Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Earl’s Court Surgery on 14 April 2016. The overall rating for the practice was Good. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Earl’s Court Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 June 2017 to confirm that the provider had taken the action we said they should take to address concerns that we identified in our previous inspection on 14 April 2016. This report covers our findings in relation to improvements made in response to those concerns since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

At the inspection on 14 April 2016, the practice was rated overall as ‘good’. However, within the key question caring, areas were identified as ‘requires improvement’, as the practice was not taking sufficient action to identify and support carers. We told the provider it should take action to review systems to improve the identification of carers and provide support.

At our inspection on 1 June 2017, the practice was able to demonstrate improvement in identifying and supporting carers, although the system of alerts on patient records and a carers register were not put in place until immediately after the inspection.

Other areas identified where the practice was advised they should make improvements within the key question caring included:

• Advertise translation services are available.

There was now a poster on display in the reception area informing patients about the availability of translation services.

In addition we identified areas where the practice was advised they should make improvements within the key questions of safe, effective and well-led which included:

• Complete a written policy on safeguarding of vulnerable adults and arrange relevant formal training for all practice staff.

• Where telephone references are taken prior to employment, ensure these are fully documented in staff files.

• Ensure more clinical audits are completed through the full audit cycle where the improvements made are implemented and monitored.

• Consider putting on display within the practice for the benefit of patients and staff the practice’s mission statement.

• Arrange for clinical meetings to be minuted to provide an audit trail of discussion and agreed decisions and actions.

At our June 2017 inspection we reviewed the practice’s progress since the full inspection in the areas identified and looked at a range of supporting documents and records relevant to the action taken to demonstrate improvement.

At our June 2017 inspection we found the practice had not developed its own policy on safeguarding of vulnerable adults but had adopted the ‘London Multi Agency Adult Safeguarding Policy and Procedures’. A printed copy of this was available to staff within the practice along with a link to an internet copy. Staff also had access to details of local safeguarding contacts.

At our April 2016 inspection, the majority of practice staff had not completed formal training in safeguarding of vulnerable adults. However, we were told the practice was putting arrangements in place to address this. At our June 2017 inspection the practice manager told us they had been attempting since the previous inspection to arrange local classroom training but without success. We were shown some of the recent correspondence on this. They had in the meantime decided to pursue on-line training. All administrative staff had commenced this and were at various stages of completion of the on-line modules. None of the three GP Partners had initiated this training at the time of our inspection. However, immediately after the inspection the practice manager circulated a memo within the practice setting this in train and we saw a copy of this.

Following our previous inspection the practice undertook to obtain written references for one member of staff for whom telephone references had originally been taken but not documented. At our latest inspection we were told this action had not been taken because one of the GP Partners had worked with the member of staff concerned at another practice and on this basis was prepared to vouch for their suitability for the role. There had been no further recruitment since our previous inspection.

The practice had participated in two clinical audits since our previous inspection. These were initiated by NHS West London CCG in 2016/17 under the prescribing standardisation scheme (PSS). They covered patients who had been issued with asthma reliever inhalers and patients currently on repeat prescription rapid correction doses of vitamin D. The first cycle of each audit was completed in December 2016 and January 2017 respectively and action points and learning points identified. For example, the asthma inhaler review had alerted the practice to check regularly how many inhalers were prescribed and monitor potential overuse. The second cycle of these audits was due to be completed later this year. There had been no further practice initiated completed clinical audits since our previous inspection.

The practice vision and values were now on display in the reception area.

At our April 2016 inspection we noted the practice’s governance arrangements included weekly clinical meetings which were relatively informal. The practice recognised that these meetings needed to be minuted to provide documentary evidence of discussion and agreed decisions and actions. We said the provider should take this action but they had not done so at our latest inspection. However, they undertook to review this further with a view to introducing an action log for the meetings.

Whilst there had been some improvements since our previous inspection, areas of practice remained where the provider needs to make further improvements. In particular, the provider should:

• Ensure training in safeguarding of vulnerable adults currently in progress for administrative staff and planned for clinical staff is completed without further delay.

• Secure written references for all future staff prior to employment.

• Carry out practice initiated clinical audits and re-audits to improve patient outcomes.

• Ensure the system for identifying and supporting carers is fully embedded and maintained within the practice.

• Consider further the minuting of weekly to provide an audit trail of discussion and agreed decisions and actions.

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 Earls Court Surgery on 14 April 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, the practice had not proactively identified carers to offer them additional support.
• 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 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Complete a written policy on safeguarding of vulnerable adults and arrange relevant formal training for all practice staff.
• Where telephone references are taken prior to employment, ensure these are fully documented in staff files.
• Ensure more clinical audits are completed through the full audit cycle where the improvements made are implemented and monitored.
• Review systems to improve the identification of carers and provide support.
• Advertise translation services are available.
• Consider putting on display within the practice for the benefit of patients and staff the practice’s mission statement
• Arrange for clinical meetings to be minuted to provide an audit trail of discussion and agreed decisions and actions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice