Dr Christopher John George Wright (The Deerbrook Surgery) is a provider registered with CQC.

We carried out an inspection of the provider on 13 February 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall and requires improvement for all population groups.

We rated the practice as inadequate for providing safe services because:

• The practice did not have appropriate systems in place for the safe management of medicines as there was no effective system in place to ensure prescriptions were securely stored and their use monitored and patients taking high risk medicines were not consistently being monitored in line with current guidance and legislation. The provider submitted details of an action plan to address concerns around high risk drug monitoring after our inspection.

• Staff had not all completed safeguarding, fire and infection control training.
• There were no systems in place to monitor indemnity arrangements or the professional registrations of clinical staff.
• Safeguarding arrangements and the mechanisms for reporting significant events were not clear.
• The practice had not carried out a risk assessment to determine how to manage medical emergencies, and did not have the full range of recommended medicines available. The provider told us that they had purchased this missing medicines after our inspection.

We rated the practice as inadequate for providing well-led services because:

• There was a lack of future planning to ensure sustainability of the services.
• Governance was lacking in key areas including safeguarding, significant event management, policy oversight and the management of medicines which meant that key areas of risk had not been adequately assessed or addressed.
• There was a lack of effective oversight of staff training and recruitment information.
• There was limited action taken in response to below average feedback or performance and limited evidence of continuous improvement or innovation.

We rated the practice as inadequate for providing effective services because:

• The practice did not have systems to review and monitor the quality of care provided by locum staff and not all staff were being regularly appraised.
• Care planning was not being used by staff working at the practice
• Staff had not completed all required training.
• Performance indicators for patients with COPD, dementia, childhood immunisation and bowel screening were below the local and national averages.
• The practice did not always undertake effective joint working with other organisations.

We rated the practice as requires improvement for responsive services because:

• Patients did not have regular access to a female GP at the practice and staff reported that they did not have adequate clinical staffing.
• The complaint policy was not immediately accessible to patients and policy staff provided to patients was out of date.
• Some patients fedback that care and treatment was difficult to access. The practice had not undertaken any action in response to below average national patient survey results around access.

These areas in effective and responsive services affected all population groups so we rated all population groups as requires improvement

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue with work to improve the quality of care provided to people with long term conditions, people experiencing poor mental health and families children and young people.
• Introduce care planning for patients with complex medical conditions so that information is shared effectively with other services.
• Consider and develop a policy around the frequency of DBS checks to be completed for staff.
• Formalise systems for recording action taken in response to patient safety alerts.
• Implement a formal process for reviewing patients discharged from hospital and assessing frailty.
• Implement systems to identify and follow up children living in disadvantaged circumstances and who were at risk.
• Put plans in place aimed at addressing issues of future sustainability.
• Take action in response to patient feedback related to access.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Christopher John George Wright, aka The Deerbrook Surgery on 26 November 2014.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for population groups including older people; people with long term conditions; mothers, babies, children and young people; the working age populations and those recently retired; people in vulnerable circumstances and people experiencing poor mental health.

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

• There were systems in place for reporting, recording and monitoring significant events to help provide improved care. Staff were clear of their roles in regards to monitoring and reporting of incidents, safeguarding vulnerable people and children, and following infection prevention and control guidelines.

• Staff shared best practice through internal arrangements and meetings and also by sharing knowledge and expertise with external consultants and other GP practices. There was a strong multidisciplinary input in the service delivery to improve patient outcomes.

• Feedback from patients about their care and treatment was very positive. Patients were treated with kindness and respect and felt involved in their care decisions.

• The practice was responsive to the needs of vulnerable patients and there was a strong focus on caring and on the provision of patient-centred care. The practice also provided Information on health promotion and prevention, on the services provided by the practice and on the support existing in the community that was available for patients.

• The practice has a clear vision and strategic direction which was to improve the health, well-being and lives of those that they care for at the practice. Staff were suitably supported and patient care and safety was a high priority.

We saw several areas of outstanding practice including:

• The practice worked in partnership with a local community initiative, Lambeth ‘message in a bottle’ program’ to provide vulnerable patients with a holistic service.

• The ‘message in a bottle’ programme is a process for the practice to share agreed information with other care providers such as district nurses and health visitors who have contact with a patient, and to ensure this information is correct and up to date. This initiative, which during routine visits and in the event of an emergency attending clinicians are signposted to ‘the community green sticker initiative’, where patient related information can be viewed to indicate, who their GP is, key medical problems, what treatment, allergies and medications are currently being taken by the patient.

• The practice was working in partnership with its patients, and their carers, and had arranged to have digital key locks fitted to elderly/house bound patient’s front door so HCA could enter to obviate need for patients with poor mobility to struggle to the front door.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice