Dr WJ Degun's and Dr OO Macaulay Practice, Lee Chapel South, Basildon.
Dr WJ Degun's and Dr OO Macaulay Practice in Lee Chapel South, Basildon is a Doctors/GP specialising in the provision of services relating to diagnostic and screening procedures, family planning services, maternity and midwifery services, services for everyone, surgical procedures and treatment of disease, disorder or injury. The last inspection date here was 22nd February 2018
Dr WJ Degun's and Dr OO Macaulay Practice is managed by Dr WJ Degun's and Dr OO Macaulay Practice.
Contact Details:
Address:
Dr WJ Degun's and Dr OO Macaulay Practice 93 The Knares Lee Chapel South Basildon SS16 5SB United Kingdom
Letter from the Chief Inspector of General Practice
This practice is rated as good overall. (Previous inspection 26 June 2017– Requires Improvement)
The key questions are rated as:
Are services safe? – Good
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 population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those 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 WJ Degun’s and Dr OO Macaulay Practice, also known as The Knares Medical Practice on 26 June 2017. The overall rating for the practice was requires improvement. We issued the practice with a warning notice in relation to the governance at the practice.
We carried out a focused inspection on 14 November 2017 and we found that the practice had met the requirements of the warning notice as sufficient improvements had been made. The full comprehensive report of both the June 2017 and November 2017 inspections can be found by selecting the ‘all reports’ link for Dr WJ Degun’s and Dr OO Macaulay Practice on our website at www.cqc.org.uk.
This inspection was a comprehensive inspection carried out on 23 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulations that we identified in our previous inspection on 26 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 now rated as good.
Our key findings were as follows:
The provider had put in place an effective action plan to make improvements.
There was now open and transparent leadership. There were regular minuted meetings with clinicians, local practices, other providers and all practice staff.
Staff were supported and trained. The infection control lead had received appropriate training. Staff were supported to undertake additional training relevant to their role.
Areas of underperformance had been identified. Unverified data indicated improvement.
All chaperones had received a Disclosure and Barring (DBS check) to assess their suitability for the role.
Systems to learn from significant events had been improved. Risk was effectively managed 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. This was discussed with clinicians, staff, other practices and stakeholders. The practice 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 had identified patients who had been identified as carers. Carers were provided with support when they needed it.
More GPs and nurses had been recruited and patients reported that they were able to access care when they needed it.
There was a strong focus on continuous learning and improvement at all levels of the organisation.
The provider encouraged staff at all levels to attend neighbouring practices to review and improve their ways of working. Staff presented their analysis at a team meeting and changes were made as a result of their findings.
However, there were also areas of practice where the provider should make improvements.
The provider should:
Review, monitor and improve antibiotic prescribing.
Improve uptake of breast cancer screening for women aged 50-70 within six months of invitation.
Continue to monitor and improve patient feedback in relation to GP’s explanation of tests and treatments.
Facilitate regular meetings with the Patient Participation Group.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr WJ Degun’s and Dr OO Macaulay Practice, also known as The Knares Medical Practice on 26 June 2017. The overall rating for the practice was requires improvement. Specifically the practice was rated as inadequate for providing well-led services, requires improvement for safe and effective and good for caring and responsive. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Dr WJ Degun’s and Dr OO Macaulay Practice on our website at www.cqc.org.uk.
As a result of the issues identified on the day of the inspection we took enforcement action against the provider and issued them with a warning notice in relation to the governance at the practice. The practice was required to be compliant with the warning notice by 10 November 2017.
This inspection was an announced focused inspection carried out on 14 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the warning notice that we issued after our previous inspection on 26 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Our key findings were as follows:
The provider had put in place an effective action plan to meet the requirements of the warning notice.
There was now open and transparent leadership.
Regular, minuted meetings took place which involved all staff.
Staff were supported and trained. The infection control lead had received appropriate training.
Areas of underperformance had been identified. Unverified data indicated improvement.
All chaperones had received a Disclosure and Barring (DBS check) to assess their suitability for the role.
Letter from the Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection at Dr WJ Degun’s and Dr OO Macaulay Practice, also known as The Knares Medical Practice on 16 May 2016. At that time, the overall rating for the practice was requires improvement. It was rated as requires improvement for providing safe, effective and well-led services, and good for caring and responsive. The full comprehensive report of the 16 May 2016 inspection can be found by selecting the ‘all reports’ link for Dr WJ Degun’s and Dr OO Macaulay Practice on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 20 June 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 16 May 2016. So that we could provide a rating for the practice, we inspected all domains and key questions. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice continues to be rated as requires improvement following our most recent inspection.
Our key findings across all areas we inspected were as follows:
Sufficient action had not been taken to improve since our previous inspection of 16 May 2016.
Significant events were recorded although these continued to show little evidence of review and shared learning.
There was a system in place to ensure that patients on high risk medicines were receiving regular blood tests.
Relevant risk assessments had now been completed, including those that related to health and safety and legionella.
The infection control lead had not received relevant and up to date training for the role.
Prescription stationery was tracked and stored securely.
Recruitment checks had been improved for new members of staff. However, not all staff who may have been requested to undertake chaperone duties had a DBS check or a risk assessment to ascertain if one was necessary. This was contrary to the provider’s action plan. There was no DBS check for one member of the clinical team.
Outcomes for patients continued to be in line with or below national and local averages. The practice was not aware of the reasons for underperformance and therefore, had not implemented an action plan to improve.
Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment had improved. Patients continued to respond positively about the care they received from the practice.
Improvements had been made to safeguarding processes. Relevant patient records clearly identified to all clinicians those patients identified as the subject of safeguarding concerns.
Pictorial aids were available to enable patients with learning disabilities to be involved in their care. Patients with learning disabilities were invited an annual health check.
Carers were now routinely identified and invited to a routine health check.
The premises were modern and well equipped to ensure services were accessible including a lift and a car parking space for patients who had a disability.
There were a range of services available on site including ultrasound, phlebotomy and counselling.
A health visitor, midwife and COPD nurse held weekly clinics at the practice.
There was not an open, transparent relationship between all staff who worked at the practice. This was also the case at our previous inspection. Although staff received an appraisal, this did not consistently evidence a discussion, despite staff raising concerns about their employment.
There was effective working with other healthcare professionals. Care plans for patients receiving palliative care were routinely updated.
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.
An area where the provider should make improvements is:
Continue to identify more patients who are carers and provide them with appropriate support.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr WJ Degun's Practice on 16 May 2016. Overall the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
Significant events were recorded although this was brief and showed little evidence of review and shared learning.
Risks at the premises were not always assessed and well managed. These included an effective health and safety risk assessment, the risk associated with legionella and the security and issue of prescription stationery.
Recruitment checks were not always robust in relation to employment checks.
Not all staff acting as chaperones had received a disclosure and barring service check. Although this role was primarily undertaken by nurses who had received a disclosure and barring service check, there had been occasions where non-clinical staff performed this role. Although the practice manager had considered some of the measures that were in place to mitigate the risk, there was no detailed, written risk assessment.
There was not a robust system in place to ensure that patients on high risk medicines were receiving regular blood tests. Outcomes for patients were in line or below national and local averages. Where the practice reflected low performance data, we were told that clinical staff were not routinely updating patient records.
Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was variable, with patients responding positively about the care they received from the practice.
Practice staff had received safeguarding training for vulnerable adults and children. However, the system did not clearly identify to all clinicians those patients identified as the subject of safeguarding concerns.
There were care plans with pictorial aids to enable patients with learning disabilities to be involved in their care. All patients with learning disabilities had received an annual health check, although carers were not routinely identified.
The premises were modern and well equipped to ensure services were accessible including a lift and a car parking space for patients who had a disability.
There were a range of services available on site including ultrasound, phlebotomy and counselling.
A health visitor, midwife and COPD nurse held weekly clinics at the practice.
There was not an open, transparent relationship between all staff who worked at the practice. Not all staff had received appraisal.
Records did not always an accurate, complete representation of patient’s care, treatment and decisions made.
The practice was not aware of the most recent national GP patient survey data, although they had taken some steps to make improvements to access, including opening one late night and one Saturday on alternate weeks.
The areas where the provider must make improvements are:
Ensure the security and adequate tracking of prescription pads through the practice.
Ensure staff are fit for the role for which they are employed by making appropriate pre-employment checks.
Ensure all staff acting as chaperones receive a DBS check or a risk assessment as to whether or not one is not required.
Undertake a legionella risk assessment.
Improve the system in place for the reviewing and monitoring of patients taking high risk medicines.
Take steps to improve access and respond to the issues raised in the national GP patient survey.
Ensure patient records represent an accurate, complete representation of patient’s care and treatment and decisions made.
In addition the provider should:
Ensure that those patients identified as subject of safeguarding concerns are clearly identifiable by all clinicians reviewing the patients.
Put in place a more robust system to identify, record and discuss significant events.
Ensure findings from clinical audit are clear and evidence whether improvements have been made.
Ensure that the Health and Safety risk assessment adequately identifies the risks to staff and patients. Where remedial action is identified, this should be actioned in a timely way.
Put in place a robust protocol to manage safety alerts received at the practice.
Ensure all staff receive appraisal.
Take steps to identify more patients who are carers and provide them with appropriate support and health checks where relevant.
Promote open, transparent discussion and involvement with all people who work at the practice.
People told us they experienced treatment and care that met their needs. We received positive comments from five people about the care provided by the practice. For example one person told us: “I consider the practice gives me good care.” and another person told us: “The receptionists are polite and sympathetic to my needs.”
The practice demonstrated they had suitable arrangements to co-operate with other providers to provide care and protect people’s health, safety and welfare when more than one provider was involved in care and treatment.
There were effective recruitment processes were in place to ensure appropriate checks had been undertaken before staff had begun to work for the practice.
Both paper and electronic records held at the practice were accurate, appropriately maintained and kept securely.
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