The Care Quality Commission
  • Doctor
  • GP practice

Archived: The Practice Loxford

Overall: Inadequate read more about inspection ratings

417 Ilford Lane, Ilford, Essex, IG1 2SN (020) 8822 3800

Provided and run by:
The Practice Surgeries Limited

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

All Inspections

6 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Practice Loxford on 6 November 2015. Overall the practice is rated as inadequate.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. But local clinical staff did not have regular meetings to learn from incidents and other safety information.

  • The practice did not have systems in place to manage some key risks, for example in relation to repeat prescribing.

  • Patients’ clinical needs were assessed and care was planned in line with national guidance. The practice had prioritised long-term care for improvement and had introduced condition-specific clinics, for example for diabetic care to improve patient outcomes.

  • Patients we spoke with described doctors, nurses and reception staff as caring. However, the practice scored consistently below average in the 2015 national GP patient satisfaction survey for questions on care and patient involvement.

  • The practice provided information about its services in the form of a practice leaflet and a website. Information about how to complain was available at the practice. The practice employed a complaints officer who met with patients as soon as they raised a concern and the practice had seen a reduction in complaints.

  • Appointment systems were not working well. We spoke with patients who said they were queueing before 8.00am in the morning to make an appointment because of difficulty getting through on the telephone.

  • The practice had suitable treatment facilities but some of the shared facilities such as the furniture and television screens in reception were damaged or not working and had been in this condition for months. The practice had raised issues with the relevant agencies but the problems had not been addressed.

  • Staff told us they had access to the training they needed to develop in their role. Appraisals for non-clinical staff had recently been reintroduced.

  • The practice had not addressed longstanding issues with quality and safety. The practice had not acted on some of the failures identified at our previous inspection of April 2014 and had not complied with a warning notice issued at that time.

The areas where the provider must make improvements are:

  • The practice must ensure that facilities, including shared facilities used by their patients, are safe and take immediate action when a safety risk has been identified.

  • Fire marshals must receive appropriate training. The practice must have sight of all relevant health and safety risk assessments and obtain assurance that any recommendations have been carried out by the responsible agency.

  • The practice must ensure that repeat prescriptions are processed in line with its repeat prescribing policy and patients receive medicines on time.

  • The practice must make sure the service is accessible to registered patients. The telephone appointment system must be fit for purpose.

  • Local management arrangements must be sufficiently robust to ensure that safety and quality concerns are addressed without undue delay.

In addition the provider should:

  • Provide regular opportunities for clinical staff to meet to discuss and review their practice, including significant events, safeguarding cases, learning and improvement.
  • Review and monitor clinical staffing, skill mix and systems for routing patients to the most appropriate clinician to ensure that patient needs are being met in a safe and timely way.
  • Carry out staff appraisals annually and provide structured opportunities for staff to review their performance with their manager.
  • Explore ways of improving the patient experience. The practice was consistently scoring below average on indicators of compassionate care as measured by the 2015 national GP patient survey.
  • Increase the information and support available for carers.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

13 March 2014

During an inspection looking at part of the service

Since the last inspections measures had been put in place to protect people's privacy. People we spoke with did not express any concerns about their privacy at the reception counter. The provider did not take care to ensure the care and treatment provided had due regard to people's cultural and linguistic background.

Improvements had been made in the planning of people's care and treatment. One nurse said "the process (for checking emergency medicines and equipment) is now more structured." Responsibility for monitoring the various conditions such as asthma, coronary heart disease and diabetes had been shared out between the clinicians. The provider should note that reviews should be recorded in people's records to ensure effective communication between all of those providing care and to ensure people receive continuity of care.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received, nor did it have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

13, 18 November 2013

During a routine inspection

People who use the service did not always have their privacy respected. People who arrived at the surgery had to go to one of three receptionists who were situated next to each other at a single front counter. The front counter did not have any separating screens at the sides and people could be easily overheard by other patients. One patient told us, 'it's not very private, everyone can hear what you are saying'. The internet booking system had not been available since the beginning of 2013. Patients have to wait for too long to get through to the surgery by telephone. If patients wanted to see a GP they would have to queue up from 7.30am onwards as the Walk In centre was not open to the surgery's patients.

Care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. We found that people with chronic illnesses such as diabetes and asthma were not always being regularly reviewed to support them with managing their conditions.

There were inadequate arrangements in place to deal with foreseeable emergencies. Emergency drugs had not been checked properly with some of them being out of date. Emergency Oxygen equipment had not been checked daily. This did not ensure the health and safety of people would be protected in the event of an emergency.

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.

Appropriate checks were undertaken before staff began work. We found evidence that the practice had checked the professional registrations of the GPs and practice nurses against the professional registers and the performers list. There were effective recruitment and selection processes in place.

People who used the service, their representatives and staff were not asked for their views about their care and treatment so they could be acted on. We were advised that the Patient Reference Group (PRG) had formally raised a number of serious concerns with the practice at the start of 2013 but the practice were unable to find this letter during our inspection.

There was a lack of clarity about who was accountable for what. For example the manager was unclear about the chain of responsibility for the checking of emergency drugs. We found that some nurses checked and recorded the vaccine stock in the fridges in their rooms and some did not.

The provider did not take account of complaints and comments to improve the service. Staff told us they received a large volume of formal and informal complaints about the fact that people had to queue before the surgery opened to get an appointment or how long it took to get through on the phone. The practice did not have a plan in place to address these concerns.