the significant improvements made to the quality of care provided by this service. Our key findings across all the areas we inspected were as follows:

  • There was an effective system in place for reporting and recording significant events and lessons were shared to make sure action was taken to improve safety in the practice.

  • The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse although most staff had yet to receive child and adult safeguarding training.

  • The practice had undertaken appropriate recruitment checks for newly appointed staff but had yet to receive a Disclosure and Barring Service check for the practice healthcare assistant.

  • The practice had introduced effective systems to manage results from secondary care and there was evidence of regular multidisciplinary meetings.

  • The practice had not implemented the recommendations from their fire risk assessment and there was no effective lead for infection control. All other infection control concerns had been addressed.

  • There were sufficient numbers of staff to meet patient need.

  • Concerns around high risk drug monitoring had been addressed. However, the practice healthcare assistant was administering medicines in line with Patient Group Directions and not Patient Specific Directions or prescriptions in accordance with current legislation.

  • The practice had effective systems in place to deal with emergencies.

  • Most staff had still not been appraised within the last 12 months.

  • Policies had been updated, contained all necessary information and were accessible to all staff.

The areas where the provider must make improvement are:

  • Ensure that medicines administered by a healthcare assistant are done so in accordance with a valid Patient Specific Direction.

  • Ensure that the practice has an infection control lead that is adequately trained for the role and that all staff are aware of this person.

  • Ensure all staff have completed all necessary training in accordance with current legislation.

  • Ensure that all staff are regularly appraised.

The areas where the provider should make improvement are:

  • Review the high exception rates for those with atrial fibrillation and chronic obstructive pulmonary disease to ensure that all exemptions are appropriate.

  • Continue efforts to ensure that staff feel valued.

The findings of this report should be read in conjunction with the findings detailed in the report from our initial inspection conducted on 26 July 2016

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on To Be Confirmed

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Masterton, Thomson, Bolade & Otuguor on 26 July 2016. Overall the practice is rated as inadequate.

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

  • Risks to patients associated with recruitment of staff, management of medicines and emergencies and infection control were not always assessed and well managed.

  • Safeguarding processes and procedures were not sufficiently robust to ensure that patients were kept safe from harm.

  • The processes in place for receiving, reviewing and taking action in response to test results from secondary care organisations did not keep patients safe.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, investigations were not always thorough enough and it was not always clear what action had been taken in response to significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the clinical knowledge and skill to deliver effective care and treatment, though essential training had not been completed by all staff.
  • We were told that clinical staff were working excessive hours and that the practice found it difficult to recruit additional staff due to financial pressures.
  • 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. However, patients were sometimes given insufficient information about what had caused the incident which resulted in the complaint.
  • Some patients said they sometimes found it difficult to make advanced appointments with a named GP but they were satisfied with the level of continuity of care and urgent appointments were available the same day if needed.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure in place but more needed to be done to ensure that staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

  • Establish effective systems and processes which significant event process and ensuring that all relevant staff are involved in discussions regarding significant events, that all investigations are thorough and appropriate action is taken to prevent similar incidents from happening in the future and ensuring that there are effective systems in place to keep patients safeguarded from abuse.

  • Ensure that care and treatment are provided in a safe way by ensuring that medicines are managed safely and properly, that staff recruitment processes are adequate, infection control risks are assessed and mitigated, that equipment is safe to use and that the practice has equipment and systems in place to respond to emergencies and that risks associated with these are regularly reviewed and acted upon.

  • Maintain securely such records necessary to be kept in relation to the management of the regulated activity including policies that are complete, reviewed periodically and are easily accessible to staff.

  • Ensure that staffing levels are sufficient to ensure safe and effective care and treatment.

  • Put systems in place to ensure all staff receive regular appraisals and appropriate training in accordance with current legislation and guidance.

The areas where the provider should make improvement are:

  • Monitor the high exception rates for those with chronic kidney disease and cancer to ensure that all exemptions are appropriate.

  • Review induction processes for locum staff to ensure they have all necessary information.

  • Continue to work on improving and documenting multidisciplinary working and clinical meetings.

  • Ensure that all staff are aware of current legislation and guidance for assessing capacity and obtaining consent from children and young people.

  • Continue work to ensure that staff feel valued and supported.

  • Consider how best to address the action points detailed in any risk assessment.

  • Ensure complaints policy and responses comply with current legislative requirements.

Due to delay on the part of CQC in producing a finalised report from this inspection and the significant patient safety concerns identified, we undertook a second focused inspection of the practice on 1 December 2016 in order to ascertain whether or not the provider had taken the necessary action to address the concerns raised. The current overall rating for this practice is an aggregation of the ratings for caring and responsive in this report and the rating for safe, effective and well led in our second inspection report which focused on these key questions. You can read the report from the subsequent comprehensive inspection by selecting the ‘all reports’ link for Drs Masterton, Thomson, Bolade & Otuguor on our website at www.cqc.org.uk.

Had CQC found that the practice were still inadequate for any key question during our inspection on 1 December 2016 the service would have been placed in special measures for a period of six months after which time a further inspection would have been undertaken to see if sufficient improvement had been made.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 14, 15 January 2014

During a routine inspection

We spoke with eleven patients. The majority of patients told us they felt their GP was thorough in their approach, they considered their symptoms and spent time listening to their concerns and explaining to them about any treatment needed.

One patient told us "I feel the doctors are responsive, I feel safe and confident about this practice".

Patients were involved in making decisions about their care. If they needed to be referred to a specialist service this was explained and they were able to express a preference of where they were referred to.

The practice had four GPs, all have worked at the practice for ten years or more. People told us they liked the continuity and consistency of the service. The practice did not employ locums.

The practice had an effectively organised system to regularly assess and monitor the quality of service that patients received. Patients we spoke with told us they were happy with the service they received.

We found that waiting times for patients could be longer than thirty minutes. A patient told us “Sometimes appointments over run but I feel this is due to the dedication of the doctor, I would prefer the thoroughness of my GP even if I have to wait a little longer for my appointment."