This practice is rated as inadequate. (Previous rating October 2018 – Inadequate)

We carried out an announced focused inspection at Halbutt Street Medical Practice on 11 February 2019. This was to follow up on breaches of regulations set out in Warning Notices which were served on the provider on 7 November 2018. All five key questions were inspected, however only the issues identified in the Warning Notice were followed up on during this inspection. A full comprehensive inspection of this practice will follow within six months after the original comprehensive inspection on the 7 November 2018.

At this inspection we found:

• Some of the issues identified in the previous Warning Notices had been addressed, including some of those relating to infection control, patient feedback and fire safety and those relating to medicines and medical records management, staff roles, employment checks and cervical screening.
• Other issues identified had not been effectively addressed, in particular, those relating to safeguarding.
• The practice still scored below average for some areas in the national GP patient survey; specifically, regarding consultations with doctors and nurses.
• The practice informed us action had been taken to address telephone access delays and delays after patients’ appointment times were yet to produce demonstrably improved results.
• There was an inconsistent coding of patients, for example of those patients who failed to attend hospital appointments, meaning there was a risk that necessary treatment would not be followed up on.
• There was no effective policy to ensure vulnerable adults were identified and correctly coded on the clinical management system.
• There was no clear recall system for vulnerable adults with long term conditions.
• There was no effective palliative care register in place.

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.

This practice will remain in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

This practice is rated as inadequate overall. (Previous rating September 2017 – Requires improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Halbutt Street Medical Practice on 23 October 2018 to follow up the concerns identified at our previous inspection and because of concerns raised by the Clinical Commission Group (CCG). You can find the reports of our previous inspections by selecting the ‘all reports’ link on our website.

At this inspection we found action had been taken on most of the issues identified at the previous inspections. However, we found the systems in place did not keep people safe. There was a lack of governance arrangements and management oversight at the practice. The practice is now rated as inadequate.

At this inspection we found:

• The practice had succeeded in making improvements to some aspects of performance, but there were other areas that had not been addressed effectively.
• The practice still scored below the national average in the National GP Patient Survey in relation to satisfaction with both doctors’ and nurses’ consultations. The practice was aware of this and had identified themes in patient feedback and had an action plan in place to address lower scoring areas in the NHS national patient survey.
• The practice had failed to act effectively on issues with telephone access and delays after appointment time.
• There was evidence that in some areas quality improvement activity was driving improvements to patient care. At this inspection there was a record of completed audit with two cycles where the improvements made were implemented and monitored.
• The practice was not consistently following its own policies and procedures.
• The practice did not have clear systems to manage risk so that safety incidents were less likely to happen.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a culture of integrity, openness and transparency and the provider was keen to address concerns found during the inspection.

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:

• Improve uptake of childhood immunisations and cervical screening.
• Improve engagement with patients with diabetes.
• Consider how to record verbal complaints and actions.
• Review systems to allow patients with communication needs to access services.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs B B Quansah and A Adedeji Practice on 8 September and 7 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 8 September and 7 November 2016 inspection can be found by selecting the ‘all reports’ link for Drs B B Quansah and A Adedeji Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 September 2017 to confirm 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 8 September and 7 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At the previous inspection we rated the practice as requires improvements for effective and caring as the registered person could not demonstrate they had a system in place to improve and monitor patient satisfaction as results from the national GP patient survey showed lower than average scores. In addition, the practice exception reporting for diabetes was higher than the local CCG and national averages. We also issued a requirement notice in relation to staffing as the provider failed to provide us with evidence all staff had received statutory training and other mandatory training necessary for them to carry out their roles effectively.

At this inspection we found improvements had been made and the practice is now rated as good overall and the provision of effective service is now also rated good, however caring key question remains rated as requires improvement.

Our key findings were as follows:

• At this inspection there had been six clinical audits commenced in the last two years; one of which was completed and where the improvements made were implemented and monitored.

• We saw evidence which confirmed all clinical and non-clinical staff had received training in safeguarding, infection control and basic life support (BLS).

• The number of carers had increased from eight (0.1%) to 46 (0.5%), however this was still less than 1% of the practice population.

• We reviewed unpublished and unverified data submitted for the Quality and Outcomes Framework (QOF) 2016/17 and found there had been improvements in the clinical indicators and most patients were exception reported appropriately.

• Annual internal infection control audits were now undertaken and we saw evidence that action was taken to address any improvements identified as a result.

• The practice had carried out control of substances hazardous to health (COSHH) risk assessments on substances which could be harmful to employee’s health.

• Data from the national GP patient survey published in July 2017 showed patients rated the practice below CCG and national average for several aspects of care.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

• Take steps to monitor and improve patient feedback from the GP patient survey so as to ensure it is in line with CCG and national averages.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

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 Drs B B Quansah and A Adedeji Practice on 8 September 2016 and 7 November 2016. Overall, the practice is rated as requires improvement.

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, with the exception of those relating to infection control and staff training.
• Data showed patient outcomes were comparable to the national average with the exception of those relating to diabetes and cervical smears.
• Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for and listened to. This was in line with findings in the GP national survey.
• Patients said they found it difficult to make an appointment with a named GP and to access the practice by telephone. Patients said waiting times were too long.
• 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.
• 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 must make improvements are:

• Ensure all staff receive formal training within the recommended time frame for safeguarding, information governance and basic life support relevant to their roles.

In addition the provider should:

• Implement a programme of quality improvement including complete audits to show improvements in patient outcomes.
• Carry out annual infection control audits and complete a COSHH risk assessment.
• Review systems to identify carers in the practice to ensure they receive appropriate care and support.
• Put systems in place to improve and monitor patient satisfaction so that it is in line with national survey results.
• Ensure improvements are made in the uptake of cervical screening programme and exception reporting in diabetes to meet the local and national standards.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice