Wakering Medical Centre

Letter from the Chief Inspector of General Practice

On 10 March 2016, we carried out a comprehensive announced inspection. We rated the practice as inadequate overall. The practice was rated as inadequate for providing safe and well led services. It was found to require improvement in providing effective services and good in delivering caring and responsive services to their patients.

As a result of the inadequate rating overall the practice was placed into special measures for six months. Enforcement action was taken against the provider and they were required to make the following improvements;

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and medicine errors.
• Conduct risk assessments for health and safety, legionella and the control of substances hazardous to health.
• Conduct Disclosure and Barring Service checks for clinical staff and staff acting as chaperones or conduct a formal risk assessment to address this issue.
• Conduct safety testing on electrical appliances.
• Provide staff with appropriate practice specific policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Monitor the use of prescription pads.
• Ensure there is a robust method of measuring and recording fridge temperatures to maintain the cold chain for medicines.
• Proactively seek patient feedback.

We also told the provider that improvements were required in the following areas;

• Formalise the practice strategy to ensure all staff are aware of the vision and values of the practice.
• Ensure actions taken to address complaints are recorded
• Implement an induction program for new staff
• Ensure discussions at multi-disciplinary meetings are recorded.
• Encourage the identification of patients who are carers.

Practices placed into special measures receive another comprehensive inspection within six months of the publication of the report. The practice put an action plan in place to ensure the timely progression and resolution of the concerns highlighted.

On 2 November 2016 we conducted a further announced comprehensive inspection at Dr J Freel and Partners. We checked whether sufficient improvements had been made to take the practice out of special measures.

We found improvements had been made and the practice achieved an overall rating of Good. They had addressed all points raised in their earlier inspection. For example;

• The practice had revised their identification, management and sharing of learning from significant incidents. Their recording of them had increased significantly and staff told us they were confident in reporting them. Incidents were discussed and learning shared during meetings and the minutes distributed for those unable to attend.
• There were established systems and processes in place to keep patients and staff safe. The practice had conducted a comprehensive assessment of risks (including health and safety, legionella and control of substances hazardous to health). These were supported by an action plan where all issues had been addressed or were subject to an ongoing review.
• All staff undertaking chaperone responsibilities had received a Disclosure and Barring Service check and training to perform the role. Good practice was evident in the chaperones endorsement of the patient record.
• Electrical equipment had been tested. Medical equipment calibrated and fire safety assessments and equipment appropriately maintained.
• The practice had revised their policies and procedures to ensure they were service specific and reflective of current guidance and best practice.
• The practice had revised their management of medicines. Prescriptions were kept securely and their use monitored. All fridge temperatures were being actively and appropriately monitored.
• The practice sought, listened and responded to feedback from their staff and patients to improve the delivery of services.
• The practice had a formal five year plan for their service and included succession planning for clinical staff. All staff were aware of and shared their objectives to provide high quality care their patients.
• Verbal and written complaints were documented and appropriately responded to in a timely manner. Complaints were discussed with individuals and as a team and learning highlighted and disseminated. This was evident within the practice meeting minutes.
• An induction program had been designed and used for new locum GPs.
• Regular multi-disciplinary meetings and palliative care meetings were held. Patient care plans were reviewed and shared with the extended team of health and social care professionals for comment and actioning.
• The practice had improved their systems for identifying and supporting carers. They had 156 carers listed and provided them with a broad range of educational and information leaflets. Essex carers attended the service weekly to give confidential support, advice and guidance.

We also told the provider that improvements should be made in the following area;

• Improvements were required in the management of patients with poor mental health and patients with dementia receiving a face to face review.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr J Freel & Partners. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate Disclosure and Barring Services checks on staff had not been undertaken prior to their employment, risks associated with health and safety and legionella had not been identified and electrical equipment had not been safety tested.

• Policies were not practice specific and did not govern activity within the practice.

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• There were no practice specific standard operating procedures in place for the dispensary service offered by the practice. The practice was not signed up to the Dispensary Services Quality Scheme and medicine errors or near misses were not being reported or analysed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice had a staff structure, however not all staff were aware of lead roles.

• The practice had limited feedback with patients and the public; there was no patient participation group.
• There was little information available regarding how to complain. Complaints were dealt with in a timely manner but actions taken were not documented and there was no evidence that learning outcomes being shared with all staff.
• Staff worked together and with other health and social care services to understand and meet the range and complexity of patients’ needs and to assess and plan ongoing care and treatment. However meetings were not recorded in detail.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and medicine errors.

• Conduct risk assessments for health and safety, legionella and the control of substances hazardous to health.

• Conduct Disclosure and Barring Service checks for clinical staff and staff acting as chaperones or conduct a formal risk assessment to address this issue.

• Conduct safety testing on electrical appliances.

• Provide staff with appropriate practice specific policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Monitor the use of prescription pads.

• Ensure there is a robust method of measuring and recording fridge temperatures to maintain the cold chain for medicines.

• Proactively seek patient feedback.

The areas where the provider should make improvement are:

• Formalise the practice strategy to ensure all staff are aware of the vision and values of the practice.
• Ensure actions taken to address complaints are recorded
• Implement an induction program for new staff
• Ensure discussions at multi-disciplinary meetings are recorded.
• Encourage the identification of patients who are 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