Archived: Dr Tom Frewin Also known as Clifton Village Practice

Letter from the Chief Inspector of General Practice

We carried out an unannounced focussed inspection at Dr Tom Frewin, Clifton Village Practice on 16 June 2015. This was the third inspection at this practice since 15 April 2015. We found during the comprehensive inspection undertaken on 15 April 2015 a number of significant areas of high risk concerns for patients in respect of their health, safety and wellbeing. On 15 May 2015 we issued two Warning Notices to the provider outlying within our statement of reason the identification of risks and our concerns. The provider was given until 29 May 2015 to take remedial action and comply with these notices.

This inspection was to check compliance with these Warning Notices in respect of previous breaches of Regulation 12, (Safe care and treatment) and Regulation 17, (Good governance). From this inspection, we found that the provider had not taken sufficient action to comply with the warning notices and the risks for patients’ health, safety and wellbeing remained a concern.

Following the inspection on 15 April 2015 we also issued six requirement notices in respect of the following areas, the provider must:

• Ensure the practice environment is accessible in regard to meeting the Equality Act 2010.
• Ensure patients consent is obtained and recorded before treatment is provided.
• Ensure the practice has effective systems in place for cleaning.
• Ensure that persons employed at the practice receive the appropriate support, training, supervision and appraisal to carry out their role. There must be safe recruitment procedures in place and sufficient staff employed to meet the needs of patients.

These will be reviewed by us when we next undertake a comprehensive inspection.

Specifically we found the practice continues to be requires improvement for caring and inadequate for safe, effective, responsive well led services.

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

• Patients remain at risk of harm because systems and processes were not in place in a way to keep them safe. Areas of concern were the lack of infection control process and audit, poor medicines management, the lack of consistent maintenance of equipment and insufficient monitoring of safety and responding to risk.
• No clinical audit or governance systems were in place. The lack of audit and governance meant that audit was not driving improvement in performance to identify patient need and improve patient outcomes. We found there were no clinical audits or audits of the service provision to ensure patients safety and welfare was protected.
• There was a lack of nursing provision at the practice and poor systems for monitoring patients with long term conditions to ensure their needs were being met

On the basis of the findings at the inspection on 15 April 2015 the provider has been placed into special measures. (Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid having its registration cancelled). As a result of this inspection and the concerns for patients we have decided to take steps to prevent the continued risks to patients’ safety and welfare. On 19 June 2015 we suspended the provider’s registration and the regulated activities which were being provided by the provider at Clifton Village Practice until the 17 July 2015. During this period the expectation is the provider can rectify those immediate risks to patients’ safety and welfare.

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 focussed inspection at Dr Tom Frewin, Clifton Village Practice at 09:30 on 5 May 2015. This was to further review issues that were found at comprehensive inspection carried out on 15 April 2015. At this previous inspection it was assessed that overall the practice is rated as inadequate. Following this focussed inspection there has been no change to the rating.

We had found at the inspection on 15 April 2015 there was not a clear system for monitoring and managing test results such as blood and urine samples. There was not a safe system for information for managing information received in from hospital or other health providers at the practice. Assurances following the inspection had been given by the provider that they had improved the system of managing and responding to test results and information received from hospital or other health providers. However, a decision to return to the practice to check there was no risk to patients in regard to this matter was taken.

Our key findings at this inspection 5 May 2015 across the areas we inspected were as follows:

• Patients test results were now being reviewed and handled safely and in a timely way.
• Letters and information from hospitals and other health care providers were received and assessed by a clinician promptly.

A full report from the inspection 15 April 2015 is available from the CQC website and areas of concern from that inspection will be followed up shortly.

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 Dr Tom Frewin, Clifton Village Practice on 15 April 2015. Overall the practice is rated as inadequate.

Specifically we found the practice inadequate for safe, effective, responsive and well led services. We found that services required improvement in respect of caring. Overall the practice was found to be inadequate for providing services for all population groups.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions
• Patients were able to have appointments on the same day of them contacting the practice.
• Patients were at risk of harm because systems and processes were not in place in a way to keep them safe. Areas of concern were the lack of infection control audit and process, poor medicine management, the lack of consistent maintenance of equipment and insufficient monitoring of safety and responding to risk. The practice was working with the NHS England area team to ensure they took immediate corrective action, which would enable them to fulfil their basic functions safely. NHSE were also monitoring the concerns and issues within the practice.
• We saw no evidence that audit was driving improvement in performance to improve patient outcomes. We found there were no clinical audits or audits of the service provision to ensure patients safety and welfare were protected, such as infection control.
• There was a lack of nursing provision at the practice of systems for monitoring patients with long term conditions.

The areas where the provider must make improvements are:

Importantly, the provider must:

• Not carry our minor surgery at the practice as they are not registered for this regulated activity. On 29 April 2015 we sent a section 64 letter to the provider in order to establish further information and to determine the level of risk to patients. The provider has been given until 13 May 2015 in which to provide a response to us.
• Ensure there are systems in place for monitoring patients with long term conditions, end of life care and patients identified as at risk.
• Ensure there is adequate clinical staff employed in the practice, at the right time and have the right skills to meet the needs of patients.
• Ensure there is a system in place to ensure that equipment used at the practice is safe
• Ensure it has the necessary equipment and medicines in accordance to the Resuscitation Council (UK) guidelines to respond to medical emergencies.
• Ensure that patients consent is obtained and recorded before treatment is provided
• Implement a safe system for medicines management including the management of vaccines, and the safe keeping of prescription pads and prescription printer paper.
• Undertake an infection control audit and have effective systems in place for the cleanliness and hygiene of the practice. To assess the risks of preventing the spread of infection including the safe storage of clinical waste and substances hazardous to health.
• Document all recruitment and employment information required by the regulations in all staff members’ personnel files.
• Carry out risk assessments and document these to inform which members of staff required a DBS check and which staff did not.
• Implement a system to ensure all staff members receive regular supervision and training such as infection control and the Mental Capacity Act 2005.
• Provide clinical and operational business leadership and develop a clinical audit process and implement findings from audits.
• Develop and maintain a system to identify risks and improve quality in relation to patient safety. Undertake and record all relevant risk assessments in regard to the practice premises including fire safety.
• Take action to ensure all patients’ records are updated with appropriate information and documents in relation to the care and treatment they have received. Records must be kept secure.
• Undertake a disability access risk assessment of the building to check that it was meeting current legislation requirements in accordance to the Equality Act 2010.

The areas where the provider should make improvement are:

• Introduce a legionella risk assessment and related management schedule.
• The practice should ensure that within the complaints policy and procedure patients are given the necessary information for the complaints ombudsman.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. 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.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. GP practices rated as inadequate for one or more of the five key questions or six population groups will be inspected no longer than six months after the initial rating is confirmed. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid having its registration cancelled.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice