We carried out a previous announced comprehensive inspection on 19 October 2017 to ask the service the following key questions: Are services safe, effective, caring, responsive and well-led?

We identified a breach of Regulation 17 HSCA (RA) Regulations 2014 Good governance and two areas the service should improve relating to safe, effective and well-led services. The full report on the 19 October 2017 inspection can be found by selecting the ‘all reports’ link for Essex Lodge Surgery on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 1 May 2018 in response to concerns that were reported to us, and to check whether the practice had carried out their plan to address requirements relating to the breach in regulations we identified in the previous October 2017 inspection.

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At the last inspection on 19 October 2017 there were breaches of legal requirements due to concerns regarding arrangements for clinicians medical indemnity insurance, a lack of clinical quality improvement activity, and best practice clinical guidelines were out of date. In addition, there were areas the provider should improve for patients requiring prescribed medicines, storing patient paper records electronically, and to ensure adequate clinical staff cover.

At this inspection 1 May 2018 most of these arrangements had improved.

Dr Hardip Nandra is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• Arrangements for patients requiring prescribed medicines had improved and were appropriate.
• Effective recruitment processes were in place and clinicians were appropriately insured.
• Clinical care was provided in line with best practice guidelines.
• There was no clinical quality improvement activity to improve patient outcomes.
• There were proper policies, procedures and activities that ensured safety and were accessible to all staff.
• Storage arrangements for patient’s clinical records were appropriate.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Essex Lodge Surgery on 19 October 2017. 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.
• The service had systems to minimise risks to patient safety but policies were not always immediately accessible to staff and the recruitment procedure did not ensure clinical staff were appropriately insured.
• Staff were generally aware of current evidence based guidance but the service did not carry out clinical quality improvement activity to improve patient outcomes.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Feedback from patients we spoke to, CQC patient comment cards and service survey results showed patients were satisfied with their care and treated with compassion, dignity and respect.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they did not have to wait too long to access the service and there was continuity of care; however systems for patient prescriptions entailed delays.
• The service had good facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the service complied with these requirements.

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.

The areas where the provider should make improvements are:

• Monitor and review cover arrangements for the absence of a clinician.
• Ensure completion of planned improvements for patients requiring prescribed medicines and storing patient paper records electronically.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice