Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at

Dr Wageeh Mikhail on 23 June 2015. The overall rating for the practice was good. The practice was rated as good in all domains except for the ‘safe’ domain which was rated as ‘requires improvement’. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Dr Wageeh Mikhail on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 February 2017 to confirm that the practice had carried out their plan to make recommended improvements identified in our previous inspection on 23 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good

Our key findings were as follows:

• Our previous inspection highlighted concerns regarding the tracking and monitoring of blank prescription forms and pads and how these were handled. Action had been taken to address these concerns and we observed a comprehensive, safe and effective tracking system in place.
• Our previous inspection highlighted concerns regarding the assessment of risks to patients and staff. The practice had taken action immediately and procured an external company to make a full comprehensive health and safety risk assessment for the practice. This had generated an action plan and we saw that all actions had been taken to address any shortfalls. We also observed that staff were aware of the importance of health and safety in the workplace and that risk assessments were completed where required. We also noted that health and safety issues and risk assessment was discussed at practice meetings and reception meetings. They had also implemented a hazards/risk matrix which was accessible on the practice’s computer for all staff to log health and safety issues and risk. These were discussed and actions taken to address them.
• Our previous inspection highlighted that, although records of minor surgical procedures were being maintained, these did not include detail about the outcomes of the procedures. Action had been taken and we saw that a formal audit had been conducted based on the information collated for 2014 to 2015 and that comprehensive information was being collected for April 2016 to March 2017 in preparation for a formal audit. The information collected included outcomes of the procedure, histology reports, consent, post-operative infection, and referrals to secondary care.
• Our previous inspection highlighted that recruitment checks for new staff needed to be strengthened. We saw that action had been taken and that the three new staff recruited since the June 2015 inspection had appropriate checks and comprehensive records were maintained. This included DBS checks and an updated, comprehensive reference request from previous employers. We also noted that new staff were required to sign a confidentiality agreement and this was kept in their staff file.
• Since the June 2015 inspection, the practice had actively reviewed some of their processes and made changes where required to improve these. Staff were encouraged to share ideas for improvement. For example; a newly recruited a reception supervisor identified two areas for improvement within the reception area. These were discussed with management which resulted in additional training for staff in use of spillage kits and a protocol was drawn up to support this. A protocol was also implemented to support reception staff in managing ‘ad hoc’ specimens brought to the practice by patients and allied health professionals. The protocol included use of a checklist to ensure sufficient information was obtained prior to accepting the specimen

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 Wageeh Mikhail on 23 June 2015. The overall rating for the practice was good. The practice was rated as good in all domains except for the ‘safe’ domain which was rated as ‘requires improvement’. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Dr Wageeh Mikhail on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 February 2017 to confirm that the practice had carried out their plan to make recommended improvements identified in our previous inspection on 23 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good

Our key findings were as follows:

• Our previous inspection highlighted concerns regarding the tracking and monitoring of blank prescription forms and pads and how these were handled. Action had been taken to address these concerns and we observed a comprehensive, safe and effective tracking system in place.
• Our previous inspection highlighted concerns regarding the assessment of risks to patients and staff. The practice had taken action immediately and procured an external company to make a full comprehensive health and safety risk assessment for the practice. This had generated an action plan and we saw that all actions had been taken to address any shortfalls. We also observed that staff were aware of the importance of health and safety in the workplace and that risk assessments were completed where required. We also noted that health and safety issues and risk assessment was discussed at practice meetings and reception meetings. They had also implemented a hazards/risk matrix which was accessible on the practice’s computer for all staff to log health and safety issues and risk. These were discussed and actions taken to address them.
• Our previous inspection highlighted that, although records of minor surgical procedures were being maintained, these did not include detail about the outcomes of the procedures. Action had been taken and we saw that a formal audit had been conducted based on the information collated for 2014 to 2015 and that comprehensive information was being collected for April 2016 to March 2017 in preparation for a formal audit. The information collected included outcomes of the procedure, histology reports, consent, post-operative infection, and referrals to secondary care.
• Our previous inspection highlighted that recruitment checks for new staff needed to be strengthened. We saw that action had been taken and that the three new staff recruited since the June 2015 inspection had appropriate checks and comprehensive records were maintained. This included DBS checks and an updated, comprehensive reference request from previous employers. We also noted that new staff were required to sign a confidentiality agreement and this was kept in their staff file.
• Since the June 2015 inspection, the practice had actively reviewed some of their processes and made changes where required to improve these. Staff were encouraged to share ideas for improvement. For example; a newly recruited a reception supervisor identified two areas for improvement within the reception area. These were discussed with management which resulted in additional training for staff in use of spillage kits and a protocol was drawn up to support this. A protocol was also implemented to support reception staff in managing ‘ad hoc’ specimens brought to the practice by patients and allied health professionals. The protocol included use of a checklist to ensure sufficient information was obtained prior to accepting the specimen

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with six patients and one member of the Patient Participation Group (PPG). The Patient Participation Group is a group of volunteers who work together with the practice to improve services and to promote health and improved quality of care. Patient feedback about the care and treatment received was mixed. All but one patient told us they had difficulty getting an appointment to see a doctor in a timely period. One patient told us they could always get a doctor’s appointment for their young child.

Patients told us there was a large turnover of doctors working at the practice and this affected the continuity of their care. All but one patient told us that the staff were very nice and friendly. During our inspection we saw that all staff were professional and they spoke with patients in a relaxed and appropriate manner.

The representative of the PPG offered mostly positive comments about the practice. They were aware of and fully informed of the services on offer such as; on line services, mobile text messaging and the triaging system. The only concern expressed was in relation to the waiting times to see a doctor. They told us they did not have any concerns in respect of appointments, they were happy with the service received.

We reviewed a significant number of patient records .The records were reviewed as specific concern had been raised about the use of urgent care pathways. We found that care and treatment was planned and delivered in a way that ensured most people’s safety and welfare. The quality of record keeping by the several GPs who had worked in the practice showed marked variation. However the practice did not always work in co-operation with other health providers to protect patients’ health, safety and welfare.

Effective recruitment and selection processes did not always take place; and the practice had not always followed their own policies and procedures. We found some staff had received training and professional development; however suitable systems were not in place to assure that locum clinicians had received an appropriate induction and training.

The provider had some systems in place to assess and monitor the quality of service that people received. However, improvements were required to ensure the health, safety and welfare of people using the service and others. Most people’s personal records including medical records were accurate and fit for purpose.