Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (Previous inspection 9 September 2016 was rated as requires improvement overall).

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? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The key questions in safe and well-led are rated as requires improvement, so this has affected the rating for all the population groups:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

We carried out an announced comprehensive inspection at Dr Waleed Doski on 7 November 2017 to follow up on breaches of regulations.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. Lessons learned from significant events, incidents and near misses were recorded and shared with staff and external agencies where appropriate.
• Oversight for recording, actioning and tracking patient safety alerts was not effective.
• Outstanding issues from the fire risk assessment, dated June 2013, had been actioned.
• An oxygen cylinder was now stored on the premises.
• 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.
• The practice achieved maximum points in the Quality and Outcomes Framework for 2016/17.
• Quality improvement activities, including audits, were carried out on a regular basis.
• Formal minutes were taken for meetings, so that there was a record of discussions, decisions and any actions required.
• 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.
• Patients commented that they valued the continuity of care provided by the GP.
• Results from the National GP Patient Survey 2017 showed a marked improvement to patient experience in relation to treating patients with dignity and respect and involving them in decisions about their care.
• The practice nurse provided appointments for four more hours per week than at the previous inspection, but the appointments were only available on two days during the week.
• Patients had access to a female GP at a nearby practice.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The area where the provider must make improvements is:

• 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:

• Review the system for monitoring sepsis with reference to the National Institute for Clinical Excellence (NICE) guidelines and Quality Standards for Sepsis, published in September 2017.
• Review the procedure for determining and documenting whether Disclosure and Barring Service (DBS) checks are transferable for individual members of staff.
• Review the staff training log on a regular basis to ensure that current training is logged and that staff are trained to the level appropriate for their role.

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 Waleed Doski on 28 September 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 a system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, there was no formal evidence that lessons learned were shared amongst the team.
• Risks to patients were assessed and managed, with the exception of risks identified in a fire risk assessment carried out in 2013. Risks identified had not been actioned.
• The practice had taken the decision not to keep oxygen on the premises and had documented their rationale for this decision.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received training to enable them to have the necessary skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with kindness, dignity and courtesy and that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with the GP and there was continuity of care, with urgent appointments available the same day. Although there was a system for patients to see a female GP, this was not advertised in the reception area.
• Practice nurse appointments were available for 10 hours per week over three days.
• The practice had reasonable facilities and was sufficiently equipped to treat patients and meet their needs.
• The GP spoke Kurdish and Arabic, which was appreciated by their patients who spoke those languages. The practice also accepted patients who spoke these languages from outside the catchment area.
• There was a leadership structure and staff said that they were supported by the management team. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was an ethos of care, but it was not underpinned by effective protocols.

The areas where the provider must make improvement are:

• Implement formal governance arrangements including systems for assessing and monitoring risks to the health and safety of service users.
• Take action to address outstanding issues identified in the fire risk assessment of June 2013.
• Carry out a satisfactory risk assessment around the practice’s ability to meet urgent patient needs in an emergency.

The areas where the provider should make improvement are:

• Review the frequency of quality improvement activities such as clinical audit to ensure that improvements to patient outcomes are monitored and maintained.
• Consider ways to improve patient experience in relation to treating patients with dignity and respect and involving them in decisions about their care.
• Introduce processes to ensure that any lessons learned from significant events, incidents and near misses are recorded and shared amongst all staff.
• Carry out risk assessments on long standing members of staff who do not have a CRB or DBS check.
• Keep the decision not to store oxygen on the premises under regular review.
• Carry out and record regular visual checks and portable appliance testing in accordance with Health and Safety Executive guidelines for maintaining equipment.
• Ensure that all staff know where to find practice policies on the intranet.
• Undertake a formal risk assessment before accepting a previously issued Disclosure and Barring Service (DBS) check for a new employee. Amend the DBS policy accordingly.
• Ensure that the prescriptions in the GP’s bag are tracked.
• Ensure that formal minutes are taken for meetings, so that a record can be kept of discussions, decisions and any actions required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out a previous inspection on 26 June 2013. We found that the provider was in breach of four Regulations.

During this inspection we reviewed all of the breaches and found that the provider had made significant improvements. We evidenced compliance with the four Regulations. We did this by speaking with the practice manager, the lead receptionist and we looked at documentation. We also checked the hygiene levels in the consulting rooms and the waiting room.

All staff had received safeguarding training and they had access to written guidance. The practice manager and lead receptionist demonstrated that they would take appropriate action if they had concerns about a patient's safety.

The practice was clean, tidy and well organised. An infection control audit had been carried out. It included actions where improvements could be made.

Fire safety systems were in place that protected patients from risks of injuries.

A schedule of works for Portable Appliance Testing (PAT) checks was in place and the landlord had been asked to check the electrical wiring supply to the building. Fire and water supply risk assessments had been carried out to protect patients from unnecessary injuries and illness. Staff had received annual appraisals and were supported in developing further skills. Systems were in place to monitor staff practices in respect of hygiene and infection control.

On the day of our announced inspection we spoke with five patients and four members of staff. We later spoke with a spokesperson from the patient participation group (PPG) who was also a patient. One patient told us: “Generally I am happy and I have been coming here for many years". Another patient told us: “Very favourable. I would be very sorry if it changed. It suits me I don't want X (doctor) to leave".

We saw that patient’s views and experiences were taken into account in the way the service was provided and that they where treated with dignity and respect. When patients received care or treatment they were asked for their consent and their wishes were listened to.

Staff had not received training in safeguarding children and vulnerable adults and there was little written guidance for them to follow if abuse was suspected.

Most areas of the practice were clean and organised. However the practice nurse's room was visibly dirty. This failed to demonstrate that risks of infections were minimised.

We found that safety systems were not fully in place. This meant that patients were not fully protected against the risks of unsafe or unsuitable premises.

The provider had some systems in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standards of the services they received. We found that further work was needed to demonstrate compliance with this outcome.