This practice was rated as Good overall when last inspected in September 2015.

We carried out an announced focused inspection at Dr Win Hlaing on 1st June 2018. The inspection was carried out at short notice in response to information of concern received by the Care Quality Commission. This information related to the way in which the practice interacted with other providers of healthcare. We therefore focused the inspection on provision of safe and well led services and did not update the ratings for the practice.

At this inspection we found:

• The practice had experienced a rapid increase in the number of patients registered.
• Work had commenced to restructure the staffing at the practice to respond to increased patient demand. GPs who were partners at a neighbouring practice had joined the lead GP and the practice management was receiving support from a larger GP partnership based in the Midlands.
• Systems in place to keep patients safe were not always operated effectively and consistently. For example, review of test results was not always undertaken in a timely manner and referrals for patients were occasionally delayed.
• A review of practice processes and procedures had not identified that staff were not fully trained to use computer based patient records systems that held patient information.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review the use of I.T. programmes used to hold patient data with a view to achieving consistent data entry.

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 of Dr Win Hlaing (Burma Hills Surgery) on 9 September 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice had accessible facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice had a vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

• The leadership and culture within the practice were used to drive and improve the delivery of high-quality person-centred care. The practice was able to demonstrate year on year improvement.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Burma Hills is a run by a single GP. On the day of inspection, we spoke with the GP and practice manager. We also spoke with a nurse, a healthcare assistant, two receptionists and the locum doctor. We spoke with three patients who use the practice and a member of the patient participation group (PPG).

Patients we spoke with were happy with the information and explanations they were given about their treatment. They told us they were able to obtain appointments with clinical staff when they needed to.

Patients received care and treatment appropriate to their assessed needs. We saw patient records were completed by the GP at the time patients were seen and contained detailed information about diagnoses, treatments and advice.

The building was purpose build and was of suitable design and layout. We found the building was well maintained and suitable for patients with limited mobility including wheelchair users.

Staff undertook appropriate training and were supported to deliver effective care and treatment safely. Staff told us they felt supported by management and were appraised annually.

The practice had an up to date and relevant complaints procedure. This was clearly displayed in the waiting room. Complaints were responded to appropriately and in line with the practice policy. The practice had conducted patient satisfaction surveys and acted on patients’ comments. There was also an active patient participation group involved with the practice.

We carried out an announced comprehensive inspection at Dr Win Hlaing (Burma Hills Surgery) on 17 and 19 December 2018, as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor, on the second day of the inspection (19 December 2018) the team included a second CQC inspector.

Our judgement of the quality of care at this service is based 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.

The practice is rated as Inadequate overall.

Dr Win Hlaing is registered with the CQC as an individual. However, since February 2018 Dr Win Hlaing has been working with two GPs from a neighbouring practice as GP partners. The practice is also part of a larger GP organisation, Modality Partnership, who are in the process of amending the practice registration. We undertook this inspection because although the practice was rated good overall from an inspection carried out in September 2015 we had concerns arising from a focused inspection undertaken in June 2018. At that time, we found that some of the systems operated did not identify, assess and mitigate risks to the provision of safe care.

At this inspection we found further areas of significant concern. The practice was failing to keep patients safe because:

• Prescribing was not following current national guidelines.
• Appropriate tests were not being undertaken to support safe prescribing.
• Patients with long term conditions were not always receiving safe and appropriate care due to failures to follow up test results that indicated action was needed to improve patient treatment.
• Systems to invite patients in for immunisations and treatment were not operated effectively and patients eligible for immunisations were not always receiving them.
• Staff understanding of legislation covering consent to treatment was inconsistent. Patients were at risk of receiving care they did not consent to or not receiving appropriate care due to their age.
• The practice did not have a comprehensive programme of quality improvement activity and did not consistently review the effectiveness and appropriateness of the care provided.
• The delivery of high quality care was not assured by the leadership, governance and culture of the practice.
• Cancer screening and diagnosis rates were low compared to local and national averages.
• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from harm.
• The overall governance arrangements were ineffective.
• Staff requiring supervision of their prescribing were not receiving such supervision.

However, we also found some positive areas of work within the practice:

• Patient feedback was consistently positive about being treated with care, concern and compassion.
• The appointment system was working well and patients reported no problems in accessing appointments when they needed them.
• Staff said they felt supported to do their job and received regular appraisals.

As a result of this inspection the practice has:

• Had conditions applied to the provider’s registration to reduce the risk to patients receiving care at the practice.
• Been served with a Warning Notice regarding the breach of the Health and Social Care Act 2008, Regulation 12, Safe care and treatment.

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 further 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.

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