This practice is rated as inadequate overall. (Previous rating February 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Dr Robinson & Partners on 27 November 2018 as part of our inspection programme.

At this inspection we found:

• There were processes for managing risks but they were not always effective. Risk assessments to mitigate risks from legionella or staff immunity to healthcare acquired infections had not been completed. All of the required recruitment checks had not been completed.
• A backlog of patient note summarisations and coding in patient records had occurred. The practice had put measures in place to address this.
• Not all staff had received up-to-date training. For example, safeguarding, chaperoning and fire safety.
• When incidents happened, the practice responded to them however, there was minimal evidence of learning from significant events and complaints.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. However, there was little evidence of multidisciplinary working to deliver safe care and treatment.
• An overarching system to monitor staff compliance with appraisals and required training was not in place.
• Staff were consistent and proactive in helping patients to live healthier lives.
• The practice organised and delivered services to meet patients’ needs. The elderly care facilitator supported older patients.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice offered 15-minute consultations and extended clinics when required. However, patient satisfaction with the appointment system was below the national average.
• The practice did not have a clear vision and credible strategy to deliver high quality, sustainable care.
• The arrangements for governance and management did not always operate effectively. Policies did not always reflect up-to-date guidance.

The areas where the provider must make improvements are:

• 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 training and appraisal necessary to enable them to carry out their duties.

Please refer to the requirement notice section at the end of the report for more detail.

The areas where the provider should make improvements are:

• Continue to monitor and improve the backlog of patient note summarisations and coding in patient notes.
• Update consent forms so they fully reflect the latest changes in legislation.
• Explore ways of obtaining the views of people who used the service.

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

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. Robinson and Partners practice on 02 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, responsive and caring services. It was also rated as good for providing services for all population groups.

Our key findings were as follows;

• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice offered extended opening hours every Wednesday from 6pm to 8pm.
• The practice linked with the Clinical Commissioning Group and other local providers to enhance services and share best practice.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

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

Importantly the provider should:

• Strengthen their record keeping to ensure that decisions relating to identified risks are considered and assessed; for example in respect of legionella and fire drills.
• Ensure prescribers on home visits before leaving the practice premises; record the serial numbers of any prescription forms/pads they are carrying.
• Consider ways of improving the systems in place to enable the practice to receive and act on patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this inspection to follow up on three areas of non-compliance from our previous visit. We spoke with staff as part of this inspection, although we did not speak with patients. We reviewed the action plan the provider sent us, detailing how they were going to address the issues.

A sign was in place asking patients to stand away from the reception desk when waiting to been attended to. We saw that patients respected this and queued away from the reception desk. This protected patients' privacy whilst speaking with the receptionist.

Access to the building had been improved as automatic doors had been installed. Fire evacuation procedures for patients were on display in the waiting room.

Staff had access to oxygen in the event of an emergency, and systems were in place to check the level of oxygen in the cylinders and the expiry date.

Disclosure and Barring Service (DBS) checks had been received or requested for all administration staff. The provider had recently recruited two new members of clinical staff. The DBS check was in place for one member of staff but not the other. The provider sent evidence of a DBS check from the person’s previous employment and told us they would request an updated check. The recruitment policy had not been updated to include the need to request a DBS check for appropriate staff or to consider if a DBS or a risk assessment would be sufficient.

On the day of our inspection we spoke with six patients and six members of staff. Prior to the inspection we spoke with a spokesperson from the patient participation group (PPG) who was also a patient. One patient told us, “The staff listen to me and I don’t feel rushed". Another patient told us, “It’s a really pleasant surgery. It’s very efficient and you don’t wait long to see the doctors".

We saw that patients experienced care and treatment that met their needs and complaints made by patients were responded to appropriately. Patients were cared for by suitably qualified, skilled and experienced staff but the provider had not always completed the relevant checks on staff before they started to work at the practice. We saw that patients were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

The provider has taken steps to provide care in an environment that was adequately maintained but patients who used the practice, staff and visitors were not fully protected against the risks of unsafe or unsuitable premises.

We previously carried out an announced comprehensive inspection at Dr Robinson & Partners on 27 November 2018 as part of our inspection programme. The practice was rated inadequate, placed into special measures and a warning notice in relation to good governance was issued. The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Dr Robinson & Partners on our website at

www.cqc.org.uk

.

We carried out an announced focused inspection at Dr Robinson & Partners on 25 January 2019 to ensure that the issues identified in the warning notice had been addressed. This report only covers our findings in relation to the warning notice.

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.
• information from the provider, patients and other organisations.

We found that:

• Learning from complaints and significant events had been used to improve care and treatment and a system of sharing the learning with staff had been put in place.
• Staff we spoke with were aware of the practice’s vision and values.
• A system had been implemented to obtain the views of patients who used the service.
• Staff had been provided with appraisals and staff meetings had been implemented.
• A system had been implemented to monitor and ensure that staff received the required training as identified by the practice.
• Polices and the business continuity plan had been updated to reflect current guidance.
• The practice worked with different teams and organisations in delivering care and treatment to patients with long-term conditions and patients nearing the end of their lives.
• Systems had been put in place to review and act on Medicines and Healthcare products Regulatory Agency alerts.
• Systems had been put in place to monitor that patients experiencing severe mental health received the appropriate care and treatment.
• A legionella risk assessment had been completed to mitigate potential risks to patients. However, evidence of the mitigating actions taken was not fully documented.
• The system to monitor that staff had the appropriate immunity to health care acquired infections was not effective.
• All the required recruitment documentation for the recruitment of locum GPs was not available.
• A system to track prescription stationery used in printers throughout the practice had been implemented. However, the system to track prescription pads was not effective.

At this inspection, we found that the provider had satisfactorily addressed most of the issues identified in the warning notice. However, there were areas where the provider remains in breach and must make improvements that we will follow up at our next inspection:

• Ensure that the mitigating actions taken to prevent legionella are fully documented.
• Ensure that the system for tracking prescription pads is effective.
• Ensure that systems for the recruitment of locum GPs are effective.
• Ensure that the system to monitor that staff have the appropriate immunity to health care acquired infections are effective.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice