Dr George Kamil Also known as Upper Halliford Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr George Kamil on 29 September 2106. Overall the practice is rated as Good.

Dr George Kamil was subject to a previous comprehensive inspection in January 2016 where the practice was rated as inadequate and was placed into Special Measures. Following our inspection of the practice in January 2016, the practice sent us an action plan detailing what they would do to meet the regulations. We undertook this second comprehensive inspection on 29 September 2016 to check that the provider had followed their action plan and to confirm that they now met the regulations. We found that the practice had made significant improvement since our previous inspection. The practice is now rated as good overall.

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

• There was now an open and transparent approach to safety and an effective system in place for reporting and recording significant events. We saw evidence these were investigated and learning shared with staff.
• Risks to patients were assessed and well managed. The practice were able to demonstrate they had carried out risk assessments. These included health and safety, fire safety, legionella and infection control audits.

• Vaccines and prescriptions were now stored in line with national guidance. Patient Group Directions were used by the practice to allow nurses to administer medicines. Health Care Assistants were trained to administer vaccines and medicines against a patient specific prescription or direction from a prescriber.

• The practice had improved their recruitment processes. We found at this inspection that appropriate recruitment checks and risk assessments had been undertaken prior to the employment of practice staff.
• The practice had made attempts to recruit patients to join a patient participation group but had been unsuccessful in starting the group. However, since our last inspection the practice invited patients within the practice to complete the NHS Friends and Family test (FFT). The FFT gives every patient the opportunity to provide feedback on the quality of care they receive.
• Policies and procedures were now tailored to the practice and had been reviewed to ensure they were relevant and up to date.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they usually found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
• The practice had facilities and equipment to treat patients and meet their needs.
• Improvements had been made to fire safety. For example, a fire risk assessment had been completed in May 2016 by an independent company and new smoke seals had been fitted to all fire doors.
• At this inspection we found evidence that all electrical equipment had been PAT tested in May 2016 and clinical equipment had been calibrated in May 2016.
• There was a clear leadership structure and staff felt supported by management. The practice proactively 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.

There was one area where the provider MUST make improvement:

• Review and increase nursing provision in the practice to ensure there is sufficient capacity to meet the needs of the patient list.

The areas where the provider should make improvement are:

• Provide better access to a female clinician.
• Continue to promote the role of the patient participation group.
• Consider how better to engage with patients to provide patient feedback in order to act on any findings.

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 unannounced focused inspection at Dr George Kamil also known as Upper Halliford Medical Centre on 08 March 2016 due to concerns raised during an announced comprehensive inspection completed on 05 January 2016.

The focused inspection was to ensure that patient safety was not being compromised. Specifically we reviewed:-

• If patients were receiving effective care.

• If appropriate action and risk assessments had been completed following the results of a DBS check for a member of staff.

• If patients had access to a practice nurse.

• If the practice had reviewed access to a female clinician.

• To further review medicines management.

This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr George Kamil on our website at www.cqc.org.uk.

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

• We reviewed 13 patients records and found patients were receiving effective care.

• Following the results of a DBS check the practice had appropriately taken action and had completed a risk assessment.

• The practice had employed a locum nurse for three hours a week.

• The practice nurse was female and the practice was aware that further arrangements for patient choice if requesting a female GP was still to be actioned.

• Medicines management was inadequate and the practice needed to review policies and procedures. For example, the storage of medicines and vaccines within the clinical fridges were not being monitored correctly.

The ratings for this report are taken from the initial comprehensive inspection carried out on the 5 January 2016. The findings from this focused inspection did not the affect the ratings or the actions previously required from the provider.

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 Upper Halliford Medical Centre on 5 January 2016. 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 and poor outcomes because systems and processes were not in place to keep them safe and ensure they received the care they needed.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, there was little evidence that these were investigated and learning shared with staff.
• Risks to patients were not consistently assessed and well managed. The practice was unable to demonstrate they carried out health and safety or fire or legionella or equipment risk assessments or infection control audits or reviewed cleaning logs.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Not all staff were up to date with attending mandatory training courses such as safeguarding, fire safety, Mental Capacity Act 2005 and infection control. Staff had not received regular appraisals or had personal development plans.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Vaccines and prescriptions were not stored in line with national guidance.
• Staff told us they worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs but minutes to meetings were not recorded.
• Information about services and how to complain was available and easy to understand however there was not a robust system for recording evidence of investigations undertaken or shared learning.
• 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. Data from the National GP Patient Survey showed mixed results from patients when rating aspects of care.
• Appropriate recruitment checks and risk assessments had not been undertaken prior to the employment of practice staff.
• The practice did not have a patient participation group or conduct patient surveys and was not gathering feedback from patients.
• The practice was unable to offer choice to patients in relation to a female clinician.
• Some childhood immunisation rates were below the Clinical Commissioning Group (CCG) average. Cervical cancer and bowel cancer screening was below the CCG average.
• Robust systems were not in place to deal with verbal complaints or show how they had been investigated, actioned or learnt from.
• Governance arrangements were not robust, monitoring of performance was not actively supported, to improve patient outcomes or service quality. Leadership structures and roles were unclear. The practice did not have a vision and strategy.
• Policies and procedures had not always been tailored to the practice or reviewed

The areas where the provider must make improvements are:

• Ensure risk assessments are completed including health and safety, infection control, legionella and fire risks.
• Ensure the practice has risk assessed whether it is able to respond to medical emergencies in line with national guidance.
• Revise governance processes and ensure that all documents used to govern activity are practice specific and are up to date. This includes the use of patient specific directives and patient group directives when authorising clinical staff to administer vaccines and immunisations.
• Ensure all staff are up to date with attending mandatory training courses, including safeguarding and the Mental Capacity Act 2005, and have regular appraisals.
• Revise medicines management to help ensure Department of Health guidance is followed when storing vaccines.
• Maintain records of multidisciplinary meetings, significant events, investigations and learning of complaints to evidence the on-going care and treatment of patients.
• Revise recruitment processes to ensure appropriate checks and risk assessments are undertaken prior to the employment of all staff and that the required information is recorded in recruitment files.
• Ensure all staff are either risk assessed or have received a disclosure and barring (DBS) check escepically for staff who act as chaperones.
• Revise clinical audit activity to ensure improvements to patient care are driven by the completion of clinical audit cycles.
• Revise how the practice gathers patient feedback to ensure that patients are involved with how the practice is run.
• Revise processes to ensure that blank prescriptions are tracked throughout the practice at all times.
• Improve patient access to female clinicians to allow for patient choice.
• Review nursing provision in the practice to ensure there is sufficient capacity to meet the needs of the patient list.
• Ensure clinical equipment is calibrated annually and portable appliances are safe to use.

The areas where the provider should make improvement are:

• Review the frequency of multi-disciplinary team discussions and record discussions had.

• Review management positions to ensure there is sufficient capacity to meet the needs of the practice.

• Review exception reporting figures in QOF.
• Ensure the building is compliant with the Disability Discrimination Act (DDA) including access to the surgery and if an auditory loop is required.
• Review the practice information available to patients both within the practice and on the website to ensure it is up to date.
• Review the business continuity plan in place for major incidents.
• Review patient privacy at the reception desk.

I am placing this practice in special measures. Practices placed in special measures will be inspected again after 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 varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if 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