Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Portland Road Practice on 25 March 2015. This was to follow up a comprehensive inspection we carried on 14 May 2014 where we found the practice was not meeting the essential standards of quality and safety in a number of areas. It was also to rate the quality and safety of the services under our rating scheme introduced in October 2014.

Overall the practice is rated as Good. Specifically, we found the practice to be good for providing, safe, effective, caring, responsive and well-led services. It was also good for providing services to the six population groups we looked at: older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people whose circumstances may make them vulnerable; and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• The practice had in most respects addressed concerns identified at our previous inspection and now complied with the essential standards of quality and safety that were not being met.
• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
• The practice promoted good health and prevention and provided patients with suitable advice and guidance.
• The practice had several ways of identifying patients who needed additional support, and was pro-active in offering this.
• The practice provided a caring service. Patients indicated that staff were caring and treated them with dignity and respect. Patients were involved in decisions about their care.
• The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
• The practice learned from patient experiences, concerns and complaints to improve the quality of care.
• The practice had a clear ethos that put patients first and was committed to providing the best possible service to them.
• There was an open culture and staff felt supported in their roles.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure the records of safeguarding vulnerable adults training are available for all staff and, where necessary, all staff have completed up to date formal training in safeguarding of vulnerable adults.
• Ensure the keys to vaccination fridges are removed and securely stored when staff are not present in the rooms where they are located.
• Improve prescription security by ensuring they are not left in the printer overnight.
• Take further steps to address dissatisfaction raised by patients about continuity of care, access to appointments and waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The Portland Road Practice is a GP surgery which provides a primary medical service to patients in the Notting Hill, Kensington and Shepherds Bush areas within the Royal Borough of Kensington and Chelsea. The practice currently has about 7500 patients on its list. The service is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures; maternity and midwifery services; surgical procedures; and treatment of disease, disorder or injury

We carried out an announced inspection of the service on 14 May 2014. The team, led by a CQC inspector, included a GP, a practice manager specialist advisor and an expert by experience.

We spoke with seven patients and received comments cards from six others during our inspection. All but one made positive comments about The Portland Road Practice and the service provided. They were generally happy they could get an urgent appointment but some patients expressed their dissatisfaction with the long wait for routine appointments.

The service to all population groups was generally effective, caring and responsive. The practice was effective in promoting best practice and had arrangements in place to monitor, review, and improve outcomes for people. Patients told us staff were caring and treated them with dignity and respect. The practice understood the needs of its patients and was responsive to them. There was good collaborative working between the provider and other health and social care services. However, there was scope for improvement in the waiting times for non-urgent appointments and in ensuring patient confidentiality.

There were inadequate arrangements in place to ensure the service was safe:

• The infection control arrangements in place did not fully protect patients from the risk of infection. The standards of cleanliness were inadequate and the arrangements to maintain appropriate standards of hand hygiene were not sufficiently robust. We found dust in a number of areas and a lack of general cleanliness in other areas. The practice had a cleaning schedule but the checklist for this was had not been completed since October 2013 and did not cover all areas. The regulations were not being met in relation to cleanliness and infection control.

• There were a number of potential risks relating to safety of the premises. One of the consulting rooms on the first floor had a back door which was unlocked and had no signage that the room was in use. The door opened outwards onto the stairway and there was no signage warning of this, which could put anybody passing on the stairs at risk. There was no regular testing of the fire alarm system between annual checks and no fire evacuation drills had taken place. There was no up to date record of portable appliance testing and no evidence of gas boiler servicing. The regulations were not being met in relation to safety and suitability of premises.

• There was not a robust recruitment policy and procedure in place. We saw no evidence of identity checks before recruitment. On records we looked at there was only one reference for one member of staff and no references for another. For non-clinical staff there was no documented risk assessment of which staff needed to be subject to a criminal record check. We were told the need for checks had been considered but limited progress had been made in following this up at the time of the inspection. The regulations were not being met in relation to requirements for workers.

• Patients records were not always kept securely. There was an unlocked filing cabinet in the cleaner’s cupboard, which was accessible to unauthorised people and contained identifiable patient records and x-rays in torn plastic bin liners. The computer server room was unlocked and some patient records were stored in the room. We observed one consulting room left unattended with the door open while the GP saw a patient downstairs. The computer was on and the security smart card was left on the desk. The regulations were not being met in relation to security of records.

The leadership, management and governance arrangements did not ensure the service was sufficiently well led. Communication within the practice on management and operational issues was not as effective as it could be. It was not clear how lessons learned from incidents were communicated to staff or how identified areas for improvement had been followed up to ensure lessons learned were implemented. It was not clear how recommended controls identified from the practice’s health and safety risk assessment were communicated within the practice and followed up and implemented. In addition, the systems in place to identify, assess and manage other risks to the health, safety and welfare of people who use the service and others were not effective. The regulations were not being met in relation to assessing and monitoring the quality of service provision.

We carried out an announced comprehensive inspection at The Portland Road Practice on 23 January 2019 as part of our inspection programme.

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.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• 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. Patients could access care and treatment in a timely way.
• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
• The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was an open culture and staff felt supported in their roles, however not all staff had received annual appraisals.

Whilst we found no breaches of regulations, the provider should:

• Review the system for undertaking annual appraisals for staff.
• Review the system for undertaking and recording weekly fire alarm checks.
• Continue to review systems to monitor and improve the uptake for childhood immunisations.
• Continue to review systems to monitor and improve the uptake for cervical cytology.

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