This practice is rated as inadequate overall. (Previous inspection 11 2015 – Good)

The key questions 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? – Inadequate

We carried out an announced comprehensive inspection at Leyton Green Neighbourhood HS on 26 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice did not have clear systems to manage risk so that safety incidents and significant events were less likely to recur. When incidents did happen, the practice did not effectively learn from them and improve their processes.
• The practice did not routinely review the effectiveness and appropriateness of the care it provided.
• Learning and outcomes from complaints was not shared with all relevant staff members.
• There was no evidence of quality improvement work being carried out.
• The practice did not provide appointments outside or core working hours for patients who could not attend during working hours and the practice was closed for two hours each day during lunch.
• Not all staff members had received the training required to carry out their roles effectively, for example safeguarding, infection and prevention control, fire safety and chaperone training.
• Emergency equipment was not sufficiently maintained as resuscitation equipment did not include a baby mask and had a missing valve.
• There was no documented approach to manage pathology results.
• There was no failsafe system to ensure the practice received results for all cytology samples taken.
• There were no systems to enable the process for seeking consent to be monitored appropriately.
• Home visit documentation completed by the nurse was not always comprehensive.
• Systems to ensure that electrical equipment was safe and in good working order was not effective.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had an approach for identifying and providing support to patients with caring responsibilities and had identified 2% of patients as a carer.
• Quality and Outcomes Framework achievement was in line with local and national averages.

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 g good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Ensure all premises and equipment used by the service provider is fit for use.

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 FRCGP
Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leyton Green Health Service on 24 November 2015. Overall the practice is rated as good.

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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff understood their patient demographic and provided services to meet their specific needs, for example there was a designated flu clinic for the mandarin population where interpreters were in attendance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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 provider was aware of and complied with the requirements of the Duty of Candour.

There areas where the provider must make improvements are:

• Complete a risk assessment regarding not having a defibrillator on the premises and the potential safety implications this could have.

The areas where the provider should make improvement are:

• Review the reinstatement of the patient participation group (PPG) as a means of collecting patient feedback into the services that the practice is providing.

• Review the recruitment process to ensure that at least two references are requested when employing new staff members.

• Review policies and procedures so they are kept up to date and include review dates.

• Continue to monitor the demand for appointments to ensure that there remains to be little or no demand for extended hours appointments.

• Review the prevalence of Chronic Obstructive Pulmonary Disease and Chronic Heart Disease.

• Review arrangements for patients to access a male GP.

Letter from the Chief Inspector of General Practice

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice