The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr William Paul Arnett Also known as Roker Family Practice

Overall: Good read more about inspection ratings

51-52 Roker Avenue, Sunderland, Tyne and Wear, SR6 0HT (0191) 567 8023

Provided and run by:
Dr William Paul Arnett

All Inspections

27 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a previous announced comprehensive inspection of Dr William Paul Arnett on 2 November 2015 when breaches of legal requirements were found. Overall we rated the practice as inadequate and the practice was placed into special measures. After the inspection, the practice wrote to us to say what action they intended to take to address the identified breaches of regulation.

We undertook this comprehensive inspection on 27 September 2016 to check that the practice had taken this action and to confirm that they now met legal requirements. You can read the

report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr William Paul Arnett on our website at www.cqc.org.uk

Overall, the practice is now rated as good.

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

  • The practice had enlisted support from the local clinical commissioning group to make improvements following the previous inspection in November 2015. We found that the practice had made good progress and had either addressed or were in the process of addressing all of the issues previously identified.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed.
  • The practice had implemented a schedule of clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
  • Feedback from patients about their care was consistently positive. Patients reported that they were treated with compassion, dignity and respect.
  • Urgent appointments were usually available on the day they were requested. Pre- bookable appointments were available within acceptable timescales.
  • The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
  • The practice had implemented a patient participation group and responded appropriately to feedback from patients.
  • Information about services and how to complain was available and easy to understand.
  • The practice had developed a clear vision with staff to prioritise quality and safety.

We saw an area of outstanding practice:

  • As the practice were aware that they a high number of asylum seekers and refugees on their patient list they had established links with other relevant service providers such as the refugee council and an organisation dedicated solely to the treatment and rehabilitation of torture survivors. The practice nurse was undertaking training in improving access to healthcare for migrants.

However, there were areas where the provider needs to make improvements.

Importantly, the provider should:

  • Implement a robust system to monitor the performance of the practice, including regular monitoring of Quality and Outcomes Framework (QOF) attainment.
  • Maintain a record of whether staff are up to date with routine immunisations and that staff at risk of injury from blood contaminated sharps are offered a Hepatitis B and influenza vaccination in line with recommended guidance.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service. However, we are aware that NHS England have terminated their contract with this provider since our inspection and that services for patients registered with this practice have now transferred to an alternative provider.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

4 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr William Paul Arnett on 4 November 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice to be inadequate for providing safe and well-led services and requires improvement for providing effective and responsive services. As a result it was rated as inadequate for providing services for all population groups. It was good for providing a caring service.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However, there was no system in place to annually review significant events with staff to analyse trends and themes and monitor implementation of lessons learned.
  • Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses
  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate checks on staff had not been completed, the arrangements for chaperoning of patients were not satisfactory and the arrangements for the management of medicines and infection control were not safe
  • 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.
  • Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day. However, appointment availability was sparse with a distinct lack of afternoon appointments being available.
  • The surgery had adequate facilities and was well equipped to treat patients and meet their needs.
  • Staff reported that they felt supported by management. The practice sought feedback from staff and patients, which it acted on. The practice did not have a patient participation group (PPG)
  • The practice participated in the carer’s incentive scheme and had an effective system in place to identify and support carers, which included offering health checks and referral to the local carers association.

However, there were also areas where the provider needs to make improvements. The practice must:

  • Assess the risk of, and review the arrangements for preventing, detecting and controlling the spread of infections. This should include ensuring that all staff have had infection control training, that regular infection control audits are carried out, that there is a process in place for checking and cleaning/replacing the privacy curtains in consultation rooms and ensuring a legionella risk assessment is carried out as soon as possible

  • Ensure all staff acting as chaperones are subjected to Disclosure and Barring Service (DBS) checks. A risk assessment should be completed for any other member of staff for whom a DBS check has not been felt necessary

  • Follow national guidance by ensuring medicines requiring refrigeration are safe and the cold chain is checked and maintained effectively

  • Provide staff with access to a defibrillator. If the decision is made not to have a defibrillator a risk assessment should be in place detailing why this is not felt to be necessary

  • Ensure that computer prescription forms are stored securely to prevent misuse

  • Ensure that all clinical staff are covered by an appropriate level of professional indemnity insurance

  • Review staffing arrangements and appointment availability to ensure patients have adequate access to a female GP, nursing staff and a chaperone when required

  • Change the process for reviewing hospital discharge information to ensure there is clinical oversight

  • Ensure that emergency medicines kept on the premises comply with national guidance. If the decision is taken not to keep a stock of a recommended medicine a risk assessment should be in place detailing the reason for the decision

The practice should also:

  • Carry out regular reviews of all significant events and complaints with staff to ensure trends and themes are identified and lessons learned implemented

  • Keep a record of any fire drill that is carried out on the premises

  • Review the process for identifying the reason for clinical audits and ensure that two cycle audits are completed

  • Take steps to ensure that conversations in the treatment room cannot be overheard by patients in the treatment room waiting area

  • Establish a patient participation group

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 

8 September 2014

During a routine inspection

The Dr William Paul Arnett Practice (also known as Roker Family Practice) is housed in two large converted terraced houses and is close to local amenities. The practice provides GP services for 2090 patients living in the Roker area of Sunderland.

The service is registered with CQC to provide the regulated activities of; Diagnostic and screening procedures; Treatment of disease, disorder and injury; Surgical procedures and Maternity and midwifery services. 

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. 

There are effective systems in place to ensure the service is delivered to all patients in a way that meets their needs. There is collaborative working between the practice and other health and social care agencies which help to ensure patients receive the best outcomes from their treatment.  Clinical decisions follow best practice guidelines. 

Systems are in place for medicines management.

All the patients we spoke with were positive about the care and treatment they receive. The CQC comment cards and results of patient surveys show that patients are consistently pleased with the service they receive. 

The staff are caring and ensure all treatments follow best practice guidance. 

The leadership team are approachable and visible.

There is good collaborative working between the provider and other health and social care agencies which ensure patients receive the best outcomes.  Clinical decisions follow best practice guidelines. 

The practice regularly meets with the local CCG to discuss service performance and improvement issues.

The majority of patients registered with the practice are of working age. There are approximately 500 patients registered with the practice over the age of 65 and approximately 300 under the age of 18 years. Patients with long term conditions are reviewed at least once a year. 

The practice is aware of patients in vulnerable circumstances and actively ensures these patients receive regular reviews, including annual health checks. 

The practice maintains a register of patients who experience mental health problems and they have regular reviews.  The needs of these population groups are identified by the practice and systems are in place to improve their access to care.

We currently review six population groups at all inspections, the detail of which can be found after the summary in this report. The needs of these population groups are identified by the practice and systems are in place to improve their access to care.