Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. At our previous inspection of October 2014 the practice was rated as good overall but with requires improvement for the safe domain. The practice was re-inspected in June 2015 where we found sufficient improvements had been made and the safe domain was rated as good.

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

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 Amir Ipakchi, also known as Barbara Castle Health Centre on 28 November 2017. This was as part of our inspection programme.

At this inspection we found:

• Patient feedback about access to services and involvement with clinicians was better or in line with CCG and national averages.
• Patients’ who were prescribed medicines that required monitoring were regularly reviewed to ensure medicines were being used safely.
• Staff felt supported and confident in approaching the GP provider with any concerns. Staff were listened to and their feedback was valued, although they did not receive a regular appraisal.
• Improvements were needed to ensure that children and vulnerable adults were protected from abuse, including safeguarding training for non-clinical staff.
• Recruitment checks of non-clinical staff were not consistent.
• Improvements were required to ensure that infection control procedures were effectively implemented.
• There was no central record of staff training and the practice did not have oversight of the learning needs of staff. Some staff had not received appropriate training to meet the needs of patients using the service.
• 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.
• Practice-specific safeguarding children and infection control policies were not available to staff.
• Some staff acting as chaperones had not been trained for the role and were not appropriately DBS checked or risk assessed as to their suitability for the role. This was an issue found at our original inspection in October 2014.
• There had been no health checks in the last 12 months for patients with learning disabilities and health checks were not being offered for patients over the age of 75. We were informed that patients over 75 would be reviewed in the future as part of revised services being offered.
• There were no systems to monitor the use of prescription stationery or ensure its security.
• Evidence indicated that Portable Appliance Testing for electrical devices had not taken place for ten years, although we were informed this had taken place in 2015. PAT testing was scheduled to take place in the weeks following our inspection.
• The GP provider had the skills and commitment to deliver high-quality, sustainable care, although was restricted by a lack of managerial support to underpin the safe delivery. We found that there was a lack of capacity at the practice in relation to leadership and governance.
• There was evidence of the provider working with others in the locality to secure improvements.

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 care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Take steps to identify carers and offer them a health check or other support;
• Offer patients aged over 75 an annual health check.
• Obtain a hearing loop.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Our key findings were as follows:

• The practice had comprehensive systems for monitoring, responding to and learning from incidents when things went wrong.

• The practice was proactive in helping people with long term conditions to manage their health and had arrangements in place to make sure their health was monitored regularly.
• The practice was responsive to the needs of patients and operated a flexible system for routine and health review and promotion appointments.
• The practice performed above or in line with local and nationally set targets for assessing and meeting the needs of patients.
• The practice was well managed with staff and patients reporting that they felt valued and were involved in making decisions.

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

Importantly, the provider must:

• Ensure that patients and staff are protected against the risks of health acquired infections by carrying out periodic audits to test the effectiveness of the practice infection control procedures and other risks associated with the premises, making improvements to these practices where this is required.

In addition the provider should:

• Ensure that all staff who carry out chaperone duties undertake appropriate training in respect of their roles and responsibilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Amir Ipakchi’s Practice on 28 November 2017. The overall rating for the practice was requires improvement. Safe, Effective and Well-led were rated requires improvement, and Caring and Responsive were rated as good. The practice was issued with a warning notice to improve. The full report of the November 2017 inspection can be found by selecting the ‘all reports’ link for Dr Amir Ipakchi’s Practice on our website at .

This inspection was an announced focused inspection carried out on 15 May 2018 to confirm that the practice had made the required improvements to comply with the warning notice.

Our key findings across all the areas we inspected were as

follows:

• Training records showed staff had received training appropriate and relevant to their roles.
• Staff appraisals were provided at all levels throughout the practice.
• Evidence of staff members that required immunisation for their role was recorded.
• Policies and procedures were readily available for staff.
• Recruitment procedures and policies had been updated.
• Staff chaperone training had been carried out.
• DBS checks had been carried out for staff members undertaking the role of a chaperone.
• Prescription stationery was monitored for safety and held securely.
• The infection control policy had been updated to meet local and national guidance. However, the named infection control lead within the policy had not been trained to meet the responsibilities of their role. Risk assessments, monitoring and audits had not been undertaken by the named lead as stated within the policy.

Despite the absence of improvement in infection control, we found that the practice had made sufficient improvements and had complied with the warning notice. A further comprehensive inspection will be carried out later this year and we will check progress in relation to infection control. The practice will be rerated at the next inspection.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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