We carried out an announced comprehensive inspection at East Leicester Medical Practice on 14 July 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link to East Leicester Medical Practice - Dr A Farooqi and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 28 March 2018 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 14 July 2017 This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had implemented a new telephone system in order to improve telephone access and monitored its effectiveness on an ongoing basis. They had also reviewed the appointment system and were considering different options to improve access to appointments.

• A new system for reporting and recording significant events had been introduced and staff had received training about significant events. The new system included reviewing significant events to ensure identified actions had been taken and learning embedded.

• Improvements were made to the quality of care as a result of significant events and complaints and themes and trends were identified and acted upon.

• The system for receiving and acting on patient safety alerts had been reviewed and was now consistent and ensured that all alerts were acted on where required and discussed as appropriate.

• The system for high risk drug prescribing had been improved and was being operated effectively.

• There was an effective system for prescription security including monitoring of blank prescriptions.

• The practice had systems to minimise risks to patient safety and evidence from the landlord was available that actions identified in some risk assessments had been carried out.
• Staff were up to date with training and the practice had implemented a training matrix to monitor training needs. All staff had received an appraisal and a system introduced to ensure these were undertaken regularly.
• A comprehensive understanding of the performance of the practice was supported by use of a dashboard to monitor their performance in key areas such as appointment availability, reception and administration tasks and enhanced services.

• There was a comprehensive system to monitor the vaccine refrigerator temperatures.

• The practice had worked to increase the number of carers identified and there were now 178 patients on the carers registered which represented 1.5% of the practice population.

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 East Leicester Medical Practice on 4 November 2014. The overall rating for the practice was good but the rating for providing a responsive service was requires improvement. The full comprehensive report on the November 2014 inspection can be found by selecting the ‘all reports’ link for East Leicester Medical Practice - Dr A Farooqi and on our website at www.cqc.org.uk.

This inspection was a further announced comprehensive inspection carried out on 14 July 2017 which was also to confirm that the practice had carried out their plan to improve access to the practice.

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Overall the practice is now rated as requires improvement.

Our key findings were as follows:

• The practice monitored the access to appointment availability and telephone access and had introduced different steps to improve these areas. However this was still work in progress.

• There was an effective system in place to deal with safeguarding and staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

• There was a system in place for reporting and recording significant events. However we found that not all events had been reported within the practice and the system did not include reviewing significant events to ensure actions were taken and learning embedded.

• The system for receiving and acting on was inconsistent but a consistent approach was introduced following our inspection

• There were processes for handling repeat prescriptions which included the review of high risk medicines.

• Blank prescription forms and pads were securely stored

• The practice had some systems to minimise risks to patient safety. However evidence was not available that required actions identified in some risk assessments had been carried out. The practice had requested this information from the landlord.
• A comprehensive understanding of the practice’s performance was supported by use of a dashboard to monitor their performance in key areas such as appointment availability, reception and administration tasks and enhanced services.

• We found that refrigerators used to store vaccines did not have a secondary thermometer in place in order to cross-check the accuracy of the temperature and the system for checking the temperatures was not consistent. The practice took action on the day of inspection to rectify this.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However there were some gaps in training.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However there was no system to identify themes or trends.
• Patients commented that they were pleased with the care they received but sometimes found it difficult to get an appointment and telephone access was difficult.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure whereby staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. More detail can be found in the requirement notice section at the end of this report.

The areas where the provider should make improvement are:

• Improve the system for the identification of carers.
• Ensure the scheduled staff appraisals take place and are carried out regularly going forward.
• Continue to monitor and measure the access arrangements.
• Ensure the new system for monitoring refrigerator temperatures is embedded and annual servicing is carried out.
• Ensure there is a system to monitor themes and trends in complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

East Leicester Medical Practice provides a range of primary medical services to approximately 13,000 patients from their surgery at Uppingham Road Health Centre,131 Uppingham Road, Leicester.

We carried out a comprehensive inspection on 4 November 2014.

During the inspection we spoke with patients that used the practice and met with members of the patient participation group (PPG). A PPG is a group of patients who have volunteered to represent patients' views and concerns and are seen as an effective way for patients and GP surgeries to work together to improve services and to promote health and improved quality of care. We also reviewed comments cards that had been provided by CQC on which patients could record their views.

The overall rating for this practice is good. We also found the practice to be good in the safe, effective, caring and well led domains. We found the practice required improvement in the responsive domain and also required improvement in the care they provided to the population groups of older people, people with long term conditions, working age people, people experiencing poor mental health and people in vulnerable circumstances.

Our key findings were as follows:

• Evidence we reviewed demonstrated that most patients were satisfied with how they were treated and this was with compassion, dignity and respect. The information also demonstrated that the GPs were good at listening to patients and treated them with care and concern.

• The practice had on-going issues relating to maintenance of the premises which were owned by NHS Property Services. They had been in negotiations for some time to secure a tenancy agreement and hoped that this would soon be finalised and responsibilities relating to maintenance defined and agreed.

• The practice had robust arrangements in place to manage emergencies. Staff had received relevant training and there was equipment available for staff to use in the event of an emergency. Emergency medicines were available and all staff knew of their location.

• The practice had achieved and implemented the gold standards framework for end of life care. It had a palliative care register and had regular multi-disciplinary meetings to discuss the care and support needs of patients and their families.

• The practice had recognised that there was a lack of patient satisfaction in respect of access to appointments and telephone access to the practice. They had recently managed to recruit new GPs and told us this would increase appointment availability. The practice had been working with the PPG to address the issue of telephone access and had plans in place to increase the number of staff available to answer calls at the busiest times of the day.

• There was clear leadership with all staff being aware of their role and responsibilities. There was a strong team ethos and staff felt well supported and valued.

There were areas of practice where the provider needs to make improvements.

The provider should :

• improve access to appointments.

• ensure patients have appropriate telephone access to the practice.

• ensure that privacy curtains are replaced at least every six months.

• ensure that an up to date legionella risk assessment is in place.

• have in place generic risk assessments relating to health and safety.

• ensure that all outstanding actions from the infection control audit are completed.

• ensure all policies are reviewed and updated.

• ensure that minutes of all meetings are more comprehensive and include actions and required follow up where relevant.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice