We carried out an announced comprehensive inspection at Dr Hendrik Johan Beerstecher on 8 March 2016. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
- Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, significant event investigation and patient communication was not always completed in a timely manner.
- Governance arrangements were not robust or always effectively implemented.The practice had a number of policies and procedures to govern activity, but there was a lack of consistency in governance, for example, some policies required review and others did not contain sufficient detail.
- There was an inconsistent approach to national and local clinical guidance.
- Risks to patients were not always well assessed and well managed, for example, contingency planning in the event of an emergency or major incident or continuity planning in the event of unplanned absence of key members of staff.
- The arrangements for managing medicines in the practice did not always keep patients safe. For example, the practice nurse was administering medicines, such as vaccines, without Patient Group Directions and the use of blank prescriptions were not being monitored.
- The practice was unable to respond to a medical emergency in line with national guidance.
- The practice did not always assess needs and deliver care in line with relevant and current evidence based guidance and standards.
- Data showed patient outcomes were low compared to the local and national averages.
- There was evidence of audit activity, but this had not significantly improved performance or patient outcomes.
- Not all staff were up to date with mandatory training.
- The practice did not have a system to follow up patients recently discharged from hospital.
- Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
- Some childhood immunisation rates were lower than the local clinical commissioning group averages.
- Patients were offered health checks. However, newly registered patients did not routinely attend for health checks as part of their new patient assessments.
- Data from the National GP Patient survey was consistently better than local and national averages.
- Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care.
- Practice staff had good local knowledge about their local patient population but did not actively engage with the NHS England Area Team and the local clinical commissioning group in order to secure improvements to services.
- Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
- Information was available to help patients understand the complaints system. However, this did not contain details of who to contact in order to raise a complaint and the practice was unable to demonstrate that all complaints, including verbal complaints, were investigated and replied to in a timely manner.
- There was a structure of leadership and staff felt supported by management. However, there was a lack of clarity around responsibility and accountability between the GP and the practice manager who was also the practice nurse.
The areas where the provider must make improvements are:
- Investigate safety incidents and complaints thoroughly and ensure that people affected receive reasonable support and a verbal and written apology in a timely way.
- Revise risk assessment and management activities to ensure they include all risks to patients, staff and visitors.
- Ensure the practice follows national guidance on infection prevention and control.
- Revise medicines management to help ensure the practice is complying with relevant legislation and monitoring the use of blank prescriptions.
- Ensure the practice is able to respond to a medical emergency in line with national guidance.
- Ensure all staff have the necessary employment checks including a current Disclosure and Barring Service check in order to undertake roles such as chaperoning.
- Ensure that patients’ needs are assessed and care delivered in line with relevant and current evidence based guidance and standards.
- Implement a system for personalised care plans for vulnerable patients.
- Ensure that all staff are up to date with attending mandatory training courses.
- Ensure that patients discharged from hospital are followed up in a timely manner.
- Revise governance arrangements and ensure that all governance documents are kept up to date and contain sufficient details for staff to follow.
- Revise responsibility and accountability to ensure clarity between the GP and the practice manager/ practice nurse.
In addition the provider should:
- Engage with the NHS England Area Team and the local clinical commissioning group in order to secure improvements to services.
- Revise the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if required.
- Review information available to patients about services provided to help ensure it is accurate and up to date.
I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If sufficient improvements have not 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 receive should improve.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice