We carried out an announced comprehensive inspection at Keats Surgery on 04 February 2019. The practice was previously rated in December 2016 and rated as good in all domains and population groups.

We based our judgement of the quality of care at this service 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.

We rated the practice as requires improvement for providing safe services because:

• There was no recent assessment of the risk of, and preventing, detecting and controlling the spread of, infections, including regular infection prevention control audits and an up to date legionella risk assessment.

We rated the practice as requires improvement for providing effective services because:

• There was limited monitoring of the outcomes of care and treatment.
• Some performance data was significantly below local and national averages.
• There was no quality improvement programme in place and the practice had not carried out 2-cycle clinical audits to improve patient outcomes.

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

• The overall governance arrangements required improvement.
• The practice did not always have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

For the responsive domain, we rated all the population groups as good.

For the effective domain, we rated older people; working age people; people whose circumstances may make them vulnerable; and people experiencing poor mental health as good. We rated people with long-term conditions and families, children and young people as requires improvement. This was because performance in the uptake of childhood immunisations were below the World Health Organisation targets, and QOF scores for Asthma and Atrial Fibrillation were below local CCG and England averages. This gave an overall rating of requires improvement for long-term conditions and families, children and young people.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way (Please see the specific details on action required at the end of this report).
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Ensure regular fire drills are carried out.
• Ensure fire training records are documented for all staff.
• Review the need for fire marshals.
• Continue with efforts to improve the up-take of cervical screening

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Keats Surgery on 3 June 2014. The inspection was part of a programme testing our new inspection methodology and was therefore not rated. However, concerns were identified regarding fire safety and recruitment checks and shortly thereafter the practice sent us an action plan detailing how they would make the required improvements. (The full comprehensive report on the June 2014 inspection can be found by selecting the ‘all reports’ link for Keats Surgery on our website at www.cqc.org.uk).

We carried out an announced comprehensive, follow up inspection on 1 December 2016. Overall the practice is rated as good (this rating takes account of our previously identified concerns).

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 practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect. When we discussed this feedback with staff, they stressed the importance of engaging with patients in a compassionate and empathetic manner.
• 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 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 areas where the provider should make improvement are:

• Continue to monitor recent activity to improve performance on diabetic care and childhood immunisations.

• Consider undertaking “duty of candour” training to ensure that all staff are aware of its requirements.

• Install a hearing loop in reception to improve access for patients with impaired hearing.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Keats Surgery provides primary medical care and a range of services including maternity care, diabetes, and child health and baby immunisations clinics to 4,400 people in the Edmonton area of north London. It is open Mondays 8 am to 9pm and Tuesday to Friday 8am to 6.30pm. Outside of these times, an out of hour’s service is available.

Keats Surgery staff were a small and close-knit unit. Patients were happy with the service, found access to appointments was good, and staff were friendly and helpful. The surgery worked well with other services. There was good access to the practice for older people with mobility difficulties and staff took time with people when needed to discuss their care and treatment. A limited number of specialist clinics were provided by the practice for those with long term conditions. The appointments system was continually under review and changes had been implemented to improve the service for working people and those recently retired. Staff took time to listen to patients such as those with learning disabilities, and understood their needs.

However there was a lack of monitoring systems and clinical and staff meetings which meant that there were shortfalls in the management of the surgery and staff. Staff had not always undergone appropriate recruitment checks and did not always have appraisals. There were no fire safety procedures or checks so staff may not be able to respond appropriately in the event of a fire emergency.

We carried out an announced inspection on 3 June 2014. The inspection took place over one day and the inspection team comprised a lead inspector, a GP advisor and a practice management specialist. Before the inspection we talked to a range of health and social care professionals in the community who dealt with patients from Keats Surgery. These included pharmacists, care home manager and palliative care nurse. We talked to four patients. On the day of the inspection we observed staff talking to patients and spoke to the practice manager, two doctors including the clinical lead, practice nurse and two receptionists. We reviewed practice management and staff files, and comment cards which patients had posted on the reception desk.

The regulated activities we inspected were diagnostic and screening procedures, family planning, surgical procedures, treatment of disease and disorder or injury and maternity and midwifery services.