We carried out an announced focused inspection at East End Medical Centre on 15 February 2018. The overall rating for the practice was good but we rated it as requires improvement for providing effective services. We issued a warning notice for breach of Regulation 17 (Good governance) and a requirement notice of for a breach relating to nursing staff of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We then undertook a focused inspection on 11 June 2018 to follow up the warning notice and found the provider had complied requirements under Regulation 17 (Good governance), but that it should introduce a programme of care record reviews for all clinical staff. The full comprehensive report on the 15 February 2018 and 11 June 2018 inspections can be found by selecting the ‘all reports’ link for East End Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 October 2018 to assess whether the provider was meeting legal requirements, particularly regarding Regulation 18 of the Health and Social Care Act (HCSA) (staffing), and arrangements for care record reviews for clinical staff. This report covers our findings in relation to improvements made since our 15 February 2018 and 11 June 2018 inspections.

Overall the practice is now rated as good.

Our key findings were as follows:

• Nursing staff were appropriately trained and undertook duties in accordance with their remit.
• Arrangements were in place to monitor clinical staff to provide of safe and effective patient care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced focused inspection at East End Medical Centre on 15 February 2018. This inspection was a follow-up inspection to an earlier inspection in March 2017. At the February 2018 inspection, we issued the practice with a warning notice for breach of Regulation 17 of the Health and Social Care Act (HCSA) 2014. We found that the provider did not have effective governance systems and processes in place to keep people safe. The report on the February 2018 focused follow-up inspection can be found by selecting the ‘all reports’ link for East End Medical Centre on our website at www.cqc.org.uk.

This inspection was a focused follow-up inspection carried out on 11 June 2018 to confirm that the practice had addressed the issues in the warning notice and now met the legal requirements. This report covers our findings in relation to those requirements and will not change the current ratings held by the practice.

At the inspection we found that the requirements of the warning notice had been met.

Our key findings were as follows:

• The provider demonstrated role-specific training for nursing staff.
• Nursing staff conducted duties within a remit agreed by the provider.
• The provider had conducted appraisals for nursing staff.
• Care records completed by nursing staff had been reviewed by a GP.

However, there were also areas of practice where the provider should make improvements.

In addition, the provider should:

• Establish a programme of care record reviews for all clinical staff

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at East End Medical Centre on 15 March 2017. The overall rating for the practice was good. However, the rating for the practice providing effective services was requires improvement as we found two areas where the practice must improve and nine areas the provider should improve, mostly related to effective services. The full comprehensive report on the 15 March 2017 inspection can be found by selecting the ‘all reports’ link for East End Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection we carried out on 15 February 2018, to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations and areas it should improve identified in our previous inspection. This report covers our findings in relation to those requirements and improvements made since our last inspection.

The practice remains rated requires improvement for providing effective services and as good overall.

Our key findings were as follows:

• The practice had undertaken clinical activity to improve patient QOF data outcomes. (QOF is a system intended to improve the quality of general practice and reward good practice).
• Nursing staff were working outside appropriate clinical boundaries on some occasions and leadership and management staff were not aware of this.
• Entries in the electronic patient record system were clearly recorded with the exception of some practice nursing examinations.
• Staff had received induction and appropriate training including safeguarding and information governance but the appraisal process was ineffective.
• Improvements had been made to systems for emergency drugs, business continuity planning, and staffs use of smart cards to maintain patient confidentiality.
• Availability of appointments had been improved to meet demand and the practice GP Patient survey satisfaction scores were comparable to local and national averages.
• Appropriate arrangements were in place for recently bereaved patients and patients identified as carers.
• Written information was available for patients referred under the two week wait cancer investigations system.
• Sinks had paper towels supplied.

There were areas of practice where the provider must make improvements:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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 East End Medical Centre on 16 January 2016. Overall the practice is rated as good.

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

• Data showed some patient outcomes were low compared to the national average. The practice was an outlier for QOF clinical targets with regard to mental health indicators, including dementia; asthma and COPD (chronic obstructive pulmonary disease).
• 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, although not with a preferred GP. Urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had 26 patients on its learning disability register; however, only 15 (58%) had had an annual health check and care plan review.

• 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:

• Monitor patient outcomes and take action to improve performance where this is identified.

• Provide staff with appropriate training, including, for example, safeguarding, information governance and Mental Capacity Act 2005.

The areas where the provider should make improvement are:

• Maintain a written record of the checks of the emergency drugs.

• Review the support given both to patients recently bereaved and to patients identified as carers.

• Consider providing patients with written information if they have been referred under the two week wait system.

• Encourage staff to always remove smart cards from computers when they are left unattended, regardless of whether the room can be locked.

• Ensure all sinks are supplied with paper towels.

• Add additional emergency contact numbers to the business continuity plan.

• Ensure entries in the electronic patient record system are clearly recorded.

• Ensure all patients with a learning disability have an annual health check and care plan review.

• Review the level of demand for appointments to ensure the service provided is adequate to meet patient needs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice