We carried out an announced comprehensive inspection at Braithwell Road surgery on 17 December 2018.

At this inspection we followed up on breaches of regulations identified at a previous inspection in April 2018.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

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

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have appropriate systems in place for the safe management of medicines requiring refrigeration.
• Recruitment procedures had not been followed in the recruitment of non-clinical staff.

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

• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

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

• While the practice had made some improvements since our inspection in April 2018, it had not appropriately addressed the Requirement Notice in relation to health and safety and staff training. At this inspection we also identified additional concerns that may put patients at risk in relation to recruitment and storage of medicines requiring refrigeration.
• Whilst the practice had a clear vision and strategy there was a lack of monitoring to ensure objectives were achieved.
• The overall governance arrangements were not always effective.
• The practice did not have clear and effective processes for managing risks.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• There were high levels of patient satisfaction with the service.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. Ensure specified information is available regarding each person employed.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and update the safeguarding policy and procedure with the new practice manager's details.

• Review and update the children at risk register.
• Review and update systems to check clinical staff registration is up to date.
• Review and improve reception staff training for their role in the management of patients with severe infections such as sepsis.
• Review systems for checking immunisation status for all staff including GPs in line with the Department of Health Immunisation against infectious disease guidance (the Green Book).
• Review and improve systems for monitoring patients on high risk medicines so the information is accessible to all clinicians.
• Review and improve systems for involvement in monitoring prescribing in the practice.
• Review and improve the complaints procedure to include information about how to escalate complaints.
• Review and improve systems to support the requirements of the duty of candour.
• Review and improve patient engagement.
• Review and improve systems for monitoring curtains in consultation rooms are cleaned in line with current national guidance.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

This practice is rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires

improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Braithwell Road Surgery on 10 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had some systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. There were risk assessments in relation to most safety issues. However, there was a lack of understanding about the practice areas of responsibility in relation to fire safety and a lack of evidence to show staff had received up-to-date training in health and safety matters.
• Clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols. However, they did not routinely review the effectiveness and appropriateness of the care provided.
• 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.
• Although the practice acted on external information about patients experiences there was little evidence of practice engagement with patients.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Review and improve reception staff training for their role in the management of patients with severe infections such as sepsis.
• Review and improve the infection prevention and control policy and procedure.
• Review and improve management oversight of medical alerts.
• Review and improve systems to support the requirements of the duty of candour.
• Review and improve patient engagement.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice