Letter from the Chief Inspector of General Practice

This inspection of Dr B. Bekas was carried out on 3 May 2017 and was to check improvements had been made since our last inspection on 24 May 2016. Following our May 2016 inspection the practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe and well-led and good for effective.

The full focused report on the inspection can be found by selecting the ‘all reports’ link for Dr B. Bekas on our website at www.cqc.org.uk.

As a result of our findings at this inspection we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the inspection on 24 May 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

At this inspection we found that the improvements had been made across all areas of concern. Overall the practice is now rated as good.

Our key findings were as follows:

• Significant events were reported and fully investigated with actions identified to minimise reoccurrence. Lessons learned were shared at relevant meetings within the practice.
• There was a recruitment and induction process in place for both permanent and locum staff which included, where relevant, checks on professional registration, insurance and hepatitis B immunity status. The process also ensured that checks were completed to ensure that newly appointed staff were of good character and had suitable skills, knowledge and experience.
• We found there was a system in place to ensure that all equipment was safety tested and calibrated correctly.
• Cleaning materials were stored securely and appropriately.
• Written and verbal complaints were investigated and responded to appropriately.
• There were systems in place to monitor and improve the quality and safety of the services provided. This relates to systems for investigating and learning from when things go wrong and using this learning to reduce risks to patients and improve the service.

However, there was an area of practice where the provider needs still to make improvement.

The provider should:

• Ensure that copies of staff meeting minutes are easily accessible to staff.

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 focused inspection at the practice on 24 May 2016. This inspection was carried out to check that improvements had been made following our comprehensive inspection, which was carried out on 12 November 2015. At that time we identified areas which required improvement within the safe and effective domains. These issues were:

• The practice did not have robust systems in place for reporting, investigating or learning from significant events. The practice had only reported one event within the previous 12 months and there were arrangements for reviewing accidents, incidents or near misses to help improve safety.

• The practice procedures for recruiting new staff were not followed. Checks including proof of identity, evidence of skills and experience were not carried out.

• Relevant staff did not have a Disclosure and Barring Services (DBS) check and there was no risk assessment in place to determine that these checks were not required.

• The practice did not have oxygen or an automated external defibrillator (AED) for use in the event of a medical emergency. There was no risk assessment in place to support this decision and to identify and mitigate risks to patients.

• Clinical and diagnostic equipment had not been calibrated and some pieces of equipment such as the weight scales were damaged.

We issued a requirement notice under Regulation 12 of the Health and Social Care Act 2014 in relation to improvements that were required. The overall rating for the practice was requires improvement.

Additionally we found that some improvements were needed within the effective domain. The practice performance for outcomes for patients with diabetes was lower than other practices locally and nationally. The practice performance for patient uptake of cervical screening was also low and the practice had not been able to demonstrate what actions they had taken to address these issues.

We asked the practice to provide an action plan detailing how the areas for improvement were to be addressed. The practice submitted an action plan on 12 January 2016.

When we visited the practice on 24 May 2016 we reviewed the improvements made by the practice within the safe domain. We found:

• Significant events were reported and four had been reported since our last inspection. However these had not been fully reviewed and there were recorded actions to help minimise their recurrence.

• The practice manager told us that DBS checks had been carried out for all staff. They showed us the completed checks for a GP, two receptionists, one administrative member of staff and the practice nurse.

• One nurse recently employed at the practice had not been through a thorough recruitment process. This included a lack of recruitment checks such as proof of identity and confirmation that they were registered with their professional body.

• We found one blood pressure monitor in the GP’s room which had not been calibrated since 2014. We were not assured that other equipment in use at the practice had been calibrated.

• The practice did not have an Automated External Defibrillator and there was no risk assessment in place to support this decision.

• Written complaints were investigated and responded to appropriately. However verbal complaints and complaints were not consistently acted on and concerns arising from these were not followed up.

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

Importantly the provider must:

• Ensure that there are appropriate systems in place to monitor and improve the quality and safety of the services provided. This relates to systems for investigating and learning from when things go wrong and using this learning to reduce risks to patients.

• Ensure that appropriate checks are carried out for all newly appointed staff to determine that they are of good character and have suitable skills, knowledge and experience; and are registered with the relevant professional body if required.

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 B Bekas on 12 November 2015. Overall the practice is rated as requires improvement. We found that improvements were required in providing safe and effective services.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However we saw that the practice was under reporting safety incidents and there were no arrangements for dealing with or learning from near misses.
• Some risks to patients were not consistently assessed or well managed. There were systems for assessing risks including risks associated with medicines, premises and infection control. However we found that equipment required to asses and treat patients was not available such as oxygen and a defibrillator for use in dealing with medical emergencies. Some equipment we found was out of date and some had not been calibrated to ensure that it was fit for use.
• The practice recruitment policies were not followed consistently and not all of the checks including employment references and Disclosure and Barring Services (DBS) checks had been carried out for staff.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits and reviews were carried out to make improvements to patient care and treatment.
• Staff had received training appropriate to their roles. Staff performance was appraised and any further training needs had been identified and planned.
• 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. Complaints were investigated and responded to. However we found that not all elements of patient’s complaints were addressed or responded to in some cases.
• 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 these were accessible to patients.
• There was a clear leadership structure and staff felt supported by GP and practice manager. 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 patient safety are assessed and managed. This includes reporting, investigating and learning from safety incidents and near misses, ensuring that Disclosure and Barring Service (DBS) checks / risk assessments are carried out for relevant staff and ensuring that the practice is equipped to deal with medical emergencies and equipment is fit for use.

In addition the provider SHOULD:

• Improve the arrangements for following up on patients who do not attend health screening checks / flu vaccination clinics.

• Ensure that investigations into complaints take account of all elements of the complaint.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice