This practice is rated as good overall. (Previous rating 01 2018 – Requires improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Latymer Road Surgery on 7 November 2018 to follow up breaches of regulation.

At our inspection on 16 January 2018 following concerns raised with the CQC, we rated the practice as requires improvement for providing a safe and well led service and good for providing an effective, caring and responsive service. The practice was rated requires improvement overall. The practice was found in breach of regulations 17 and 12 of the HSCA (RA) Regulations 2014 (good governance and safe care and treatment) as staff were unclear of policies and procedures, there was no clear system for following up on patient referral letters and no policy for monitoring patients on high risk medicines. The practice also did not participate in multidisciplinary team meetings and minutes of practice meetings were not kept. Incidents were not recorded and there was no clear system for checking pathology results. Procedures for follow up on repeat prescribing were also not sufficiently robust.

At this inspection we found a new clinical team had been in place since May 2018 and had implemented new systems to address the concerns of the previous inspection. At this inspection we found

• The clinical outcomes were still below local and national averages; however, the new clinical team were working towards improving these.
• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Continue to look at ways to improve patient outcomes through the QOF programme.
• Continue to look at ways to improve patient’s outcomes from childhood immunisations and the cervical screening programme.
• Ensure the current fire risk assessment is updated;
• Look at ways to further identify and respond to carers;
• Undertake its own patient survey to gauge current patient satisfaction;
• Update the practice major incident policy;
• Continue to develop clinical audit cycles.

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

Letter from the Chief Inspector of General Practice

This practice is rated as Requires improvement. (Previous inspection November 2016 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) – Requires improvement

We carried out an announced comprehensive inspection at Dr Makuloluwe & Dr A S Jones also known as Latymer Road Surgery on 16 January 2018 as part of our inspection programme.

At this inspection we found:

• There had been a recent breakdown in communication between the three partners but they were working through how this might be resolved. This had impacted adversely on some areas of governance.

• No formal practice or clinical meetings were held where practice learning could be shared.

• The practice was not involved in formal multidisciplinary team meetings.

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice manager assessed them and informally discussed events with staff in order to improve their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines.

• Staff treated patients with compassion, kindness, dignity and respect.

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

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

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

The areas where the provider should make improvements are:

• Look at ways to improve patient outcomes for those patients with long term conditions, for example, for those with diabetes.

• Produce a log to monitor prescription stationery within the practice.

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

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 the Latymer Road Surgery on 18 November 2015. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Data showed patient outcomes were average for the locality. Some audits had been carried out, and we saw some evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity; however some risk assessments such as and safety checks were not carried out in accordance with the policy.
• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure that staff receive appropriate training for their role, including chaperone and infection control training.

• Ensure clinical staff that are responsible for patients within care homes are aware of Deprivation of Liberty Safeguards (DoLS).

In addition the provider should:

• Carry out health and safety risk assessments, fire risk assessment and regular fire drills.

• Engage in multi-disciplinary palliative care meetings.

• Share knowledge of updated clinical guidance within the practice. For example NICE guidelines.

• Introduce a register to identify patients with mental health conditions.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook an announced focussed inspection of Dr Makuloluwe & Dr A S Jones (Latymer Road Practice) on 14 July 2016. We found the practice to be good for providing safe and well led services and it is rated as good overall.

We had previously conducted an announced comprehensive inspection of the practice on 18 November 2015. As a result of our findings during the visit, the practice was rated as good for being effective, caring and responsive, and requires improvement for being safe and well led, which resulted in a rating of requires improvement overall. We found that the provider had breached two regulations of the Health and Social Care Act 2008; Regulation 17 (2) (b) good governance, and Regulation 18 (2) (a) staffing.

The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements. We undertook this focussed inspection to check that the practice had followed their plan, and to confirm that they had met the legal requirements.

This report only covers our findings in relation to those areas where requirements had not been met. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Makuloluwe & Dr A S Jones on our website at

http://www.cqc.org.uk/location/1-547351049/reports

.

Our key findings across all the areas we inspected were as follows:

• All staff were up to date with mandatory training.

• The practice had adopted PGD’s which were signed by nursing staff.

• Clinical staff demonstrated awareness of the deprivation of liberty safeguards (DoLS).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice