Archived: Dr Peter Ayegba

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