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Archived: Dr Peter Ayegba Good

The provider of this service changed - see old profile

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Inspection Summary


Overall summary & rating

Good

Updated 2 December 2016

GOOD

We had previously inspected Dr Ayegba in January 2016 and had found serious concerns. As a result the practice was rated as inadequate and placed into special measures. The inspection report was published in March 2016. Specifically, we found the practice inadequate for providing safe, effective, caring, responsive and well led services. Following the inspection the practice sent us an action plan of how they were going to address these issues. We carried out an announced comprehensive inspection at the practice on 17th August 2016. This was to review two warning notices served for Regulation 12 and Regulation 17 and to consider whether sufficient improvements had been made by the provider, and whether the concerns we had at the previous inspection had been addressed. The practice had made significant improvements. We have rated the practice as good for providing safe, effective, caring responsive and requires improvement for well led services. Overall the practice is rated as good.

Our key findings were:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • An improved recruitment process had been implemented since our last inspection and this had been followed when recruiting new staff.

  • Staff training needs had been addressed so that staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their treatment. Patients were positive about their interactions with staff.

  • 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.
  • Patients said there had been improvements at the practice and it was easier to make an appointment, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make further improvements are:

  • Review recent improvements and consider how the practice can ensure the sustainability of improvements made and have effective succession planning in place.

  • Update training records for all staff.

  • Revise the documentation and storage in relation to PGDs and PSDs

  • Review the need to document decisions made in discussions with multi-disciplinary teams.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received support and a written apology.

  • The practice had improved systems in place to keep patients safe and safeguarded from abuse.

  • Infection control procedures were well managed.

  • Medicines management was well organised. There were improved processes in place with continued working with the local CCG medicines management team.

  • Patient Group Direction (PGD) and Patient Specific Direction (PSD) documentation needed reviewing.

Effective

Good

Updated 2 December 2016

The practice is rated as good for providing safe services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement. We looked at a range of audits the practice had completed since our last inspection, two of which were completed audits.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment and training was improved with on-going training being developed and organised for new staff.

  • There was evidence of appraisals for most staff.

  • Staff worked well with multi-disciplinary teams including health visitors and other relevant organisations such as the local CCG medicines management team.

Caring

Good

Updated 2 December 2016

The practice is rated as good for providing caring services.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Results from The National GP Patient Survey for 2015 and 2016 and showed improvements for overall patients’ experience of the practice and consultations with GPs, and nurses.

  • Information for patients about services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and confidentiality.

  • Nearly 2.5% (98) of patients from the practice list had been identified as carers.

Responsive

Good

Updated 2 December 2016

The practice is rated as good for providing responsive services

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients and from Patient Participation Group (PPG).
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Most patients said they had found improvements in how easy it was to make an appointment, with urgent appointments available the same day.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised.

Well-led

Requires improvement

Updated 2 December 2016

The practice is rated as requires improvement for being well-led.

  • There was a leadership structure and most staff felt supported by the management team. The practice had to manage staffing through locums and agencies but hoped to be fully staffed within the next few months.

  • The practice had a number of policies and procedures to govern activity and held regular structured team meetings with all staff.

  • The provider was aware of and complied with the requirements of the duty of candour. The provider encouraged a culture of openness and honesty.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group worked with the practice to develop the service to patients.

  • There was a focus on continuous learning and improvement at all levels with further developments for training for all newly recruited staff.

  • Although we could see the practice had made numerous improvements. We were still not fully assured that the level of improvement could continue to be sustained. In particular we were concerned about the sustainability of the practice and the continuing capacity for management support.

Checks on specific services

People with long term conditions

Good

Updated 2 December 2016

  • Staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The practice had access for referrals to the smoking cessation service and to a consultant for COPD clinics which were delivered to patients from the practice building. ECGs and spirometry tests could be delivered to patients at the practice premises.

  • The practice offered an anti-coagulation service on site.

  • Indicators for the care of diabetic patients were in line with local and national averages. 100% of patients with diabetes, on the register, had received an influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) compared with the CCG average of 95% and the national average of 94%.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 2 December 2016

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

  • The percentage of women aged 25-65 whose notes record that a cervical screening test has been performed in the last five years, was 85% which was higher than the local clinical commissioning group (CCG) average of 80% and the national average of 81%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Priority appointments were made available for children.

  • The practice held immunisation clinics, post natal baby checks and ante natal clinics with a midwife, and eight week child development clinics.

  • We saw positive examples of joint working with health visitors.

Older people

Good

Updated 2 December 2016

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice had two designated staff who acted as direct contacts for carers, who liaised with the patients named GP, and who could interupt the named GP between consultations when circumstances required this.

  • The practice promoted screening such as bowel screening and had worked on increasing the uptake of screening with patients who initially do not take part in these public health initiatives .

  • The practice offers joint injections to help reduce the waiting times for secondary care and to offer a convenient service to their patients.

Working age people (including those recently retired and students)

Good

Updated 2 December 2016

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice offered extended opening hours each Wednesday evening up to 8.30pm. Patients were offered telephone consultations when appropriate, rather than patients having to visit the practice.

  • Health checks were offered to patients who were over 40 years of age to promote patient well-being and address any health concerns.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 December 2016

  • 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.

  • The practice worked closely with the local, ‘Improving Access to Psychological Therapies’ (IAPT) service to offer self-referrals for patients.

  • The lead GP is the clinical lead for mental health for Knowsley CCG and promotes up to date standards of care for patients with dementia.

  • The practice gave guidance and support to patients experiencing poor mental health, and information on how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 2 December 2016

  • The practice held a register of patients who had special needs such as patients with learning disabilities, palliative care patients, and patients who were carers.

  • The practice offered longer appointments and annual health checks for patients with a learning disability.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

  • The practice had a number of patients from different backgrounds who could also be vulnerable, for example, refugees or economic migrants. Staff used translation services to help communicate with these patients and usually booked double appointments to accommodate the use of interpreters.