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Archived: Dr Peter Ayegba Good

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Inspection carried out on 17 August 2016

During a routine inspection


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 carried out on 6th January 2016

During a routine inspection

We carried out an announced comprehensive inspection at Dr Peter Ayegba’s practice on the 6th January 2016. Overall the practice is rated as inadequate.

Our key findings were as follows:

  • There was a lack of clarity around the leadership structure with limited formal governance arrangements being in place. There was low staff morale amongst different staff groups within the practice.

  • Patients did not always receive their medication in a timely manner, and sometimes errors had been made with prescriptions.

  • Some staff files lacked evidence of necessary checks required to show safe recruitment and selection procedures.

  • There was a lack of safeguarding arrangements in place to protect vulnerable adults and children.

  • Staff understood their responsibilities to raise concerns, and to report incidents. However, incidents lacked evidence that they had been reviewed and shared with all of the practice staff.
  • Staff had not been supported in accessing training to meet their needs.
  • The review of patients’ hospital letters and results were subject to significant delays resulting in patient records not always being up to date.
  • There had been repeated concerns and opinions from patients regarding the service they received from reception staff, including problems accessing appointments, access to the practice by phone and problems with prescriptions for medications. There was no evidence of any feedback to patients regarding what actions were taken to improve patient satisfaction in these areas.
  • There were low numbers of recorded complaints and staff had not documented verbal complaints.
  • The practice had a number of policies and procedures to govern activity, however some were overdue a review and needed further work to ensure they were appropriate for the practice and that staff fully understood the practice policies.
  • The practice was clean and tidy.

There were areas of practice where the provider must make improvements. The provider must;

  • Develop appropriate procedures for recording, acting on and monitoring significant events, incidents and near misses.

  • All patient complaints must be recorded, investigated and responded to in accordance with the practice complaints policy. Findings should be communicated to patients and an apology offered when required. The practice should ensure that learning from complaints is shared with staff and any changes to working practices as a result of learning are implemented.

  • Take action to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held securely and can be produced when required. All policies in relation to recruitment must be updated to reflect current legislation.

  • Develop appropriate procedures for the safe management of medications and storage of prescriptions. Ensure all staff are competent in management of medicines and that they adhere to appropriate policies.

  • Ensure suitable arrangements are in place to safeguard vulnerable adults and children from abuse.

  • Implement appropriate processes to ensure the timely review of all patient hospital letters, correspondence and ensure patient’s records are accurate and up to date.

  • Review the appointment system and staffing levels to ensure there are sufficient numbers of patient appointments to meet the demands of the local population. Improve processes, and procedures for making appointments. Take steps to address the problems identified at inspection with telephone access to the practice.

  • Ensure staff undertake training to meet their needs, including induction when started in their role, training in fire safety, health and safety, managing prescriptions and infection control. Review training records to ensure that all staff have evidence of development with training relevant to their role.

  • Clarify the leadership structure and ensure there is leadership capacity at all times to deliver all improvements. Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. Undertake a programme of quality improvement activity so as to drive improvements in patient outcomes.

  • To test the practices business continuity plan to ensure its effectiveness and that it meets the needs of the practice and is prepared for emergency situations.

There were areas of practice where the provider should make improvements:

  • To develop an action plan in response to low patient satisfaction in regard to access to the practice via the phone system, accessing appointments, prescriptions for medications and the attitudes of reception staff.

  • For staff to have training in the Mental Capacity Act 2005 and Deprivation of Liberty.

  • Staff should record regular minutes of meetings with district nurses to discuss the needs of their palliative care patients.

  • 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 such that there remains a rating of inadequate 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 by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 20 November 2013

During a routine inspection

Patients we spoke with told us that staff had been friendly and helpful. Comments included, "Everything is fine I get on well with the doctor.� Another person said, "They talk everything through with me."

Some patients told us that it was sometimes hard to get an appointment at the practice, especially if they needed a specific appointment time slot.

The practice had up to date child and adult protection policies and procedures in place. This information included contact details for staff to raise concerns with the appropriate agencies.

We saw records were kept of adverse events, accidents or incidents including actions taken. The practice completed audits/reports following significant events or receiving complaints, in order to learn and make improvements as required.