This practice is rated as Good overall. (Previous rating November 2017 – Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Isis Neoman on 30 March 2016 and the overall rating for the practice was Requires Improvement. We issued Requirement notices under Regulation 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

An announced comprehensive inspection was carried out on 15 November 2017 to confirm that the service had carried out their plan to meet the requirements in relation to the Requirement Notices issued. The overall rating for the practice was Inadequate and the practice was placed in special measures for a period of six months. Following the inspection, one Requirement Notice was issued under Regulation 19 and two warning notices were issued under Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive reports on the March 2016 and November 2017 inspections can be found by selecting the ‘all reports’ link for Dr Isis Neoman on our website at cqc.org.uk

This inspection was an announced comprehensive inspection carried out on 17 October 2018, six months after the report was published. The purpose of the inspection was to confirm if the service had made sufficient improvements and be removed from special measures. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• The practice had clear systems 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 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.
• The practice recently increased their opening hours to allow greater patient access. Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice actively sought patient views about their experience and quality of care and treatment. There was active Patient Participation Group who met with the practice on a regular basis.
• Results from the 2018 annual GP patient survey show patient satisfaction with the service had improved.
• The practice had adequate systems in place to supervise and monitor staff induction and training.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Governance arrangements ensured that there were clear and effective processes for managing risks, incidents and performance. Support staff had been recruited to ensure the findings of the previous inspection were addressed and improvements were made.

The areas where the provider should make improvements are:

• Update the complaint and significant event logs to include the learning from the investigations.
• Add a review date to the infection control policy.
• Take action to address identified concerns with medicine prescribing and management.
• Continue to monitor and improve performance on quality indicators for some of the patient outcomes where performance is below average.
• Act to review audits at their recommended timeframe.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. (Previous inspection was on 30 March 2016 and the practice was rated Requires Improvement overall)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The practice was rated as requires improvement for providing caring services and rated inadequate for providing safe, effective, responsive and well-led services. The issues identified as inadequate overall affected all patients, therefore all of the population groups were also rated inadequate:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Dr Isis Neoman also known as St George’s Medical Centre on 15 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice did not have adequate systems in place to keep patients safe and safeguarded from abuse.

• The practice did not have effective systems in place to keep clinicians up to date with current evidence-based practice.

• The practice did not have adequate systems in place to supervise and monitor staff induction and training.

• Results from the July 2017 annual national GP patient survey were mixed in relation to patient satisfaction with the service. Action was not taken to address low patient satisfaction scores.

• The practice did not actively seek patient views about their experience and quality of care and treatment.

• There were inadequate arrangements in place for patients requiring end of life care.

• The practice did not have a system in place for handling complaints and concerns.

• Governance arrangements did not ensure that there were clear and effective processes for managing risks, incidents and performance.

• There was some innovation in relation to improving the service for housebound patients.

The areas where the provider must make improvements as they are in breach of regulations 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.

• Establish effective sustems to ensure fit and proper persons are employed.

The areas where the provider should make improvements are:

• Establish a system of identifying and supporting carers.

• Advertise within the practice the provision of translation services for patients.

• Improve processes for making appointments.

• Consider improving communication with patients who have a hearing impairment and review the requirements of Accessible Information Standard (AIS) as per national guidelines.

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.

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 Isis Neoman on 30 March 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe; relating to recruitment checks, infection control and staff training.
• Data showed patient outcomes were low compared to the national average. Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice had a limited formal governance framework which supported the delivery of the strategy and good care.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.

The areas where the provider must make improvements are:

• Implement a programme of quality improvement to include clinical audits and re-audits to improve patient outcomes.
• Ensure that all staff access requisite training within mandatory timeframe, including basic life support.
• Ensure infection control arrangements follow best practice to mitigate identified risks, within a specific timeframe. Ensure a legionella risk assessment is undertaken by the practice to mitigate any identifiable risk.

The areas where the provider should make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure all staff undertaking chaperone duties are trained to carry out this role effectively.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Review the arrangements at reception to ensure patient confidentiality is maintained at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice