We carried out an announced comprehensive inspection at Dr Amobi and Partners on 23 January 2019. 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 requires improvement overall.

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

• The practice did not have clear systems and processes to keep patients safe. This included fire safety including training, sharps bins, vaccines fridge temperature monitoring, medicines management, significant events and reading and acting on patient safety alerts.

• The practice did not ensure that staff vaccinations was maintained in line with current Public Health England (PHE) guidance.

• Although there was guidance on identifying deteriorating or acutely unwell patients, some staff were not always aware of the responding to emergencies procedure.

• The practice did not have appropriate systems in place for the safe management of emergency medicines.

We rated the practice as good for providing effective services because:

• Staff had the skills, knowledge and experience to carry out their roles; however, monitoring was required to ensure that all clinicians had clear knowledge of evidence based guidelines.

• The practice was able to show that it always obtained consent to care and treatment.

• One of the GPs had a lead role at the Brent Centre for Young People, which provided support and counselling for young people with mental health issues.

• The practice worked together with other local practices in the community to provide education and support to the Somali community and to increase childhood immunisation uptake.

• Performance was mostly in line with local and national averages; however, some areas such as cancer screening rates and exception reporting required monitoring.

We rated the practice as good for providing caring services because:

• Staff treated patients with kindness, respect and compassion.

• Feedback from patients was mostly positive about the way staff treat people, although some patients highlighted issues with some staff attitude.

• The practice worked closely with their local food bank to support and identify vulnerable individuals or families that had not registered with a GP.

• Staff understood patients’ personal, cultural, social and religious needs.

• The practice gave patients timely support and information.

• The practices GP patient survey results were in line with local and national averages for questions relating to kindness, respect and compassion for consultations with GPs and nurses.

We rated the practice as good for providing responsive services because:

• The practice organised much of its services to deliver services to meet patients’ needs.

• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.

• There was no evidence from the meeting minutes provided that complaints were discussed and learning shared.

We rated the practice as requires improvement for providing well-led services because:

• The overall governance arrangements were ineffective. This related to safety systems and processes.

• The practice did not have clear and effective processes for managing risks, issues and performance.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Take action to update equipment calibration records. .

• Continue to monitor and improve on clinical indicators where performance is not as expected. This includes high areas of exception reporting, cancer screening and childhood immunisations.

• Continue to improve the identification of carers.

• Improve the complaints log to provide sufficient information and ensure wider learning from complaints is shared.

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 Dr Amobi and partners on 28 April 2016. 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 been trained to provide them with the skills, knowledge and experience to deliver 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.

We saw one area of outstanding practice:

The practice had a significant number of patients who were residents at a local Travellers site (3% of the patient list). The practice had put arrangements in place to support this population group. A flexible appointment system had been adopted which was suited to the needs of the Travelling Community. For instance, when an appointment was booked, the practice would arrange for longer than normal appointments so that several health related matters could be discussed during the appointment. The practice would also arrange to have other services available for the same time, including immunisations, cervical screening and long term condition review. The practice’s mental health nurse worked closely with a specialist community support worker, visiting Travellers at home to promote better enagagement with health care providers and to help patients access other support organisations.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

During this inspection we spoke with three patients, the phlebotomist, a healthcare assistant, two GP partners, the nurse practitioner, the practice manager and the office manager. Patients stated that they were satisfied with the services provided and with one exception they said staff were always respectful. One patient told us, "I am well treated. I could not wish for a better doctor. I have no complaints”. Another patient said, “This is a very, very good practice. You sometimes get the odd staff, but the majority of the time, they are pleasant”.

The sample of four patients' records we looked at contained details of assessments and their past medical history. Treatment provided was documented and patients stated that treatment had been given with their consent. Reviews of treatment took place and there was a system for following up patients who had missed blood tests or other important appointments. Arrangements were in place to ensure that patients with special needs received prompt attention and health checks.

Staff stated that communication was good and they supported each other to ensure that patients were well cared for. The staff records contained essential checks carried out on staff. These included criminal record checks, evidence of identity and references. We saw documented evidence that medical and nursing staff had updated their clinical knowledge.

The practice had a policy and procedure for safeguarding people from abuse. Staff were aware of action to take when responding to allegations or incidents of abuse.

Quality monitoring systems were in place. This included patient satisfaction surveys and a suggestion box in the reception area. Multi-professional meetings had been held to review the treatment and progress of patients. Issues affecting the care of patients and the running of the practice had been discussed in Patient Participation Group (PPG) meetings. Complaints made had been recorded and promptly responded to.