Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Upminster Medical Centre on 8 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Upminster Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At the last inspection we found arrangements around cleanliness and infection control were not adequate. There were also concerns around staff training and recruitment and risk monitoring. Arrangements in respect of clinical audits and staff appraisal needed improving. We also found policies were not all adapted to the practice and low results for childhood immunisations. There were deficiencies in the practice’s vision and values and there was no supporting business plan reflecting and underpinning the vision and values of the practice. Governance arrangements did not operate effectively.

Overall the practice is now rated as good overall.

Our key findings were as follows:

• The practice had clearly defined and embedded systems and processes to minimise risks to patient safety. This included recruitment, checking of electrical equipment, fire risk assessments and fire safety arrangements.
• Staff were aware of current evidence based guidance. However, improvements were required in the management of patients with long term conditions.
• The practice had an induction programme for newly appointed staff and staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Policies and procedures used to govern activity were adapted to the practice.

In addition, at the previous inspection we identified areas where improvements “should” be made. At this inspection we found that all of the improvements had been made. Some of these improvements are described under the key questions we re-inspected. In addition to those we found:

• A new hearing loop system had been installed to support patients with hearing impairment. Staff had received training on how to use it.

• Curtains were provided in consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments. These were cleaned at regular intervals.

• A carer’s register had been implemented and was reviewed regularly.

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

The provider should:

• Continue to review processes and procedures for monitoring and managing patients with long term conditions and levels of exception reporting and take all necessary steps to improve outcomes for patients.

• Consider providing a practice website.

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 Drs SS & MM Baig on 8 March 2016. Overall the practice is rated as requires improvement.

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

• Patients were at risk of harm because systems and processes were not implemented in a way to keep them safe. This included recruitment, checking of electrical equipment, fire risk assessments and fire safety arrangements.
• Although some audits had been carried out, they were not two cycle completed audits and so the practice could not demonstrate that audits were driving improvements to patient outcomes.
• The practice did not have a formal induction programme for newly appointed staff and could not adequately demonstrate how new members of staff were familiarised with practice policies and procedures.
• Some policies and procedures used to govern activity were generic and had not been customised to the practice’s needs.
• There were gaps in staff training including infection control and information governance.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all consulting rooms had privacy curtains and some patients had concerns about privacy at reception.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses, for instance when temperature readings for the fridge used to store vaccines were outside of the normal range.
• The practice’s uptake for the breast cancer, bowel cancer and cervical screening programmes were above local and national averages.
• Patients could book appointments and request repeat prescriptions online.

The areas where the provider must make improvements are:

• Ensure electrical appliance safety checks are undertaken.
• Undertake actions to mitigate the risks associated with fire, including ensuring the fire alarm system is fully operational, fire extinguishers are serviced at suitable intervals and regular fire evacuation drills are carried out.
• Put in place an infection prevention and control protocol and ensure that all staff are provided with infection prevention and control training.
• Implement a programme of quality improvement initiatives to improve patient outcomes.
• Ensure that staff have access to practice specific policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Put systems in place to ensure the practice identifies mandatory training requirements for staff and ensures that suitable training is delivered.
• Ensure recruitment arrangements include all necessary employment checks for staff, for example proof of identity and references.

In addition the provider should:

• Ensure there is an effective system to track blank prescriptions through the practice in line with national guidance.
• Ensure there is an effective system for checking emergency medical equipment is fit for use including regular checks of the defibrillator.
• Consider how to best ensure all staff receive appropriate induction to the practice.
• Review arrangements for supporting people with hearing impairments.
• Ensure that planned arrangements to maintain patients’ privacy and dignity during examinations, investigations and treatments in all consulting rooms are carried out.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Review current arrangements for staff engagement.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We spoke with people visiting the surgery on the day of our inspection. Most people told us they were happy with the service provided by the medical staff at the practice. One person said “they’re brilliant, lovely doctors, the nurse is very nice”. Another said “the staff are very nice”. People told us the GPs were approachable, listened, and they could ask questions if they needed to.

Most people we spoke with on the day of our inspection told us they had been able to make an appointment which suited them. However, one person said “it’s difficult to get emergency appointments on the day”. People we spoke with had positive views about the reception staff at the practice. One person said “the receptionists fit you in for appointments, they’re really nice”. All those we spoke with said that their privacy and dignity were respected.

People's care was planned and delivered in a way that met their individual needs. We looked at five people's records regarding chronic disease planning, care and advice. There was evidence that plans were discussed with patients and appropriate referrals made.

We found that people were protected from the risk of abuse because the provider had some procedures in place for safeguarding vulnerable adults and children. Medical staff we spoke with were aware of these procedures. The provider had adequate systems in place to prevent, detect and control the spread of infection. There was also an adequate system for dealing with complaints made by people who used the service.