Archived: Dr Junaid Syed Also known as Kingsdowne Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingsdown Surgery (Dr Junaid Syed) on 14 July 2016. Overall the practice is rated as requires improvement.

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 recruitment checks on staff had not been undertaken prior to their employment; staff were not up to date with mandatory training such as infection prevention and control and information governance; the process in place for updating changes to repeat prescriptions and reviewing letters relating to patients from external clinicians was unsafe.
• The processes in place for storing and administering medicines were not effective. For example, at the time of the inspection there was no arrangement in place for the temperature of the vaccine fridge to be monitored on days when there were no nursing staff present, the practice did not have systems in place to ensure that the legal documentation required for the administering of medicines was up to date. There was no process in place for monitoring the use of blank prescription sheets, and sheets were left in printer trays in unlocked consultation rooms overnight.
• Staff were not clear about reporting incidents, near misses and concerns and there was limited evidence of learning and communication with staff when these incidents occurred.
• We saw evidence that patient safety alerts were being sent to appropriate staff members; however, there was no evidence that these were being acted on. Following the inspection the practice put a process in place to ensure that action is taken on all relevant alerts.
• Care plans for vulnerable patients had been completed and were sufficiently detailed; however, these had not been saved to the patient records system, and therefore, these were not accessible to staff who were reviewing these patients, nor could they be updated when a patient’s condition changed.
• At the time of the inspection the practice did not have a working fire alarm in place (they were in the process of procuring a new system) and had not completed a risk assessment or mitigation plan in relation to this. There was no evidence that the practice carried out regular fire drills or that staff had received training in fire safety.
• Data showed patient outcomes were comparable to the national average with the exception of those relating to patients with diabetes; however, the practice had a high exception reporting rate.
• The practice had completed two complete audit cycles which showed quality improvement; however, there was limited evidence that the improvements made as a result of the initial audits had been embedded.
• 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; however, at the time of the inspection it was not clearly displayed in the waiting area. Complaints were responded to promptly and in appropriate detail; however, there was limited evidence that improvements were made to the quality of care as a result of complaints and concerns, and learning from complaints was not routinely shared with staff.
• Patients said they found it easy to make an appointment with a named GP and 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 practice had a number of policies and procedures to govern activity, but some were overdue a review.
• There was a leadership structure in place, and overall, staff felt supported; however, there was some ambiguity around the roles and responsibilities of some staff members.

The areas where the provider must make improvements are:

• Ensure improved arrangements for safety to include: safe storage, prescribing and administering of medicines and storage of prescription sheets; completion of pre employment staff recruitment checks, in adherence with the practice’s recruitment policy; correspondence relating to patient care being reviewed by a clinician; suitable fire safety systems being in place; all staff being familiar with new guidance for reporting and recording significant events and for the learning to be shared with relevant staff; and the new process for dealing with patient safety alerts being followed.
• Take action to ensure that patients receive the necessary reviews of their clinical conditions and complete and contemporaneous electronic patient records are kept, including patient care plans and records of meetings where individual patients’ care is discussed.
• Ensure that all staff are up to date with training.
• Ensure that all policies and procedures are up to date.
• Ensure that learning from complaints is shared with all relevant staff.
• Ensure that audit is being used to drive quality improvement.

In addition the provider should:

• Review arrangements to identify carers so their needs can be identified and met.
• Review how they inform patients of the availability of language translation services.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice