We carried out an announced comprehensive inspection on 31 October 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

Dr Michael Mitchell is an independent provider of general medical services and treats both adults and children from a location at 2 Dene Road, Northwood, Middlesex, HA6 2AD. The provider is a single-handed private GP who is supported by two reception staff. The location is inaccessible to patients with mobility issues however home visits are offered to those who are unable to attend.

The provider is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury. Services provided include the management of long-term conditions, flu, chicken pox, meningitis B & travel vaccinations, childhood immunisations, well persons examinations & health screening, HIV testing, end of life care, substance misuse, cryotherapy and wound management.

Appointments are available weekdays from 8am to 12pm which includes a walk-in service. For out of hours care the provider has an agreement with a private locum agency, alternatively patients are signposted to the local urgent care centre. The GP has an active list of over 1000 patients and provides an average of four consultations a day.

Our key findings were:

• There was no documented system in place for the reporting and investigation of incidents and significant events. However, the provider demonstrated they had learnt from them.
• There were some systems and processes in place to keep patients safe. However, we identified shortfalls in relation to safeguarding, chaperoning, infection control, equipment safety, medicine management and medical emergency provisions.
• The GP was aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, there were shortfalls in staff training.
• Quality improvement including clinical audit was limited. There were no medicine audits carried out to monitor the effectiveness of prescribing.
• Patient feedback from 25 Care Quality Commission comment cards was very positive about the GP and generally about the service provided.
• Information about the services and how to complain was available. A complaints procedure was in place. The provider had never received a formal complaint and verbal complaints were dealt with when they occurred.
• There was a clear staffing structure and staff were aware of their own roles and responsibilities.
• There were no formal processes in place to ensure all members of staff received an appraisal however staff told us that their learning and development needs were discussed on an ongoing basis.

We identified regulations that were not being met and the provider must:

• Ensure patients are protected from abuse and improper treatment.
• Ensure care and treatment is provided in a safe way to patients.
• Introduce effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

In addition the provider should:

• Review the need for staff appraisals to identify their learning and development requirements.
• Review the facilities available for patients with a hearing impairment.
• Review the frequency of basic life support training.
• Review fire evacuation arrangements.
• Review the use of patients relatives for translation purposes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 31/10/17 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led? At the inspection we found the provider was not meeting the regulations for providing safe, effective and well-led care. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Dr Michael Mitchell on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 29/11/18 to confirm that the practice had taken action to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 31/10/17. This report covers our findings in relation to those requirements.

At this inspection we found the provider had made the necessary improvements

Our key findings were:

• There was a system in place for reporting and investigating significant events.
• Systems were in place to keep patients safe and safeguarded from abuse.
• Quality improvement activity had been initiated.
• There was a process in place to ensure staff received annual appraisals.
• Staff had been trained to carry out their roles.
• There was a system in place to gather and act on feedback from patients.
• Governance and oversight had improved.

There were areas where the provider could make improvements and should:

• Continue to develop quality improvement activity.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice