We carried out an announced comprehensive inspection at Drs Cartwright & Mahfouz on 20 November 2017. Overall the practice was rated as good with requires improvement for providing safe services. The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Drs Cartwright & Mahfouz on our website at .

This inspection was a desk-based review carried out on 10 December 2018 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 20 November 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• The practice had strengthened its recruitment procedures to include Disclosure and Barring Service (DBS) checks a physical and mental health assessment for all staff.
• Environmental risks had been formally assessed and monitored.
• The practice had redefined roles and responsibilities within the management structure.
• An action plan had been produced to explore how ongoing improvement work could be used to address patient feedback

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. We previously inspected the service on 6 January 2015 and rated the service Good overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Keelinge House Surgery on 20 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems, processes and practices in place to protect people from potential abuse. Staff were aware of how to raise a safeguarding concern and had access to internal leads and contacts for external safeguarding agencies.
• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• There were systems in place for identifying, assessing and mitigating most risks to the health and safety of patients and staff. However, not all risks to patients and staff had been formally assessed.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• The partners had reviewed and increased its workforce and employed additional clinicians with a varied skill mix to help meet the health and social needs of patients and the demand for access to appointments.
• There was a structured programme for staff to receive essential training to enable them to carry out their duties safely. We saw that training had been completed or planned.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients commented on good access to same day appointments but told us appointments with GPs did not always run on time.
• The practice had suitable facilities and was well equipped and maintained to treat patients and meet their needs.
• The practice worked proactively with the patient participation group (PPG) to meet the needs of their patients.
• There was a focus on continuous learning and improvement at all levels of the organisation.

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. For details, please refer to the requirement notice at the end of this report.

The areas where the provider should make improvements are:

• Implement a formal induction programme for all new staff.
• Improve the prescription tracking system to minimise the risk of fraud.
• Explore how waiting times for patients can be reduced.
• Clarify roles and responsibilities within the management structure.
• Regularly review policies and protocols to assess that they are governing activity.
• Further explore how on-going improvement work can be used to address patient feedback.

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 Cartwright Mahfouz and Bullock’s practice on 6 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and responsive services and for being well-led. It was also good for providing services for the six population groups: 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 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.
• Risks to patients were assessed and generally well-managed, although records relating to recruitment and staff training were not well maintained.
• 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 about services and how to complain was also available and easy to understand.
• The practice had reviewed and made changes to appointments systems in response to patient feedback. Urgent appointments were 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.

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

Importantly the provider should

• Ensure records of staff recruitment and training are well maintained so that the practice can be assured the appropriate checks and training relevant to staff roles have been completed.
• Maintain accurate records of defibrillator checks to ensure that it has been done and the defibrillator is fit for use and of the emergency medicines available to ensure none are missing.
• Ensure audits complete their full audit cycle in order to demonstrate improvements made to practice.
• Implement a robust system to ensure correspondence is handled appropriately when a patient with no fixed abode registers.
• Ensure governance issues discussed at meetings are clearly documented to ensure actions required are not missed and that there are clear lines of accountability for action.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice