Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Patrick Morant on 17 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr Patrick Morant on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 April 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 17 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had taken action on all of the areas identified at the last inspection.
• Safety had improved. Staff had relevant training, and risks were well managed. There were arrangements to deal with emergencies and major incidents.
• Performance on measures of care for people with diabetes had improved.
• Quality improvement activity had increased.
• The overall governance arrangements had improved, with stronger arrangements for managing risks, for managing training, and for ensuring policies (e.g. recruitment) were implemented consistently.

However, there were still some areas where the practice should continue to make improvements.

The provider should:

• Continue to develop quality improvement activity, including audit to improve outcomes for patients with coronary heart disease.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them. Although the practice had taken some action in this area, only 18 carers had been identified (0.4% of the practice list).

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 Patrick Morant (Sydenham Surgery) on 17 August 2016. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events, but there was no standard form to ensure that events were fully explored, discussion about events was limited, and records kept did not always show the full actions taken.
• Some risks to patients were well not assessed and well managed, especially those associated with infection control and prevention. There were other risks that had not been identified associated with clinical rooms (containing prescription slips and clinical equipment) being left unlocked during the day. There was no oxygen or benzylpenicillin (a medicine used to treat suspected bacterial meningitis).
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• There was no training policy or plan that specified the training topics and levels required for different roles. There were some gaps in the training provided to staff, for example infection control training and the practice was unaware of the recommended update frequency for basic life support and child safeguarding.
• There was evidence of quality improvement activity, but audits had not been repeated to check that these had resulted in improvement for patients.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. National survey data showed that patients were less satisfied with how nurses involved them in decisions.
• Information about services and how to complain was available and easy to understand and improvements were made to the quality of care as a result of complaints and concerns. However some complaints were not acknowledged in the timeframes stipulated in the practice’s complaint’s policy.
• 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 was generally well equipped to treat patients and meet their needs; while there were consultation rooms on the ground floor, there were no toilets or baby changing facilities on the ground floor.
• 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.

The areas where the provider must make improvement are:

• Ensure that all staff receive the required training at appropriate intervals, including child safeguarding, basic life support, infection control and role-specific training.
• For infection prevention and control comprehensive audits are carried out and the findings acted upon.
• Ensure there is adequate equipment to manage medical emergencies. If the practice decides not to obtain oxygen or benzylpenicillin, there should be a formal risk assessment that details how any medical emergency requiring these would be managed.
• Ensure that prescription forms are stored securely at all times and that there is no risk to patients from items left in unlocked clinical rooms.
• Repeat audits to check that improvements had been made.

The areas where the provider should make improvement are:

• Consider taking notes of clinical meetings, so that actions can be followed up.
• Consider keeping documents and checks during recruitment processes in staff files.
• Save copies of the business continuity plan away from the practice premises.
• Consider how to improve the care of patients with diabetes.
• Consider how to improve the number of patients identified as having coronary heart disease, so that they can be offered appropriate support.
• Continue to monitor and work to improve patient satisfaction with how nurses involve them in decisions about their care.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Acknowledge all complaints in line with practice policy.

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 Patrick Morant on 17 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr Patrick Morant on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 April 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 17 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had taken action on all of the areas identified at the last inspection.
• Safety had improved. Staff had relevant training, and risks were well managed. There were arrangements to deal with emergencies and major incidents.
• Performance on measures of care for people with diabetes had improved.
• Quality improvement activity had increased.
• The overall governance arrangements had improved, with stronger arrangements for managing risks, for managing training, and for ensuring policies (e.g. recruitment) were implemented consistently.

However, there were still some areas where the practice should continue to make improvements.

The provider should:

• Continue to develop quality improvement activity, including audit to improve outcomes for patients with coronary heart disease.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them. Although the practice had taken some action in this area, only 18 carers had been identified (0.4% of the practice list).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice