This practice is rated as Requires Improvement overall. (Previous inspection 17 November 2016 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Requires Improvement

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 Anis and Anis on 7 March 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There was evidence of learning and improvement when things went wrong, but the system for this was not clear or consistent.
• Staff recruitment and training records were incomplete.
• 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 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had not reviewed the results from the annual national GP patient survey 2017.

The areas where the provider must make improvements 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:

• Develop processes to improve the take up of cervical screening
• Review and consider how best to improve satisfaction scores from the national GP patient survey.
• The practice should take steps to increase awareness of medical emergencies across the clinical team.

• Review the system for appraisals for nursing staff.
• Staff should be made aware of the interpretation services available for patients.
• Introduce easy read materials for those patients that may need them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook this focused inspection of Dr Anis and Anis on 17 November 2016 for one area within the key question safe.

We found the practice to be good in providing safe services. Overall, the practice is rated as good.

The practice was previously inspected on 10 December 2015. The inspection was a comprehensive inspection under the Health and Social Care Act 2008. At that inspection, the practice was rated good overall. However, within the key question safe, overview of safety systems and processes was identified as requires improvement, as the practice was not meeting the legislation at that time; Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

• The registered person did not ensure recruitment arrangements include all necessary employment checks for all staff were in place that included taking up references and completing disclosure and barring service checks, in particular for staff who were already undertaking chaperoning duties.

On this inspection we reviewed a range of documents which demonstrated they were now meeting the requirements of Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

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 Anis and Anis on 10 December 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough.
• Risks to patients were assessed and well managed.
• 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. However staff had been undertaking chaperone duties but did not have a disclosure and barring service (DBS) check or risk assessment in place.
• 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.
• Patients said they found it easy to make an appointment with a named 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 not a clear leadership structure however 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.

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

Importantly the provider must:

• Ensure that a Disclosure and Barring Service (DBS) check or risk assessment is in place for staff who carry out the role of a chaperone.

Importantly the provider should:

• Ensure the clinical audit cycle is completed for all audits.
• The practice should consider having a formal structure for the review, implementation and audit of NICE Guidance.
• Ensure there are formal governance arrangements in place and staff are aware how these operate.
• Ensure that there is a record of all meetings that take place both internal and external to the practice and actions from these meetings are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On 18 October 2018 we carried out a full comprehensive inspection of Dr Anis and Anis. The practice was given an overall rating of inadequate and placed into special measures.

The domain ratings were:

Safe – Inadequate

Effective – Inadequate

Caring – Requires improvement

Responsive – Inadequate

Well-led – Inadequate.

Warning notices were issued in respect of Regulation 12 (safe care and Treatment and Regulation 17 (good governance).

This inspection, on 4 February 2019, was to check the requirements of the warning notices had been met. We found that significant progress had been made to meet the requirements of the warning notices, although some further improvement was still required.

In particular:

• The practice was a high prescriber of hypnotics and other medicines and now had a system in place for reviewing patients on these medicines.
• Test results received by the practice were now reviewed in a timely manner.
• There was an improved system in place to recall or follow up patients. However there were still some patients with long term conditions who had not got a recall or medication review in place.
• There was an effective system in place to follow up on patients who had failed to attend for an appointment including children.
• No non-clinical staff now undertook chaperone duties without training.
• There was now a policy in place in the event of the vaccine fridge temperature being out of range.
• All emergency medicines and single use items on the emergency trolley were in date.
• There was a business continuity (major incident) plan in place, however it was incomplete and there were still no staff trained to deal with major incidents.
• There were now records of staff immunisations held but this did not include all staff.
• A practice nurse was now the lead for infection prevention and control.
• Staff had received training on how to report and record significant events.
• There was a policy in place to determine which emergency medicines should be held in the practice.
• The system for managing safety alerts was now applied consistently.
• There was now a training matrix in place for staff training but not supported by a training plan.

The rating of inadequate awarded to the practice following our full comprehensive inspection on 18 October 2018 remains unchanged. The practice will be re-inspected and their rating revised if appropriate in the future.

Details of our findings are set out in the evidence table.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice