Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mile End Road Surgery on 5 May 2016. The overall rating for the practice was good, with the safe domain being rated as requiring improvement. The full comprehensive report on the 5 May 2016 inspection can be found by selecting the ‘all reports’ link for Mile End Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 5 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• We reviewed safety records, incident reports, patient safety alerts and the amended recording process that had been implemented after our last inspection. We saw evidence that lessons were shared and action was taken to improve safety in the practice.
• Cleanliness concerns and premises related risks were addressed appropriately, including outstanding actions following a legionella assessment.
• The provider had reviewed its carers’ register and identified additional carers. The register had increased from 140 (just under 1%) at our 5 May 2016 inspection, to 227 (over 1%) at our 20 June 2017 inspection. The provider explained they worked closely with local carers groups and signposted patients when required. Various carers’ information was available in the practices.
• After our 5 May 2016 inspection we requested the provider to ensure that annual reviews for patients experiencing poor mental health or with a learning disability were undertaken in a timely manner. At our 20 June 2017 inspection the provider had 216 registered patients experiencing poor mental health, of which 141 had undergone a review in 2016/17. 25 patients had refused a review and 11 patients were noted as exempt from a review. 39 patients had not attended despite the provider sending multiple invitations. The provider had 103 patients with confirmed learning difficulties, of whom 55 had undergone a review in 2016/17. The provider had contacted all patients with learning difficulties and sent multiple invitations. The coding system for these patients had been reviewed and amended with the aim to increase the number of patients on the register. The provider had also undertaken various other actions with the aim to improve the number of reviews for these patients. These included the addition of system alerts on patient records, ensuring the same GP was available and making every effort to contact any patients that didn’t attend, which included referral to external learning disability services.

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 Castle Partnership at Mile End Road Surgery on 5 May 2016. As part of this inspection we also visited the branch locations Tuckswood Surgery and Gurney Surgery in Norwich. 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 but recommendations resulting from the most recent legionella assessments had not been addressed. There was also improvement needed in addressing premises related risks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the training, skills, knowledge and experience to deliver patients effective care and treatment.
• 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.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The area where the provider must make improvement is:

• Ensure cleanliness is of a good standard, especially at the Tuckswood and Gurney locations.

The areas where the provider should make improvement are:

• Ensure that annual reviews for patients experiencing poor mental health or with a learning disability are undertaken in a timely manner.
• Maintain an audit trail of the dissemination and implementation of national safety alerts and updates to all relevant staff.
• Ensure actions from the legionella assessment are undertaken.
• Ensure premises related risks are highlighted and addressed appropriately.
• Review patients’ records to identify additional carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The practice recognised the diversity of its patients and took steps to maintain their privacy and dignity. The practice consent policy and chaperone policy, both dated January 2014, supported patients' rights. The practice had a Patient Participation Group (PPG) which acted on behalf of patients.

Computerised patient records we saw included notes of discussions that had taken place regarding treatments. A patient described staff as "...open and honest." This showed us that the practice ensured that patients could participate in decisions relating to their care.

The practice offered patients the opportunity to make routine appointments with named GPs if they preferred. Same day appointments and telephone consultations were also offered to patients. A 'duty doctor' system was in place to help patients who needed urgent consultations. A patient acknowledged that the appointment system was improving. They told us that the duty doctor rota had helped in this and said "I think it's a system all surgeries should use."

Computerised patient records included electronic copies of correspondence and test results. Consultation details showed that patients had been assessed and their needs identified by the doctor or nurse, before treatment plans were developed. Procedures for dealing with correspondence such as test results ensured that urgent information was brought to the attention of a doctor or nurse each day. Records were stored safely and securely.