We carried out an announced comprehensive inspection at Eastern Avenue Medical Centre on 27 February 2019 as part of our inspection programme for practices rated inadequate in one or more key question at our last inspection of the practice.

We based our judgement of the quality of care at this service is on a combination of:

• What we found when we inspected
• Information from our ongoing monitoring of data about services and
• Information from the provider, patients the public and other organisations

We have rated this practice as requires improvement overall, requires improvement for providing safe, effective and well led services and good for providing caring and responsive services.

We rated the practice requires improvement for safe services because

• Prescription security was not maintained during working hours.
• The practice nurse was not working to a recognised protocol which legally authorised them to administer vitamin B12 injections.
• Not all Patient Group Directions (PGDs) in use had been authorised by the provider or the practice manager.
• Safety alerts received were disseminated amongst staff but there was little evidence indicating that all relevant staff had read them.

We rated the practice as requires improvement for effective services because

• Not all patients on high risk medication had received recent reviews.
• Clinical staff did not always use current best practice guidelines when making clinical decisions.

We rated the practice requires improvement for well-led services because

• There was no oversight by the provider of the work undertaken by clinical staff employed at the practice.
• Meeting minutes showed a key member of clinical staff did not attend clinical meetings at the practice.

We rated the practice good for caring and responsive services because

• The practice made use of social prescribing to encourage patients to take ownership (with clinical support) of their health needs.
• The practice conducted clinical audits and could show improvement in patient care because of audits.
• Patient experiences at the practice were positive, except for occasionally not being able to obtain suitable appointments and the manner of some members of staff.
• Complaints were dealt with in line with recognised guidance.
• The practice had scored well in some areas of the National GP Patient survey relating to decisions about their care.

We have rated the practice as good for all the responsive population groups and requires improvement for the effective population groups. This means that the population groups are rated as requires improvement overall.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please refer to the requirement notice section at the end of the report for more detail).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Eastern Avenue Medical Centre on 26 June 2018 and found that the practice was in breach of Regulation 12: ‘Safe care and treatment’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we issued a warning notice which required Eastern Avenue Medical Centre to comply with the Regulations by 11 August 2018.

The full report of the 26 June 2018 inspection can be found by selecting the ‘all reports’ link for Eastern Avenue Medical Centre on our website at www.cqc.org.uk.

We carried out this announced focused inspection on 9 November 2018 to check whether the practice had addressed the issues in the warning notice and now met the legal requirements. This report covers our findings in relation to those requirements and will not change the current ratings held by the practice.

At the inspection on 9 November 2018 we found that the requirements of the warning notice had been met, except for one area relating to the administration of medicines.

Our key findings were as follows:

• Risk assessments had been completed and effective safety systems were in place in relation to fire, health and safety, legionella and infection control.
• The practice had purchased a defibrillator, although the checks of the equipment had not been documented.
• Patient Specific Directions (PSDs) were in place for the healthcare assistant (HCA), however the GP was signing these as the authorising prescriber after the medicines had been administered to patients, rather than before.

We identified regulations that were not being met and the provider must:

• Ensure care and treatment is provided in a safe way to patients.

You can see full details of the regulations not being met at the end of this report.

We also identified an area of practice where the provider should make improvements:

• Review the system for ensuring checks of the defibrillator are completed on a regular basis and recorded.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and evidence table for further information.

This practice is rated as Requires improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement.

We carried out an announced comprehensive inspection at The Eastern Avenue Medical Centre on 26 June 2018. This inspection was carried under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service. This is the first inspection since the change in legal entity in May 2017.

At this inspection we found:

• The practice did not have systems or processes to manage and mitigate some risks specifically those relating to fire safety, health and safety, legionella and infection control.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• Although significant events were reported, recorded and investigated, learning was not always evident.
• The practice encouraged complaints and took them seriously, however not all complaints were responded to as per practice policy.
• Performance data for diabetes and cervical screening cytology was below local and national averages.
• Most staff had the skills, knowledge and experience to carry out their roles although not all staff had received updated training the practice identified as mandatory.
• Staff involved and treated patients with compassion, kindness, dignity and respect.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• 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 policies and procedures to reflect practice’s current arrangements.
• Take action to acquire a hearing loop for patients who have difficulty hearing.
• Take action to improve underperforming areas such as those relating to the GP patient survey, diabetes and cervical cytology screening.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected no longer than six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.