Dr B. Bekas

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At the previous inspection in September 2023, we rated effective as inadequate because: patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidelines. There was not an effective system in place to demonstrate that persons providing care or treatment to patients had the competence skills, qualifications and experience to do so safely, there was not an effective programme of audits in place. There was no evidence that staff had received clinical supervision to be assured that were competent to carry out their roles, there was no system in place to ensure that all patients who required an annual health check were offered one and there was a backlog of patients who had not been reviewed in the previous 12 months. The uptake for childhood immunisations was below the World Health Organisation (WHO) targets and the uptake for the 3 cancer indicators was below the local and national averages. At this inspection we found that these areas had not been adequately improved.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The percentage of respondents to the GP patient survey 2024 who stated that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment was 82% compared to a national average of 91%.

There were referral pathways in place to make sure that patients’ needs were addressed, however these needed strengthening to ensure they were routinely followed. We were unable to gain assurances that processes were effective for all patients registered with the practice. Staff we spoke to were aware of the workflow, however we found limited evidence to demonstrate how the practice provided further education and support to patients. Staff told us that the GP was not always available on the day of a patient’s appointment to authorise prescriptions which often led to delays in patients receiving their prescription and therefore the medicines they needed.

We found there was a lack of systems and processes in place to ensure the effective care and treatment of patients. We found there were backlogs in monitoring patients with long term conditions and carrying out learning disability and mental health reviews. During the remote clinical reviews, we found medicines management did not always reflect current and relevant best practice and patients care needs were not always reviewed.

Patients did not always receive the required reviews for their care and treatment within the required timeframes.

Leaders told us they had systems in place to ensure patients received care and treatment in line with guidance. However, we found that systems did not always ensure effective monitoring of patients care and treatment.

We found people with long-term conditions were not always offered a structured annual review to check their health and medicines needs were being met. The remote clinical searches that we undertook of the practice’s clinical records system showed the monitoring of people with some long-term conditions was not always in line with National Institute for Health and Care Excellence (NICE) recommendations. A search on potential missed diagnoses of diabetes identified 3 patients. We reviewed all 3 patients and 1 of these patients was confirmed as having a missed diagnosis, which could mean that the patient was not receiving the treatment they required. We found that patients with a long-term condition were not always monitored or followed up within an appropriate timescale or reviews did not always demonstrate best practice guidelines. For example, our clinical searches found there were 5 patients who had been prescribed 2 or more courses of rescue steroids for asthma in the previous 12 months and we reviewed 3 of these patients. Of these, all three were overdue an annual asthma review. We found there were 6 patients with hypothyroidism who had not had a thyroid function test in the last 18 months. We reviewed 2 of these patients and found that 1 patient had a recent medication review, and this test was not included as an action. This test is necessary to ensure patients are receiving the correct medicine dosage for their condition.

Leaders told us they regularly attended the monthly primary care network (PCN) meetings. We were provided with evidence of 5 PCN meetings that had taken place between October 2023 and April 2024 and the practice was only represented at 3 of these meetings. PCNs are groups of GP practices that work together, and with other health and care providers, to deliver a wider range of services to the local population than might be possible within an individual practice. Attending PCN meetings enables the member practices to keep up to date with opportunities, concerns and other developments in their local area. We found on speaking to a range of staff that there was a clear lack of communication within the practice with staff not always having the opportunity to approach leaders to discuss people's care and treatment in a timely way. We were told that information was usually cascaded via email.

There was no evidence of the practice attending safeguarding or palliative care meetings.

There were some processes in place for working with agencies to manage care. For example, PCN meetings were regularly held, although not always attended by staff from the practice. There was time allocated for shared team learning on a monthly basis and we saw information relating to 4 of these meetings from December 2023 to June 2024. For 2 of these meetings, there was no evidence of who had attended and for 1 of them 4 staff attended, but the GP was not present. Whilst the meetings included discussions on operational issues, there was no evidence of sharing best practice, any training or national guidance. Systems were in place to share information about patients electronically with other services, however we found a limited approach to collaborating and coordinating patient care internally within the practice.

Due to difficulties in the consistency of systems and processes we found some delays in carrying out annual reviews for patients. We were not fully assured that the practice was identifying patients who may need extra care or support and directing them to relevant services. This included patients at risk of developing a long-term condition, carers and those with a learning disability. We were therefore not assured that patients had access to appropriate health assessments and checks.

We were told by staff that there was no overall lead in managing patient recalls and this was managed between clinical and non-clinical staff.

Patients’ record systems did not always alert clinicians about patients who required ongoing monitoring. The recall system needed strengthening to ensure all people with complex health needs and long-term conditions were regularly reviewed and received support to manage their health needs. We found a lack of clinical oversight to ensure systems were effective to enable patients to be monitored and supported to live healthier lives where possible. The practice had recently developed a website which outlined information and links for health promotion, health conditions and common health questions.

Although leadersreported difficulties with their patient population demographic, there was no plan in place to address this.

Staff we spoke with told us that they had competing priorities for their time at work and were not always able to implement systems to identify and manage patients who required monitoring.

We found inconsistent approaches to monitoring people’s care and treatment and found during the remote clinical reviews that not all patients had received an annual review and were not being appropriately monitored to ensure their high-risk medicines and long-term conditions were regularly reviewed. For example, we found patients were identified who had a potential missed diagnosis of diabetes. Patients with hypothyroidism did not routinely have regular thyroid function tests. Patients with asthma who had been prescribed 2 or more doses of steroid medication in 12 months were not issued with steroid warning cards. During this assessment the practice agreed to review those patients who required both urgent and non-urgent action. We found that processes required action as there was a lack of systems to recall and monitor patients with long term conditions and those who were prescribed high risk medicines and required regular monitoring. We found no evidence to demonstrate that the practice had a programme of targeted quality improvement and monitoring and used information about care and treatment to make improvements. We found the practice systems were not sufficient to ensure that those patients requiring medicine reviews and ongoing monitoring were actively being reviewed and recalled. There were limited systems in place to identify and manage patients who required monitoring. Our clinical searches showed systems were ineffective to ensure patients were safely monitored.

The overall trend for child immunisation was below 90% for all 5 indicators and cervical screening uptake was significantly below the 80% target and this had been a trend since 2016.

The practice had not made any do not attempt cardiopulmonary resuscitation (DNACPR) decisions.

Staff we spoke with told us that they routinely recorded consent to care and treatment, including implied consent.

Staff were able to tell us the process they followed when obtaining consent. For example, when carrying out certain types of physical examinations.