We carried out an announced comprehensive inspection at Dr Jedth Phornnarit (Garway Medical Practice) on 14 September 2017. The overall rating for the practice was Requires Improvement. The full comprehensive report on the 14 September 2017 inspection can be found by selecting the ‘all reports’ link for Dr Jedth Phornnarit on our website at www.cqc.org.uk.

This inspection, on 13 September 2018, was an announced comprehensive inspection to confirm that the practice had carried out their plan to meet the requirements that we identified in our previous inspection on 14 September 2017. This report covers our findings in relation to those requirements and any improvements made since our last inspection. The practice is now rated as Good overall.

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

At this inspection we found:

• The practice had addressed the findings of our previous inspection in respect of the management of infection prevention and control, medicine management, clinical protocols, staff appraisals and clinical supervision.
• There were systems in place to safeguard children and vulnerable adults from abuse and staff we spoke with knew how to identify and report safeguarding concerns.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. When incidents did happen, the practice learned from them and improved their processes.
• Clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols.
• Some patient outcomes, in particular the cervical screening programme, fell below national targets. However, we saw that some improvements had been made and the practice had plans in place to further address these shortfalls.
• Results from the national GP patient survey showed patients rated the practice comparable with others for aspects of caring. Patients told us they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of feedback.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Review the system for sharing and discussing new evidence-based practice with GPs.
• Consider undertaking clinical audits relating to current evidence-based guidance, for example, NICE.
• Continue to monitor patient outcomes in relation to the cervical screening and the child immunisation programme.
• Review the process to feedback to practice staff the outcomes from external meetings attended by the principal GP.

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

We carried out an announced comprehensive inspection at Dr Jedth Phornnarit (Garway Medical Practice) on 3 September 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the 3 September 2015 inspection can be found by selecting the ‘all reports’ link for Dr Jedth Phornnarit on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 14 September 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 3 September 2015. This report covers our findings in relation to those requirements and any improvements made since our last inspection.

Overall the practice is rated as requires improvement.

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

• Although the practice had addressed all the issues identified as requiring improvement at our previous inspection we found additional concerns relating to some aspects of infection prevention and control and medicine management.
• Staff were aware of current evidence based guidance and were trained to provide them with the skills and knowledge to deliver effective care and treatment. However, clinical protocols were not available to support the entire scope of responsibility undertaken by some clinical support staff and there was no regular or formal mentoring and clinical supervision in place.
• The practice had not undertaken formal staff appraisals since 2014.
• Data showed patient outcomes were low compared to the local and national averages for cervical screening uptake and childhood immunisations.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events and acting upon patient safety alerts.
• Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they could make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement 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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvement are:

• Continue to monitor patient outcomes in relation to the childhood immunisation and the cervical screening programme.

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 Jedth Phornnarit’, also known as Garway Medical Practice, on 3 September 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Systems were in place to report and record significant events, incidents, and near misses, however information about safety was not always documented. Learning from incidents was shared with staff.
• Some risks to patients were assessed and well managed, with the exception of those relating to dealing with medical emergencies and fire safety.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Most 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.
• Most patients said they found it easy to access the service and make an appointment, although many patients commented on waiting for long periods after their appointment time to be seen.
• Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

Importantly, the provider must:

• Ensure staff have access to medical oxygen in the event of a medical emergency.
• Ensure safety incidents are recorded and reviewed.
• Carry out an up to date fire risk assessment and ensure staff receive appropriate training in fire safety.

In addition the provider should:

• Carry out a comprehensive risk assessment to manage infection prevention and control.
• Formalise the practice’s vision and values and ensure staff are made aware of this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Dr Jedth Phornorrit provides primary care services at the Garway Medical Practice in West London. The practice provides care to a diverse local community of approximately 4500 patients. Services provided include antenatal care, child health and immunisation, chronic disease management, counselling, cognitive behavioural therapy and end of life care. The service is not available out-of-hours or at the weekend.

The practice is registered with the Care Quality Commission to provide the following regulated activities: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures; and treatment of disease, disorder or injury.

We carried out an announced inspection of the service on 14 May 2014. We spoke with eight patients attending the practice on the day of the inspection and collected six comment cards which patients had completed about the service in the days running up to the inspection.

The practice provided a safe service with systems in place to manage risks associated with infection control, medicines management, staff recruitment, child protection and adult safeguarding and medical emergencies. There were mechanisms to investigate and learn from incidents and complaints. The practice provided an effective service. Patients’ needs were assessed and treatment and referral patterns were in line with current guidelines and best practice. Staff participated in collaborative clinical audits and external peer group meetings and used this evidence to improve.

Patients told us the service was caring. Most patients we spoke with were happy with the service they received at the practice. They said they were involved in decisions about their treatment. We observed that reception staff were usually polite although on occasion their interactions were less positive. The practice was responsive to the needs of its patients. The practice provided services tailored to particular patient groups, routinely booked interpreters for patients and had extended its opening hours. Patients were able to access appointments when they needed them although some patients told us they had to wait several weeks to book an appointment with their preferred doctor. The practice did not yet enable patients to book appointments online. The practice promoted health and prevention of illness but written information for patients tended to be available in English only.

The service was well-led in some respects but some areas needed improvement. The practice ethos was to put patients first and provide a high quality service. There were governance arrangements in place and an open reporting culture. However, we found that incident reports and an in-house cytology audit were poorly documented. We were also concerned that some clinical incidents might be missed for review because the system for collating them was not robust. The practice had not developed an in-house audit plan and was not yet exploiting the full potential of its information technology for quality assurance. The practice benefitted from an active patient participation group and acted on patient feedback. However members of the patient participation group were concerned that communication was sometimes difficult. The practice did not have a development plan for longer term growth and had not carried out any succession planning despite a number of doctors leaving.