Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Plana & Partners on 28 June 2016. We inspected the practice’s main site at 71 Sherard Road SE9 6ER, and its branch sites at 444-446 Rochester Way SE9 6LJ and 115 Tudway Road SE3 9YX. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the 28 June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Plana & Partners on our website at www.cqc.org.uk.

Since the 28 June 2016 inspection the registered provider has closed one of its branches, 444-446 Rochester Way SE9 6LJ.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 25 April 2017. The provider had made improvements in all the areas where issues were identified in the inspection on 28 June 2016. Overall the practice is now rated to requires improvement.

Our key findings were as follows:

• Data for 2015/2016 showed several patient outcomes were below local and national averages in relation to the Quality and Outcomes Framework clinical targets; the practice had not adequately addressed some of these areas in order to make improvements to patient outcomes. The practice provided evidence for, 2016/2017 that clinical performance had improved but this data had not been independently verified or published at the time of our inspection.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to the safe care of patients were now clearly monitored and managed.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients; however, the Patient Participation Group felt that some of the suggestions they made were not acted on. For example, they suggested the layout of the practice/reception area could be changed and a door put in, so that there is more privacy for patients when they are discussing issues.

• The provider was aware of and complied with the requirements of the Duty of Candour.
• Systems and processes for ensuring all staff were suitably trained had been addressed and the practice had ensured that all staff had the necessary skills and competencies to carry out their role.

• Audits had been conducted and we saw evidence audits had driven improvements to patient outcomes.

• The practice now had a policy to allow people with no fixed address to register as patients to receive on-going care at the practice.
• Immunisation rates were slightly below average for all standard childhood immunisations.
• The practice addressed difficulties in patients getting appointments by recruiting two salaried GPs, although it was too early to see if this improved patient feedback on access.
• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was slightly below local and national averages and had gone down in some areas since the previous GP patients survey.
• Extended hours were provided from 6.30 to 7pm on Tuesdays, Wednesdays and Thursdays, and from 9am to 12pm on Saturday. Patients also had access to weekend appointments at Greenwich Access Hubs.

The areas where the provider must make improvement are:

• Review ways to improve patient outcomes in long term conditions.

The areas where the provider should make improvement are:

• Review emergency medicines risk assessments to ensure all eventualities are considered.

• Ensure all working prescribers know where and how to check that monitoring tests are up to date.

• Review practice procedures to ensure that the suggestions made by the Patient Participation Group are acted on appropriately.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service, however outcomes are not clear yet.

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 Plana & Partners on 28 June 2016. We inspected the practice’s main site at 71 Sherard Road SE9 6ER, and its branch sites at 444-446 Rochester Way SE9 6LJ and 115 Tudway Road SE3 9YX. Overall the practice is rated as inadequate.

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

• Risks to patients were not assessed or managed enough to keep patients safe. This was in relation to the absence of evidence of training for several staff that was relevant to their roles, ineffective fire safety and infection control processes, the absence of risk assessments at the practice’s branch sites, and ineffective medicines management systems. The practice had not assessed the risks associated with the absence of defibrillators and oxygen for use in medical emergencies.

• Data for 2014/2015 showed several patient outcomes were significantly below local and national averages in relation to the Quality and Outcomes Framework clinical targets; the practice had not adequately addressed some of these areas in order to make improvements to patient outcomes.The practice provided evidence, after the inspection, that in 2015/2016 clinical performance had improved but this data had not been independently verified or published at the time of our inspection. 

• Audits had been conducted and we saw evidence that some audits had driven improvements to patient outcomes; however, the practice did not have any formal processes in place to continuously monitor and improve clinical and overall performance.

• The majority of patients said they were treated with compassion, dignity and respect, but there were no policies or arrangements to allow people with no fixed address to register as patients to receive on-going care at the practice.

• Patients found it difficult to get appointments and they had faced long waiting times after arriving for appointments. The practice had not adequately addressed this or implemented any action plans to make improvements.

• There was limited health and support information, and information about services at the Rochester Way branch site.

• The practice had a number of policies and procedures to govern activity, and all staff we spoke with felt supported and valued by the practice’s leaders; however record keeping, such as for governance meetings and training received, was limited.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations of incidents were thorough, and patients received apologies where appropriate.

The areas where the provider must make improvements are:

• Ensure emergency medicines and equipment are available in sufficient quantities across all sites with effective systems in place for monitoring them, ensure nurses are authorised to administer medicines, and ensure there are adequate systems in place to allow staff to raise an alarm in emergencies.

• Ensure there are effective systems in place for infection control and prevention, and for monitoring risks across all sites.

• Ensure all staff complete training (including basic life support), training is updated at appropriate intervals with records kept of training received, and include safeguarding, fire safety, infection control, health and safety and confidentiality in staff inductions.

• Ensure all staff have a good understanding of the practice’s procedures, implement an effective system for documenting practice processes, and ensure there are systems and processes to identify and improve where quality is being compromised.

In addition the provider should:

• Review the process for recording consent.

• Provide information for patients, including translation services available, in appropriate languages and formats.

• 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, and ensure homeless patients are able to register to receive on-going continuity of care.

• Review the need to install panic alarms in the disabled toilets.

• Ensure the business continuity plan includes emergency contact numbers for all staff.

I am placing this practice in special measures. Practices 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 practice will be kept under review and if needed could be escalated to 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice