Archived: Cecil Avenue Surgery

This practice is rated as Inadequate overall. (Previous rating June 2017 Requires Improvement overall.)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Cecil Avenue Surgery on 17 July 2018. This was to follow up the inspection of the 19 June 2017, when the practice was rated as requires improvement overall, and requires improvement for providing safe and effective services. The practice was in breach of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008.

This was because the provider did not do all that was reasonably practicable to assess, monitor, manage and mitigate risks to the health and safety of service users; specifically regarding fire, infection control, emergency and major incidents and the storage and management of medicines and prescription forms and pads. In addition, the registered person did not do all that was reasonably practicable to ensure effective systems and processes were in place. Specifically, by failing to address below average clinical performance for the care of some patient groups and not ensuring all mandatory training was completed by all staff including fire safety and information governance.

At this inspection on 17 July 2018 we found:

The provider had made improvements when providing effective care to patients and had addressed clinical performance, and staff had completed some of the mandatory training. We found the practice had made some improvements to the management of infection control and of prescriptions. However, the lack of assessment and mitigation to the risks of the health and safety, premises, hazard substances, fire and some of the management of medication put patients and staff at risk.

In addition, we found the provider did not always have in place the written policies and protocols necessary to ensure a consistent approach. The practice did not always have systems in place to make sure equipment, staff training, clinical waste, medicines documentation and staff immunisations were up to date. There was no clarity around processes to identify, understand, monitor, and address current and future risks, including risks to patient safety.

For example:

• The management of the risks associated with fire, health and safety, premises and hazardous substances continued to be either unidentified or not mitigated and risks remained for both staff and patients.
• The practice did not have a system in place to check whether staff vaccinations were maintained in line with current Public Health England guidance (PHE).
• The management of medicines and safe storage of prescriptions had improved. However, we found four patient group directions that had expired. The practice did not have a risk assessment in place to identify and mitigate any risks associated with the decision not to hold all the recommended emergency medicines.
• The practice had oxygen and a defibrillator which the practice manager said was checked by the GP. However, we found two masks had passed the date for safe use and there was no documentary evidence of regular checks of the emergency equipment.
• The practice had a small staff team that responded to patient needs but did not always have the written policies and protocols necessary to ensure a consistent approach by staff. For example, there was no significant events or incident policy, no medical emergency protocol, no protocol for reception staff to follow to decide on priority when a patient contacted the service, and no induction pack for locum GPs.
• The practice did not always have systems in place to make sure equipment, staff training, clinical waste, medicines documentation, legionella monitoring and staff immunisations were up to date. The provider did not provide any evidence of medical indemnity insurance for the nurse.
• The practice had 2,466 patients registered with the practice. This meant patients often saw the same GP who understood their individual needs and tailored the services in response to those needs.
• Twenty-five out of 27 patients stated that the practice was excellent and they were treated with dignity and respect. They stated they could not fault the care, were always listened to and the doctor explained things clearly and do their best to respond to patient needs.
• The practice had appropriate systems to safeguard children and vulnerable adults from abuse. The doctor and nurse had received up-to-date safeguarding and safety training appropriate to their role.
• The practice had improved in the monitoring of treatment and care and had made improvements following the inspection in June 2017.
• The practice had introduced e-learning for staff to ensure they completed their mandatory training.
• The practice carried out appropriate staff checks at the time of recruitment and on an ongoing basis.
• The care records we saw showed that information needed to deliver safe care and treatment was available to staff.
• We saw records that showed that all appropriate staff were involved in assessing, planning and delivering care and treatment.
• The practice had an active patient participation group and had carried out their own patient survey, which they had responded to. However, they were unaware of the national GP survey and had therefore not reviewed or responded to the results.

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:

• Review the approach for identifying and providing support to patients with caring responsibilities.

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 FRCGPChief Inspector of General Practice