We carried out an announced comprehensive inspection at Preston Road Surgery on 15 January 2019 as part of our inspection programme. We last inspected this practice on 8 December 2015 when they were rated good overall and for all 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 good overall and good for all population groups but requires improvement for providing safe services.

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

• Arrangements in relation to infection control did not mitigate the risk of spread of infection.

• Risk assessments to ensure the fire safety and health and safety of staff and people using the service had not been undertaken.

However, we found that:

• Patients received effective care and treatment that met their needs.
• 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.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found one area of outstanding practice:

The practice had a significant number of Tamil-speaking patients with diabetes who were unable to benefit from the NHS diabetes education programme DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) as this was not available locally in Tamil. The practice facilitated the delivery of the programme quarterly at its practice with a Tamil interpreter from its team. This was initially for its own registered patients but had recently extended this to all patients registered with a Brent GP. We saw that from the last four events 15 patients had benefited from the programme.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Review safeguarding contact details available to staff in policies and guidance.
• Review how children coded as a safeguarding risk are maintained on a risk register.
• Review the clinical equipment calibration inventory.
• Review the system to check uncollected prescriptions.
• Review how the process for the management of patients on high-risk medicines is documented on the clinical system.
• Continue with efforts to improve the uptake of child immunisations and cervical screening.

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

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 Preston Road Surgery on 8 December 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. There was a strong emphasis on health promotion and prevention. The practice ensured staff had access to relevant training and learning opportunities to maintain their skills.
• Patients said they were treated with compassion and respect and they were involved in decisions about their treatment.
• 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 and affected patients received an apology.
• Most patients we spoke with said they found it easy to make an appointment. Urgent appointments were available the same day.The practice promoted continuity of care for patients with long term conditions and older patients. 

• The practice was well equipped to treat patients and meet their needs but space was limited and this was a constraint on the service. The practice was planning to extend the building. 
• There was a clear leadership structure and staff felt supported by management. The practice had a strategic approach to managing long-term conditions and reviewing its performance. 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.

We saw one area of outstanding practice:

The practice had a significant number of Tamil-speaking diabetic patients who were unable to benefit from NHS education and self management courses (known as 'DESMOND') which were not available locally in Tamil. The practice therefore put on DESMOND courses for patients at the practice in Tamil.

The areas where the provider should make improvement are:

• The practice should ensure that it obtains a satisfactory written explanation of any gaps in employment as part of its recruitment process. 
• The practice should continue to monitor and if necessary improve patient access to the service by telephone.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice