This practice is rated as Good overall. (Previous rating 03 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Not rated

Are services effective? – Not rated

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Not rated

We carried out an announced comprehensive inspection at Claremont Medical Centre on 16 January 2018 to follow up on breaches of regulations 17, 18 and 19, found at our inspection in March 2016 where the practice was rated as requires improvement overall. At the inspection in January 2018 the practice was rated requires improvement for being caring and responsive and issued with a requirement notice for a breach in regulation 17. This led to an overall rating of requires improvement.

This inspection was an announced focussed follow-up inspection on 9 October 2018, carried out to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation identified in our previous inspection on 16 January 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• The practice had good facilities, including a hearing loop and was well equipped to treat patients and meet their needs.
• Vital signs were documented for patients who attended the practice for acute illnesses.
• The practice had a system to capture, respond to and learn from verbal complaints.
• Learning and outcomes from incidents and changes made in the practice was cascaded to all staff members.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had increased their opening hours and appointments could now be booked on an App.
• National GP patient survey results were now in line with local and national averages for the practice showing care and concern and access to care and treatment.

The areas where the provider should make improvements are:

• Continue to work to improve patient satisfaction with services provided.

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

This practice is rated remains rated Requires improvement overall. (Previous inspection 08/03/2016 – Requires improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? - Good

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 Claremont Medical Centre on 8 March 2016 and rated the practice as requires improvement for safe, effective and caring key questions. This led to an overall rating of requires improvement. Breaches of legal requirements were found and requirement notices were issued in relation to fit and proper persons employed (Regulation 19), staffing (Regulation 18) and governance (Regulation 17). The full comprehensive report can be found by selecting the ‘all reports’ link for Claremont Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection which we undertook on 16 January 2018 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 March 2016. This report covers our findings in relation to those requirements. The overall rating from this visit was requires improvement.

Overall the practice remains rated as requires improvement.

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

• The practice had clear 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.

• 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 understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.

• Systems were in place to protect personal information about patients

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

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients rated the practice significantly below local and national averages on how they could access treatment and care.

• Information about how to make a complaint or raise concerns was available, however the service did not record verbal concerns or complaints.

• The practice had a vision which now formed part of their business plan. The practice’s vision was to give something back to the community & offer the people of Walthamstow especially the highly deprived ward of Higham Hill a better health care.

The areas where the provider must make improvement is:

• 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:

• Consider recording the vital signs for patients who attends for acute illnesses.

• Take steps to improve communication for patients who have difficulty hearing and those visually impaired.

• Review how information from practice meeting is discussed and cascaded to the practice nursing team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Claremont Medical Centre on 08 March 2016. Overall the practice is rated as requires improvement.

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

• A system was in place for reporting and recording significant events and there was an open and transparent approach to safety.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Data showed patient outcomes were low compared to the national average. There were too few staff with the necessary skills and experience to ensure patients’ clinical needs were met.
• Most non clinical staff had not completed, or were overdue mandatory and refresher training.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• There was a documented leadership structure, however there was an over reliance on the main GP partner to make decisions and authorise changes.
• 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 there are sufficient staff with the appropriate skills, knowledge and experience to meet the clinical needs of patients and improve outcomes.

• Ensure non-clinical staff have the skills and knowledge they need through a programme of mandatory and refresher training.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure governance arrangements are in place that effectively monitor and improve the quality and safety of services provided and mitigate risk.

In addition the provider should:

• Strengthen systems in place to make the out of hours GP service aware of patients’ end of life decisions.

• Amend the consent process for minor surgery to include a written record of the risks involved and of the discussion held with the patient about these risks.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice