We carried out an announced comprehensive inspection at Enderley Road Medical Centre on 20 July 2017. The overall rating for the practice was good. The practice was rated as requires improvement for providing safe services as the practice had not taken action on a number of areas related to safety within the practice environment. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Enderley Road Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 18 September 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 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for providing safe services. Overall the practice remains rated as good.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• Since our last inspection the practice had taken action to improve safety of the environment and for patients and staff. There were clear 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.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Some patients reported difficulty accessing the practice by telephone. The practice had reviewed this feedback and were taking action to improve telephone access. Other feedback from patients relating to their experience during consultations was positive.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw an area of outstanding practice:

• Unverified practice data showed the practice’s catchment area of patients in Wealdstone was one of the highest sources of new referrals to children’s services. The practice proactively contacted social services every two weeks to receive an update on patients on the safeguarding register. We were told this was to ensure safety given the transient population.

The areas where the provider should make improvements are:

• Review and improve the system for documenting staff annual appraisals.

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

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Enderley Road Medical Centre on 5 February 2015. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the February 2015 inspection can be found by selecting the ‘all reports’ link for Enderley Road Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 20 July 2017. Overall the practice is rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented sufficiently in all respects to ensure patients were kept safe. Several shortcomings identified at our previous inspection had been addressed but some action had not been implemented in full and some additional shortcomings were found.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Not all patients we spoke with said they found it easy to make an appointment with a named GP but the practice was taking action to improve access to appointments.
• The practice had the facilities and equipment 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

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

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients. In particular: to do all that is reasonably practicable to mitigate the risks to the health and safety of patients receiving care and treatment associated with: infection prevention and control (particularly with regard to legionella); the proper and safe management of medicines (relating to vaccine storage); the safe use of premises and equipment (regarding electrical safety checks and fire risk assessment and monitoring systems); and in ensuring sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to deliver a safe service,(specifically relating to training in fire safety and basic life support).

In addition the provider should:

• Keep the practice’s action plan to improve patient access to appointments under close monitoring and review.

• Strengthen governance arrangements regarding performance monitoring to ensure ongoing shortcomings in providing safe services and access to appointments are addressed.

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 Enderley Road Medical Centre on 5 February 2015. Overall the practice is rated as Good.

Specifically, we found the practice to be good for providing, effective, caring, responsive and well-led services. It was also good for providing services to the six population groups we looked at: 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).

We found the practice requires Improvement for providing safe services.

Our key findings were as follows:

• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
• The practice promoted good health and prevention and provided patients with suitable advice and guidance.
• The practice had several ways of identifying patients who needed additional support, and was pro-active in offering this.
• The practice provided a caring service. Patients indicated that staff were caring and treated them with dignity and respect. Patients were involved in decisions about their care.
• The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
• The practice learned from patient experiences, concerns and complaints to improve the quality of care.

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

Importantly, the provider must:

• Ensure all GPs are trained to Level 3 in child protection in accordance with national guidance.
• Take action to address identified shortcomings with infection prevention and control practice.
• Undertake regular health and safety risk assessments and fire evacuation drills to ensure the safety and suitability of the premises.

In addition the provider should:

• Ensure evidence of discussion of significant events and complaints and the communication of lessons learned from them is recorded in the minutes of practice meetings.
• Take steps to communicate the practice’s chaperone policy more clearly to patients in clinical areas.
• Ensure monthly emergency lighting checks are fully documented and up to date.
• Put in place a written business continuity plan to deal with emergencies that may impact on the daily operation of the practice.
• Arrange for a spare battery for the defibrillator to be available.
• Install an emergency pull cord in the patients’ toilet.
• Review the practice’s consent protocol to ensure mental capacity is appropriately taken into account.
• Take further steps to address dissatisfaction raised by patients about continuity of care, access to appointments and waiting times and overcrowding whilst waiting in reception.
• Ensure the complaints leaflet available in reception is made readily accessible to patients.
• Update the complaints procedure to make it clear how patients can pursue matters further if they remain dissatisfied with the handling of their complaint.
• Ensure that the practice has a written whistleblowing policy and procedure that is accessible to staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice