Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ericson Laudato on 10 March 2016. The overall rating for the practice was Good. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Ericson Laudato on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

At the inspection on 10 March 2016, the practice was rated overall as ‘good’. However, within the key question safe, areas were identified as ‘requires improvement’, as the practice was not meeting the legislation around ensuring that staff providing care or treatment to patients had the qualifications, competence, skills and experience to do so safely and in ensuring patients were fully protected against the risks associated with the recruitment of staff. There were deficiencies in the documentary evidence for safeguarding training of one member of the clinical staff and the documentation of appropriate pre-employment checks. The practice was issued a requirement notice under Regulation 12, Safe care and treatment and under Regulation 19, Fit and proper persons employed.

Other areas identified where the practice was advised they should make improvements with the key question of safe included:

• Ensure clinical meetings are minuted to provide an audit trail of discussion and agreed decisions and actions.
• Consider placing details of external safeguarding contacts within the practice’s safeguarding children policy.
• Ensure portable appliance testing arranged for immediately after the inspection is completed.
• Secure with the landlord of the premises the completion of planned works in the patient toilets and the implementation of action arising from the recent legionella risk assessment.
• Organise and document regular fire drills.

At our May 2017 inspection we reviewed the practice’s action plan submitted in response to our previous inspection and a range of supporting documents which demonstrated they are now meeting the requirements of Regulation 12, Safe care and treatment, and Regulation 19, Fit and proper persons employed, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice also demonstrated improvement in the other areas identified in the report from March 2016 which did not affect ratings. These improvements have been documented in the safe section, showing how the registered person has demonstrated continuous improvement since the full inspection.

Areas identified at the March 2016 inspection where the practice was advised they should make improvements within other key questions of effective and well-led included:

• Ensure arrangements for the completion of outstanding appraisals for administrative staff are concluded.
• Continue discussions with patients about setting up a patient participation group.
• Display information in the patient waiting area about the practice’s vision and values.

At our May 2017 inspection we found appraisals for administrative staff were up to date and complete.

We saw correspondence with patients inviting them to join a patient participation group (PPG). Despite these attempts the practice had still been unsuccessful in encouraging patients to join a PPG. However, the practice continued to seek patient feedback through other means including an ongoing patient satisfaction survey and the NHS Friends and Family test. We reviewed the latest responses to these and they were all positive about the care and treatment received.

The practice vision and values were now on display in the reception area.

However, there were areas of practice where the provider needs to make further improvements. In particular, the provider should:

• Ensure all electrical equipment is PAT tested at the annual inspection and testing of medical equipment arranged for July 2017.
• Complete the outstanding remedial action identified in the legionella risk assessment.
• Consider establishing a ‘virtual’ PPG (for example via email) to encourage patient participation in practice development and improvement.

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 Ericson Laudato on 10 March 2016. The overall rating for the practice was Good. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Ericson Laudato on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

At the inspection on 10 March 2016, the practice was rated overall as ‘good’. However, within the key question safe, areas were identified as ‘requires improvement’, as the practice was not meeting the legislation around ensuring that staff providing care or treatment to patients had the qualifications, competence, skills and experience to do so safely and in ensuring patients were fully protected against the risks associated with the recruitment of staff. There were deficiencies in the documentary evidence for safeguarding training of one member of the clinical staff and the documentation of appropriate pre-employment checks. The practice was issued a requirement notice under Regulation 12, Safe care and treatment and under Regulation 19, Fit and proper persons employed.

Other areas identified where the practice was advised they should make improvements with the key question of safe included:

• Ensure clinical meetings are minuted to provide an audit trail of discussion and agreed decisions and actions.
• Consider placing details of external safeguarding contacts within the practice’s safeguarding children policy.
• Ensure portable appliance testing arranged for immediately after the inspection is completed.
• Secure with the landlord of the premises the completion of planned works in the patient toilets and the implementation of action arising from the recent legionella risk assessment.
• Organise and document regular fire drills.

At our May 2017 inspection we reviewed the practice’s action plan submitted in response to our previous inspection and a range of supporting documents which demonstrated they are now meeting the requirements of Regulation 12, Safe care and treatment, and Regulation 19, Fit and proper persons employed, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice also demonstrated improvement in the other areas identified in the report from March 2016 which did not affect ratings. These improvements have been documented in the safe section, showing how the registered person has demonstrated continuous improvement since the full inspection.

Areas identified at the March 2016 inspection where the practice was advised they should make improvements within other key questions of effective and well-led included:

• Ensure arrangements for the completion of outstanding appraisals for administrative staff are concluded.
• Continue discussions with patients about setting up a patient participation group.
• Display information in the patient waiting area about the practice’s vision and values.

At our May 2017 inspection we found appraisals for administrative staff were up to date and complete.

We saw correspondence with patients inviting them to join a patient participation group (PPG). Despite these attempts the practice had still been unsuccessful in encouraging patients to join a PPG. However, the practice continued to seek patient feedback through other means including an ongoing patient satisfaction survey and the NHS Friends and Family test. We reviewed the latest responses to these and they were all positive about the care and treatment received.

The practice vision and values were now on display in the reception area.

However, there were areas of practice where the provider needs to make further improvements. In particular, the provider should:

• Ensure all electrical equipment is PAT tested at the annual inspection and testing of medical equipment arranged for July 2017.
• Complete the outstanding remedial action identified in the legionella risk assessment.
• Consider establishing a ‘virtual’ PPG (for example via email) to encourage patient participation in practice development and improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with five people who used the service, looked at 17 feedback questionnaires and spoke with a representative from the Clinical Commissioning Group (CCG). People told us that they were always able to see a GP when they wanted to. There were only two GPs working at the practice so people received good continuity of care. Comments from people included "absolutely excellent" and "fantastic doctors surgery. Helpful, thoughtful and professional".

People were involved in making decisions about their care. People told us they were given sufficient time with the GP to discuss their concerns and were referred to other services, if recommended by their GP. People understood the treatment required as the GP took time to answer their questions. The provider monitored the quality of the service by encouraging feedback from people, working with other relevant professionals and gathering evidence in order to meet the Quality and Outcomes Framework (QOF) indicators.

Care was planned and delivered in a way to ensure people's safety and welfare. People were seen and treated by qualified clinicians who had undergone the appropriate employment checks. There were out of hours doctor arrangements and people who were unable to come to the practice were visited in their homes. If staff were concerned about the welfare of a person who used the service, safeguarding policies and procedures were available. There were some arrangements in place to deal with medical emergencies.