The Care Quality Commission
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Archived: Dr Anis and Anis

Overall: Inadequate read more about inspection ratings

Golborne Health Centre, Kidglove Road, Golborne, Warrington, Cheshire, WA3 3GS (01942) 481600

Provided and run by:
Dr Anis and Anis

All Inspections

30 May 2019

During a routine inspection

This practice is rated as Inadequate overall. (Previous rating 18 October 2019 – (Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Anis and Anis on 30 May 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This full comprehensive inspection took place following concerns found at the previous inspection on 18 October 2018 resulting in a rating then of ‘Inadequate’. Two warning notices for Regulation 12 Safe Care and Treatment and Regulation 17 Good governance were issued and the practice was placed in special measures. A follow up inspection to check the progress of the improvements highlighted in the warning notices took place on 4 February 2019 and we noted some improvement had taken place. This most recent inspection was to measure the improvements made to date.

At this inspection we found:

We identified that not all improvements from the previous inspection in 18 October 2018 had been made and found new serious concerns resulting in continuing breaches of regulation.

We rated the practice as inadequate for providing safe services because:

  • There was evidence that some patients on high risk medicines were not being monitored appropriately and consultation records were inadequately detailed.

We rated the practice as inadequate for providing effective services because:

  • Continuing concerns were found regarding the level of detail recorded in medical records.
  • Coding for medication reviews had been added to the clinical system with no evidence of these reviews taking place therefore patients were not receiving the monitoring they required. A large number of these had been completed when the surgery was closed and on the same day.
  • There were some patients identified with a raised indicator for diabetes but had not had a coded diagnosis of diabetes or pre-diabetes and therefore not been followed up or offered appropriate management.

We rated the practice as inadequate for providing well-led services because:

  • Leaders had not demonstrated the capacity or capability to make required improvements or provide safe care to patients.
  • At the pre-inspection briefing we were informed by the lead GP that the workload at the practice was now unmanageable for clinical and administration staff

These areas affected all population groups so we rated all population groups as inadequate.

We rated the practice as requires improvement for providing caring services because:

  • The GP National Survey data was below the CCG and National averages for providing caring services.

We rated the practice as requires improvement for providing responsive services because:

  • The GP National Survey data was below the CCG and National averages for providing responsive services.
  • There was insufficient data presented that demonstrated that quality had improved in response to complaints and no evidence that this was considered.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

This service was placed in special measures following the inspection on 18 October 2018. Insufficient improvements have been made such that there remains an overall rating of inadequate. We will now be taking 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. The practice will remain in special measures.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

19 Oct to 18 Oct 2018

During a routine inspection

This practice is rated as Inadequate overall. (Previous rating 7 March 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Anis and Anis on 18 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. This full comprehensive inspection took place following concerns found at the previous inspection resulting in a rating then of ‘Requires Improvement’. Following the inspection of 7 March 2018, we were provided with an action plan detailing how they were going to make the required improvements. This most recent inspection was to measure the improvements made to date.

At this inspection we found:

We identified that not all improvements from the previous inspection in March 2018 had been made and found new concerns resulting in continuing breaches of regulation.

  • The practice was a high prescriber of hypnotics and other medicines and not all patients on these medicines had been reviewed appropriately.
  • Concerns were found regarding the level of detail recorded in medical records. Medical advice given was not consistently recorded.
  • Test results received by the practice were not reviewed in a timely manner.
  • There was no effective system in place to recall or follow up patients.
  • There was no effective system in place to follow up on patients who had failed to attend for an appointment including children.
  • Some non-clinical staff undertook chaperone duties without training.
  • The vaccine fridge temperature went out of range on one occasion and no significant event had been raised.
  • There was an out of date emergency medicine and single use item on the emergency trolley.
  • No major incident plan was in place and no staff were trained to deal with major incidents.
  • No records of staff immunisations were held.
  • No clinical staff were involved in infection prevention and control.
  • Not all staff were aware of how to report and record significant events.
  • There was no risk assessment in place to determine which emergency medicines should be held in the practice.
  • The system for managing safety alerts was not applied consistently.
  • There was a lack of management oversight of staff training.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Develop different ways to gather patient feedback.
  • Set up a patient participation group.
  • Review and improve satisfaction scores from the national GP patient survey.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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 service 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 by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

7 March 2018

During a routine inspection

This practice is rated as Requires Improvement overall. (Previous inspection 17 November 2016 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? - Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We carried out an announced comprehensive inspection at Dr Anis and Anis on 7 March 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

  • There was evidence of learning and improvement when things went wrong, but the system for this was not clear or consistent.
  • Staff recruitment and training records were incomplete.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had not reviewed the results from the annual national GP patient survey 2017.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Develop processes to improve the take up of cervical screening
  • Review and consider how best to improve satisfaction scores from the national GP patient survey.
  • The practice should take steps to increase awareness of medical emergencies across the clinical team.
  • Review the system for appraisals for nursing staff.
  • Staff should be made aware of the interpretation services available for patients.
  • Introduce easy read materials for those patients that may need them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 November 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We undertook this focused inspection of Dr Anis and Anis on 17 November 2016 for one area within the key question safe.

We found the practice to be good in providing safe services. Overall, the practice is rated as good.

The practice was previously inspected on 10 December 2015. The inspection was a comprehensive inspection under the Health and Social Care Act 2008. At that inspection, the practice was rated good overall. However, within the key question safe, overview of safety systems and processes was identified as requires improvement, as the practice was not meeting the legislation at that time; Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

  • The registered person did not ensure recruitment arrangements include all necessary employment checks for all staff were in place that included taking up references and completing disclosure and barring service checks, in particular for staff who were already undertaking chaperoning duties.

On this inspection we reviewed a range of documents which demonstrated they were now meeting the requirements of Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

10 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Anis and Anis on 10 December 2015. Overall the practice is rated as good.

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. However, reviews and investigations were not thorough enough.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. However staff had been undertaking chaperone duties but did not have a disclosure and barring service (DBS) check or risk assessment in place.
  • 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 found it easy to make an appointment with a named GP and that 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.
  • There was not a clear leadership structure however staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

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

Importantly the provider must:

  • Ensure that a Disclosure and Barring Service (DBS) check or risk assessment is in place for staff who carry out the role of a chaperone.

Importantly the provider should:

  • Ensure the clinical audit cycle is completed for all audits.
  • The practice should consider having a formal structure for the review, implementation and audit of NICE Guidance.
  • Ensure there are formal governance arrangements in place and staff are aware how these operate.
  • Ensure that there is a record of all meetings that take place both internal and external to the practice and actions from these meetings are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice