The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Philip Matthewman

Overall: Good read more about inspection ratings

87-89 Prince of Wales Road, London, NW5 3NT (020) 7284 3888

Provided and run by:
Dr Philip Matthewman

All Inspections

13 June 2019

During a routine inspection

We carried out an announced comprehensive inspection at Dr Philip Matthewman, on 7 August 2018, and rated the practice as inadequate for safe, effective and well-led and good for caring and responsive. This gave the practice an overall rating of inadequate and the practice was placed into special measures.

At the inspection, on 7 August 2018, we rated safe, effective and well-led as inadequate because:

  • The practice had not provided care and treatment in a way that kept patients safe and protected them from avoidable harm;
  • Clinical outcomes for patients with diabetes and those due for cervical cytology screening were low; and
  • There was a lack of systems and processes established and operated effectively to ensure compliance with requirements to demonstrate good governance.

Following our inspection, on 7 August 2018, we served a warning notice under Section 29 of the Health and Social Care Act 2008, as the provider was failing to comply with the relevant requirements of Regulation 12, (1), Safe care and treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also served a requirement notice, as the provider was failing to comply with the relevant requirements of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report on the August 2018 inspection can be found by selecting the ‘all reports’ link for Dr Philip Matthewman on our website at www.cqc.org.uk.

We carried out a warning notice follow up inspection, on 18 December 2018, to assess whether the concerns identified in the warning notice had been addressed by the provider. At that inspection we found that the provider had appropriately addressed all the concerns identified in the warning notice. The warning notice report can also be found by selecting the ‘all reports’ link for Dr Philip Matthewman on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out, on 13 June 2019, to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in the warning notice and requirement notice issued after the August 2018 inspection.

This report and the supplementary evidence table covers our findings in relation to those requirements and a re-rating of all five key questions.

We based our judgement of the quality of care at this service on a combination of:

  • What we found when we inspected;
  • Information from our ongoing monitoring of data about services; and
  • Information from the provider, patients, the public and other organisations.

At this inspection we have rated this practice as good overall.

We rated the practice as good for providing safe services because:

  • The practice now provided care and treatment in a way that kept patients safe and protected them from avoidable harm.
  • The provider had an effective system in place for the monitoring and recording of the availability of emergency equipment and medicine.
  • Comprehensive care records were maintained for patients that were administered high-risk anticoagulant medicine.

We rated the practice as requires improvement for providing effective services because:

  • Although there was some evidence of improvement we were not satisfied that the practice had fully addressed the previous concerns identified for patients with diabetes.
  • The practice’s performance was lower than the CCG and England averages for cancer indicators relating to cervical screening, bowel cancer screening, breast cancer screening and two-week wait cancer referrals.
  • The practice carried out clinical audits to improve patient outcomes.
  • The practice able to show that staff had the skills, knowledge and experience to carry out their roles.

We rated all population groups in effective as good except for people with ‘long-term conditions’ and ‘working age people’ which we rated as requires improvement. This was because clinical outcomes for patients with diabetes and cancer were lower than local and national averages.

We rated the practice as good for providing caring services because:

  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice organised and delivered services to meet most patients’ needs and preferences.

We rated the practice as good for providing responsive services because:

  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
  • Patients found the appointment system easy to use and reported that they could access care when they needed it.

We rated all population groups in responsive as good.

We rated the practice as good for providing well-led services because:

  • Systems and processes had now been established and operated effectively to ensure compliance with requirements to demonstrate good governance.
  • There were now arrangements for identifying, recording and managing risks, issues and implementing mitigating actions and these were operated effectively, in particular in relation to the management of emergency equipment and medicines, medicines management as a whole and staff training.
  • The provider had increased its clinical and administrative staff to provide a more efficient service for its patients.

The provider should:

  • Continue with efforts to improve outcomes for patients with diabetes.
  • Continue with efforts to improve the uptake of cervical, bowel and breast cancer screening.
  • Consider whether the practice opening times are in line with NHS contractual obligations.
  • Establish a formal patient participation group in addition to the virtual group.

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

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

18 December 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Dr Philip Matthewman on 7 August 2018. The overall rating for the practice was inadequate and we placed the practice into special measures. We served a warning notice under Section 29 of the Health and Social Care Act 2008, as the provider was failing to comply with the relevant requirements of Regulation 12, (1), Safe care and treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report on the August 2018 inspection can be found by selecting the ‘all reports’ link for Dr Philip Matthewman on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 December 2018 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in the warning notice issued after the August 2018 inspection. This report covers our findings in relation to those requirements.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from the provider, patients, the public and other organisations.

We have not re-rated the practice on this occasion. We will consider re-rating the practice when we carry out our follow up comprehensive inspection, this will be within six months from the publication date of the August 2018 report.

We found that:

  • The practice had addressed all the issues identified within the warning notice and now provided care and treatment in a way that kept patients safe and protected them from avoidable harm.
  • The provider had an effective system in place for the monitoring of uncollected prescriptions.
  • The provider had effective arrangements in place for the monitoring and security of prescriptions pads and computer prescription paper, both on delivery and when they were distributed through the practice.
  • The provider had effective arrangements in place to ensure any unused medicines handed in to the practice by patients were safely destroyed or disposed of as recommended by national clinical guidance.
  • The provider had an effective system in place for the monitoring and recording of the availability of emergency equipment and medicine. We found the emergency medicines stocked at the practice were in accordance with national guidance. There were appropriate risk assessments in place for those recommended in the guidance that were not stocked.
  • Comprehensive care records were maintained for patients that were administered high-risk anticoagulant medicine.
  • The provider demonstrated both clinical and non-clinical staff had completed the appropriate level of safeguarding children training for their roles.
  • The provider ensured all non-clinical staff were trained in identifying deteriorating or acutely unwell patient’s suffering from potential illnesses such a sepsis.
  • The provider completed a documented health and safety/ premises and security risk assessment.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

7 August 2018

During a routine inspection

This practice is rated as Inadequate

(Previous rating 15 January 2018– Requires Improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Dr Philip Matthewman on 7 August 2018. We undertook this inspection to follow up on breaches in regulations identified at our previous inspection on 15 January 2018 and to confirm that the practice was now meeting legal requirements.

At this inspection we found:

  • Systems and processes were in place to keep people safe. However, these systems were not operated effectively to ensure care and treatment to patients was provided in a safe way.

  • The practice did not have effective systems in place for the management, monitoring and recording of emergency equipment and emergency medicines.

  • The practice did not have appropriate systems in place to ensure the safe management of medicines. For example, those in relation to the monitoring and security of prescriptions, management of patients prescribed high risk medicines, following up vulnerable patients who failed to attend an appointment or collect their medicine, and the safe disposal of unwanted medicines returned to the practice.

  • We were not assured both clinical and non-clinical staff had completed the appropriate level of safeguarding children training. We were not assured that there was an effective process in place to ensure all children who did not attend their appointment following referral to secondary care or for immunisations were appropriately monitored and followed up.

  • There was no practice policy for significant events and incident reporting and we were not assured staff reported, recorded and learned from significant events and incidents effectively.

  • There had been insufficient improvements since our previous inspection in outcomes for patients with long term health conditions, particularly those with diabetes. In addition, cervical screening uptake rates were still significantly below local and national averages.

  • Non-clinical staff had not undertaken sepsis training and were unable to demonstrate an understanding of what sepsis was or how to identify a deteriorating patient.

  • There was no evidence to demonstrate that health and safety risk assessments had been carried out at the premises.

  • We were not assured clinical staff understood the Gillick competency and Fraser guidelines for the care and treatment of patients under the age of 16.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • The practice organised and delivered services to meet most patients’ needs and preferences.

  • Patients found the appointment system easy to use and reported that they could access care when they needed it.

  • We found there was a lack of systems and processes established and operated effectively to ensure compliance with requirements to demonstrate good governance.

  • The arrangements for identifying, recording and managing risks, issues and implementing mitigating actions were not operated effectively, in particular in relation to medicines management; health and safety of premises; staff training in safeguarding and the identification of symptoms associated with sepsis.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way to patients. Please refer to the enforcement actions at the end of this report for further details.

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. Please refer to the enforcement actions at the end of this report for more details.

The areas where the provider should make improvements are:

  • Review clinical staff training for Gillick competency and Fraser guidelines for the care and treatment of patients under the age of 16.

  • Review the provision of sharps injury guidance to ensure it is available in consulting or treatment in order to provide staff with quick access to information on the steps to be taken in the event of a sharps injury.

  • Review the availability of practice information in easy read and large print material.

  • Review the arrangements for cleaning/washing curtains in consultation rooms to ensure they are in line with current national guidance.

I am placing this service in special measures. Services 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 service 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 remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

15 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Matthewman’s practice on 15 January 2018, undertaken in accordance with our published process to re-inspect a proportion of practices previously rated as good or outstanding. In August 2016, we had carried out a follow up inspection when the practice rating had improved to good.

The practice is now rated as requires improvement overall and for providing effective and well-led services. It remains rated as good for the key questions of safe, caring and responsive.

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. We have rated the practice as requires improvement overall and for the key questions of effective and well-led. The concerns which led to these ratings apply to everyone using the service. Accordingly, the population groups are rated as follows:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

At this inspection we found:

  • Published data showed the practice performance was below local and national averages in some areas of care and had fallen slightly since our last inspection, following gradual improvement over the preceding few years. Performance in relation to diabetes care and cervical cancer screening remain significantly lower than average. However, steps were being taken to improve this.
  • There were governance processes to identify, understand, monitor and address current and future risks, but these were not sufficiently robust to ensure that services were delivered in accordance with the fundamental standards of care.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence-based guidelines.
  • There was evidence that clinical audit drove improvement.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found it easy to use the appointment system and told us they could access care when they needed it. Patient feedback was particularly positive regarding the walk-in surgery which operated each morning.
  • Data from the GP patient survey showed that patient satisfaction was generally comparable with local and national averages in relation to caring aspects of the service and above average regarding the responsiveness of the service.

The areas where the practice must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example, introducing robust systems for monitoring patients’ two-week referrals; for conducting records searches when drugs alerts are received; to monitor uncollected prescriptions; and the monitoring and recording of emergency equipment and medication.

In addition, the areas where the practice should make improvements are:

  • Continue with planned action to improve the practice’s overall QOF results; for improving the outcomes of patients with long term health conditions, particularly diabetes, and to increase the uptake of cervical screening tests.
  • Ensure that patients are aware that chaperone services are available.
  • Review the availability of information regarding services in languages other than English, together with easy read material, and an induction loop for patients with hearing impairment.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

3 August 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection on 3 August 2016. This was to follow up our comprehensive inspection of the practice on 17 November 2015, when we found breaches of legal requirements, relating to the safe management of vaccines and infection control issues. We served a requirement notice relating to the breaches and rated the practice as requires improvement for providing safe services. We also noted concerns relating to the key questions of effective and well-led services and rated these as requires improvement. The practice’s rating for providing caring and responsive services was good. The overall rating was requires improvement. The concerns which led to these ratings applied to all the patient population groups.

Following the inspection, the practice wrote to us to say what it would do to meet the legal requirements in relation to the breach of regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to Safe care and treatment.

We undertook this focussed inspection on 3 August 2016 to check that the practice had implemented its action plan and to confirm that it now met the legal requirements. This report covers our findings in relation to those requirements and to the improvements needed to provide effective and well-led services. We found that the practice had taken appropriate action to meet the requirements of the notice and have revised the practice’s rating for providing safe services to good. We also identified improvements relating to the key questions of effective and well-led services and have revised those ratings to good. As the practice was now found to be providing good care for safe, effective and well-led services this affected the ratings for all the population groups we inspect against.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Philip Matthewman on our website at www.cqc.org.uk.

Professor Steve Field

CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

17 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We carried out an announced comprehensive inspection of the practice on the 17 November 2015. Overall the practice is rated as requires improvement.

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

  • Patients’ needs were assessed and care was delivered in line with current evidence based guidance. The provider had the skills, knowledge and experience to deliver effective care and treatment.

  • Patients were very positive in their comments about the service. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available.

  • Patients said they found it easy to make an appointment, with urgent access available the same day at the walk in clinic.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Staff felt well supported. The practice sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the requirements of the Duty of Candour.

However, there are areas where improvement is required -

  • Staff generally understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, we found evidence of incidents relating to safe medicines management that had not been brought to the GP’s attention.

  • There was no evidence to show that the practice’s infection control policy had been reviewed this year.

  • There was no full assessment of the risks associated with there being no defibrillator on the premises for use in medical emergencies.

  • Data showed patient outcomes were low for the locality. This related to the care of patients with diabetes and hypertension (high blood pressure), cervical screening and flu vaccinations for over-65s and at-risk patients. Although the practice had made noticeable improvement over the last year, work should continue to sustain the improvement.

  • Records of staff training and annual appraisals were not well kept and were difficult to assess.

  • The practice had a number of protocols and procedures to govern how the services were provided, but very few could be seen as having been reviewed recently and updated as appropriate.

  • Although we were told that there were regular practice meetings, they were not sufficiently recorded.

  • There was no active patient participation group.

The areas where the provider must make improvements are:

  • Review and update as necessary the medicines management policy and ensure that staff know of the appropriate action to take in the event of medicines fridge temperatures being outside the appropriate range.

In addition the provider should –

  • Review and update as necessary the infection control policy.

  • Carry out a full assessment of the risks associated with there being no defibrillator on the premises for use in medical emergencies.

  • Continue to work on sustaining and improving and outcomes for patients with diabetes and hypertension, and increase the uptake of cervical screening and flu vaccinations for over-65s and at-risk patients.

  • Review staff training and appraisal records so that training needs can be easily identified and training be provided. Ensure that staff appraisal meetings are fully recorded.

  • Review and update as necessary the practice governance protocols, ensuring these are tailored to suit the practice needs and that staff are made aware of any changes.

  • Arrange more regular practice meetings and ensure that they are fully recorded.

  • Proceed with efforts to set up a patient participation group to increase patients’ involvement in discussions and decisions relating to service provision.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice