This practice is rated as Good overall. (Previous rating 04/10/2017 – Good)

We carried out an announced comprehensive inspection at Dr Agha and Siddique on 4 October 2017. The overall rating for the practice was good, with requires improvement for safe. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Dr Agha and Siddique on our website at www.cqc.org.uk.

The key question at this inspection is rated as:

Are services safe? – Good

We carried out an announced focused inspection at Dr Agha & Siddique on 26 September 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 4 October 2017. We inspected the key question safe as this area related to the breach of regulation.

This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• A legionella risk assessment had been carried out and there was a legionella management policy in place at the practice. There were processes in place to monitor and control the risk of legionella.
• Prescription stationery was stored securely and there was system in place to monitor its distribution throughout the practice.
• The practice had identified 2.2% of the patient list as carers. The practice offered support to carers, including annual health reviews and information packs.
• The Patient Participation Group (PPG) was led by the patients.

• There was a system in place to monitor training that had been identified by the practice as mandatory for all staff. The records showed that most training was up to date and organised for the future where required.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Agha & Siddique (Thorpe Bay Surgery) on 4 October 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had many clearly defined and embedded systems to minimise risks to patient safety. However, one of the processes relating to medicines management and the system in place for the management and control of Legionella were insufficient. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
• 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.
• The patients we spoke with or who left comments for us were very positive about the standard of care they received and about staff behaviours. They said staff were professional, helpful, considerate and friendly. They told us that their privacy and dignity was respected 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 raised with the practice.
• Almost all patients were positive about access to the practice and appointments. One patient said it could be difficult to see their preferred GP and another patient said there could be a delay waiting for their appointments. However, those patients said access to urgent and same day appointments was good.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and 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.

The area where the provider must make improvements is:

• Ensure care and treatment is provided in a safe way to patients. (Please refer to the requirement notice section at the end of the report for more detail).

The areas where the provider should make improvements are:

• Progress the training schedule so that all staff employed complete the essential training relevant to their roles, including safeguarding adults and infection prevention and control training.
• Continue to support carers in its patient population with access to information, advice and annual health reviews.
• Take steps to embed a patient led approach to the Patient Participation Group (PPG).

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 Dr Agha and Siddique on 03 February 2016. Overall the practice is rated as requires improvement. The practice is rated as good for caring, responsive and well led domains. The practice is rated as requires improvement for safe and effective.

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

• The practice referred to and used published safety information to monitor and improve safety outcomes for patients. Staff reported concerns about patient safety and when things went wrong these were fully investigated. Learning from safety incidents was shared with staff to minimise recurrences.
• All equipment was routinely checked, serviced and calibrated as needed. However risks to patients and staff were not always assessed and managed. There were no risk assessments in place for areas including fire safety, health and safety including premises or equipment. There was limited information available in relation to the Control of Substances Hazardous to Health (COSHH) such as cleaning materials.
• There was no business continuity plan in place to deal with any untoward incidents which may disrupt the running of the practice.
• Appropriate checks including employment references and DBS checks were not made when some staff were employed to work at the practice.
• Staff training was not updated and some staff had not undertaken training in fire safety and infection control.
• There were arrangements in place for managing medicines. However we found some medicines were out of date.

• The practice used published guidelines, reviews and audits to monitor how patients’ needs were assessed and the delivery of care and treatment.

• Patients consent to care and treatment was not routinely recorded within their patient records.

• Patients said they were treated with respect and care. They said that all staff were helpful and caring.
• Information about how to complain / escalate concerns should patients remain dissatisfied was not available.
• Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or they experienced poor care or services.
• Patients said they found it easy to make an appointment with their 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 a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

Importantly the provider MUST:

• Ensure that risks to patients and staff are assessed and managed. These relate to risks associated with premises, fire, medicines, and hazardous substances.

• Ensure that staff undertake training appropriate to their roles and responsibilities and for the safe running of the practice.

• Ensure that all of the appropriate checks including employment references and DBS checks in relation to the fitness and suitability of staff are carried out as part of the recruitment procedure.

The practice SHOULD

• Implement a business continuity plan to deal with foreseeable incidents which may disrupt the running of the practice.

• Carry out a risk assessment to support the decision if a defibrillator is not available for use in medical emergencies

• Keep records of patients consent to care and treatment where this is sought and obtained.

• Provide accessible information to advise patients how they can complain and how to escalate their concerns should they be dissatisfied with the outcome or the way in which their complaint was handled.

• Update policies and procedures so that they are practice specific.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice