Archived: Dr Ayoola Makanjuola Also known as Bicknoller Surgery

Updated 24 January 2017

The Dr Makanjuola practice is a surgery located in the London borough of Barnet. The practice is part of the Barnet Clinical Commissioning Group (CCG) which is made up of 69 practices. It currently holds a PMS contract (a contract between NHS England and general practices for delivering general medical services and is the most common form of GP contract) and provides NHS services to 2000 patients.

The practice serves a diverse population group and many patients do not speak English as their first language. The practice does not have a large older population (14% of the patient list) and 41% of patients are aged between 18 and 65.

The practice is open between 8.00am and 6.30pm Monday to Friday. The practice runs an open access clinic each day between 9am and 11am and between 5.00pm and 6.30pm. The practice is closed on a Thursday afternoon and patients are directed to the out of hour’s service provider. Pre-bookable appointments are available between 4.30pm and 5.00pm each afternoon except Thursday. Appointments for the practice nurse are available on a Monday, Tuesday and Friday. The practice runs an extended hour’s clinic on Mondays between 6.30pm and 7.30pm. The GP provides telephone consultations and home visits each day for those unable to attend the practice. The practice has opted out of out of hour’s provision and refers patients to the local out of hour’s provider.

The practice staff comprised of one male GP (9 sessions per week), four regular locum GPs offering a total of 9 sessions per week, a part time female practice nurse (undertaking 28 hours per week), practice manager and reception staff. There was previously no arrangement in place to provide a female GP for any patient that requested one; however the practice now employs a female locum GP. The practice employs a full time chaperone who helps in reception when needed.

The practice is situated within a purpose built health centre and shares facilities with three further health providers. Consulting rooms are on the ground floor with wide doors to allow wheelchair access.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and the treatment of disease, disorder or injury. However the practice does not currently undertake any surgical procedures.

The practice provides a range of services including child immunisation, smoking cessation advice and clinics for those with long term conditions.

We inspected Dr Ayoola Makanjuola’s practice as part of our new comprehensive inspection programme on 23 October 2014. At that time the practice was rated as inadequate for safe and well led, requires improvement for effective, good for caring and responsive. The practice was rated overall as inadequate and placed into special measures in April 2015 for a period of for six months.

At the 2014 inspection the practice was found non-compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and compliance actions were issued in relation to the following regulations:

• Regulation 9 – Care and welfare of people who use services.

• Regulation 10 – Assessing and monitoring the quality of service provision

• Regulation 12 – Cleanliness and infection control.

• Regulation 13 – Management of medicines.

• Regulation 21 – Requirements relating to workers.

We undertook a further inspection on 9 December 2015. We found that the practice had made some progress and rated the practice as inadequate for effective, requires improvement for safe and well led, good for caring and responsive. The practice was rated overall as requires improvement. However there were still breaches of Regulations in relation to:

• Regulation 17 – Good governance

• Regulation 18 – Staffing

It was decided that the practice would remain in special measures.

At our inspection in October 2016 we found that improvements had been made and rated the practice as requires improvement for providing an effective, caring and well led service. The practice was rated as good for provided a safe and responsive service, and rated as requires improvement overall. We found that recall systems and nurse cover had improved but the practice needed to improve their health related performance indicators and address the feedback from the national patient survey. Also, the practice needed to develop a long term sustainability plan to address the issue of care being delivered largely by locum staff.

The General Medical Council’s register shows that Dr Makanjuola has conditions on his registration as a GP. Those conditions include that Dr Makanjuola should be supervised in his post by a clinical supervisor and that he should not carry out any clinical work if there is no other qualified GP on the premises except in the case of an emergency.

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ayoola Makanjuola (Bicknoller Surgery) on 17 October 2016. Overall the practice is rated as requires improvement. We previously inspected the practice in October 2014 where the practice was rated inadequate for safe and well led, requires improvement for effective and good for caring and responsive. The practice was rated inadequate overall and placed into special measures. We inspected again in December 2015. The practice was rated inadequate for effective, requires improvement for safe and well led, good for caring and responsive. Overall the practice was rated as requires improvement. The practice remained in special measures.

At our 17 October 2016 inspection our key findings across all the areas we inspected were as follows

• The lead GP was currently under GMC conditions and employed locums to undertake the majority of the clinical work. However, we found no evidence that a practice sustainability plan had been considered or developed to ensure that the risk of running a practice with locum GPs in the long term had been addressed.

• The practice was performing below the local and national averages for many of the performance indicators, including diabetes, cancer and hypertension. The practice had produced an action plan in order to be able to address this.

• The practice did not have a plan in place in relation to the low scores received through the national patient survey.

• There was no active patient participation group (PPG) to provide feedback to the practice.

• 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. This included the employment of a new practice nurse who was trained to undertake long term conditions management.

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events.

• Risks to patients were assessed and managed.

• The practice had implemented a patient recall system.

• Patients said they were treated by the regular GP with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However some felt rushed by the locum GPs.

• 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 found it easy to make an appointment with a GP. The practice ran an open access clinic throughout the day and patients that we spoke with were happy to wait for an appointment as they knew they would be seen.

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

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure a practice sustainability plan is produced.

The areas where the provider should make improvement are:

• Investigate ways to improve patient satisfaction scores.

• Continue working to facilitate meetings of the PPG.

• To continue to review staffing levels to ensure adequate nursing cover.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 January 2017

The provider was rated as, requires improvement for effective, caring and well led and good for providing a safe and responsive service. The issues identified as requiring improvement overall affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators were comparable to the CCG and national average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 January 2017

The provider was rated as, requires improvement for effective, caring and well led and good for providing a safe and responsive service. The issues identified as requiring improvement overall affected all patients including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 76%, which was comparable to the CCG average of 79% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 24 January 2017

The provider was rated as, requires improvement for effective, caring and well led and good for providing a safe and responsive service. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• All patients over 75 had a named GP and a telephone number to bypass the main switchboard for appointments.

• The practice provided a regular ward round to two care homes.

Updated 24 January 2017

The provider was rated as, requires improvement for effective, caring and well led and good for providing a safe and responsive service. The issues identified as requiring improvement overall affected all patients including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

• Online appointment booking was offered by the practice.

Updated 24 January 2017

The provider was rated as, requires improvement for effective, caring and well led and good for providing a safe and responsive service. The issues identified as requiring improvement overall affected all patients including this population group.

• Performance for mental health related indicators was comparable to the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 January 2017

The provider was rated as, requires improvement for effective, caring and well led and good for providing a safe and responsive service. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.