We previously carried out an announced comprehensive inspection at Dr Guindy and Partners (also known as Orchard Surgery) on 22 January 2018. The overall rating for the practice was requires improvement. Breaches of legal requirements were found, and requirement notices were served in relation to safe care and treatment and good governance. The full comprehensive report from the 22 January 2018 inspection can be found by selecting the ‘all reports’ link for Dr Guindy and Partners on our website at www.cqc.org.uk

This inspection was an announced comprehensive inspection carried out on 5 March 2019 as part of our inspection programme for services rated as requires improvement, and to confirm that the practice met the legal requirements in relation to the breach in regulations identified at our previous inspection.

At the last inspection in January 2018 we rated the practice as requires improvement for providing safe services because:

• Patient safety alerts from the Medicines and Healthcare Products Regulatory Agency (MHRA) were not always acted on.
• The practice had not carried out a risk assessment to reflect the emergency medicines required in the practice for the range of treatments offered and the conditions treated. The practice had not carried out a risk assessment to reflect the decision not to carry emergency medicines in doctor’s bags.
• Some patient group directives (PGD’s) had not been appropriately signed.

At this inspection, we found that the provider had satisfactorily addressed these areas.

At the last inspection in January 2018 we rated the practice as requires improvement for providing a well led services because:

• The practice did not have certificates in place to show that electrical periodic inspection tests had been completed and the risk of blind loops had not been assessed. Asbestos assessments were not in place for the main surgery and the branch surgery.
• Fire drills were not recorded.
• Practice policies, procedures and activities did not always govern practice, for example we saw that staff did not work within the chaperone policy.
• There was a lack of recording of performance for example in meeting the requirements of the Infection Prevention and Control (IPC) audit.
• Verbal complaints were not always responded to and acted upon.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 good overall and good for all population groups.

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider should consider improvements are;

• Continue to improve on the numbers of carers on the practice carer register.
• Consider verbal complaint monitoring further to remove elements of subjectivity.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. We previously inspected the service in November 2014 and rated the practice as Good overall. The practice had displayed their ratings in a prominent place within the surgery.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

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 Guindy and Partners (also known as Orchard Surgery) on 22 January 2018 as part of our inspection programme.

At this inspection we found:

• The practice had some systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice hadsome systems to keep patients safe and safeguarded from abuse.

• The systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff needed strengthening. For example, window blinds had loop cords attached to them; however there was no risk assessment in place to manage the risk to patients.

• There was a system to manage infection prevention and control and patients commented that the practice was always clean. However, there was a lack of evidence to show how the action plan was being updated with their progress in meeting the requirements of the Infection Prevention and Control (IPC) audit.

• 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 identified 339 (3%) of the patient list as carers and signposted them to local services offering support and guidance.

• Staff stated they felt respected, supported and valued.

• The practice listened and acted on issues raised by the patient participation group.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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:

• Document the outcome of fire drills.

• Record and act on verbal complaints received about the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected this service on 21 November 2014 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found that the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

Our key findings were as follows:

• Patients were kept safe because there were arrangements in place for staff to report and learn from key safety risks. The practice had a system in place for reporting, recording and monitoring significant events over time.
• The practice operated a telephone triage managed by the practice nurses, which enabled patients to access same day appointments.
• There were systems in place to keep patients safe from the risk and spread of infection.
• Evidence we reviewed demonstrated that patients were satisfied with how they were treated and that this was with compassion, dignity and respect. It also demonstrated that the GPs were good at listening to patients and gave them enough time.
• Staff were clear about their own roles and responsibilities, and felt valued, well supported and knew who to go to in the practice with any concerns.

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

The provider should:

• Complete a legionella risk assessment on completion of the improvement work to the nurses’ room.
• Have a system to check stock levels and audit to ensure all medicines remain in date and safe to use.
• Obtain all required employment checks prior to employment of all new staff.
• Inform patients that they can request to speak with the receptionist in private if required.
• Make the minutes of the patient participation group meetings available to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice