The Care Quality Commission
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Archived: Dr Ayoola Makanjuola Also known as Bicknoller Surgery

Overall: Requires improvement read more about inspection ratings

Bicknoller Surgery, Vale Drive primary care centre, Barnet, Hertfordshire, EN5 2ED (020) 8449 3514

Provided and run by:
Dr Ayoola Makanjuola

Important: The provider of this service changed. See new profile

All Inspections

17 October 2016

During a routine inspection

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

9 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Bicknoller Practice (Dr Ayoola Makanjuola) on 9 December 2015. Overall the practice is rated as requires improvement. We previously inspected the practice in October 2014 and found the practice to be rated inadequate. The practice was placed into special measures in April 2015.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Data showed patient outcomes were average for the locality. Audits had been carried out, and we saw evidence that audits were driving improvement in performance to improve patient outcomes.
  • The practice recorded low rates for flu immunisation which the practice was addressing.
  • Patients said they were treated with compassion, dignity and respect.
  • Urgent appointments were usually available on the day they were requested.
  • The practice had a number of policies and procedures to govern activity; however action plans following risk assessments had not been developed and some safety checks on clinical equipment had not carried out in accordance with practice policy.
  • The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

  • The practice must ensure that there is an effective system of recalling patients for health checks and routine vaccinations.

  • Review evidence of patient outcomes and produce an action plan on how to improve.

  • The practice must ensure that there is enough nursing provision to meet the demand of patients and to offer a full service.

  • Provide long term conditions training for the practice nurse.

In addition the provider should:

  • Produce an action plan and follow up actions from the infection control audit.

  • Undertake regular electrical equipment checks.

  • Consider employing further clinical staff to ensure there is enough support for the practice nurse to carry out routine health checks and recalls.

  • Make provision for patients to have access to a female GP.

  • Ensure that nurse appointments are managed to ensure patients are being seen effectively.

I confirm that this practice has improved sufficiently to be rated ‘Requires improvement’ overall. The practice is to remain in special measures and will be inspected in 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 if they do not improve.

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

23 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of the Dr Makanjuola practice on 23 October 2014. We rated the practice as ‘Good’ for the service being caring and responsive to people’s needs. We rated the practice as ‘Requires improvement’ for the service being effective. We rated the practice as ‘Inadequate’ for the service being safe and well led. We rated the practice as ‘Requires improvement’ for the care provided to older people, families, children and young people, working age (including those recently retired and students), people experiencing poor mental health (including people with dementia), people with long term conditions and people whose circumstances may make them vulnerable.

We gave the practice an overall rating of ‘inadequate’.

Our key findings were as follows:

  • There was good access to the surgery through the open access in nature of the appointment system;
  • Patients were positive about the practice and services provided. They were happy with the opening times and appointment flexibility.
  • Patients said that staff were welcoming, caring and treated them with dignity and respect.
  • Systems were in place to keep patients safe including incident reporting protocols and safeguarding procedures;
  • Annual reviews were offered to all older patients and those on the long term conditions registers.

There were also areas of practice where the provider must make improvements. The practice must:

  • Ensure all chaperones have a Disclosure and Barring Service (DBS) check;
  • Ensure all recruitment checks are carried out before employment commences;
  • Ensure fridge temperatures and recording systems are in line with national guidelines;
  • Ensure current guidelines are being used for the diagnosis of all conditions and in particular for the treatment of COPD;
  • Ensure equipment is kept in date including urinalysis testing strips and blood bottles.
  • Ensure audit cycles are undertaken;
  • Ensure the appropriate storage and logging of prescription pads.

There were also areas where the practice should make improvements. The practice should:

  • Ensure there is provision for patients when the practice nurse is absent;
  • Ensure all significant events are recorded, action taken and then discussed with staff to ensure learning from the event;
  • Ensure there is a record of all meetings that take place in the practice;
  • Produce own cleaning schedules and cleaning log;
  • Produce a practice risk register, fire risk assessments and fire log;
  • Ensure the practice regularly benchmarks services against the local Clinical Commissioning Group (CCG) data;
  • Review patients that are discharged from hospital to their own home;
  • Produce a long term practice strategy document;
  • Ensure legionella risk assessments and testing is undertaken

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice