Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Estuary Healthcare Services on 14 April 2016. Overall the practice is rated as good. The practice provides services for 283 patients who have drug and / or alcohol dependency and misuse, who may be homeless and patients on the special allocations scheme (for patients who have been removed form GPs practice lists due to violent, aggressive or threatening behaviour). Patients may only register at this practice if they are engaged with the Southend Treatment and Recovery Service (STARS).

The practice did not provide services to patients who were over 65 years or to children under 18 years or families. For this reason we did not rate the population groups for older people or families, children and young people.

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

• The practice referred to and used published safety information such as safety alerts to monitor and improve safety outcomes for patients. Staff were aware of how to report concerns about patient safety, and when things went wrong these were fully investigated. Learning from safety incidents was shared with staff to minimise recurrences.
• There were arrangements in place to help safeguard patients against the risk of abuse. Staff had undertaken relevant training and had access to appropriate policies and procedures.
• Risks to patients and staff were assessed and managed. There were risk assessments in place for areas including fire safety, infection control, health and safety, premises and equipment. There was information available in relation to the Control of Substances Hazardous to Health (COSHH) such as cleaning materials.
• All equipment was routinely checked, serviced and calibrated in line with the manufacturer’s instructions.
• There was a detailed business continuity plan in place to deal with any untoward incidents which may disrupt the running of the practice.
• Appropriate checks including employment references, proof of identity and registration with professional bodies (where appropriate) and DBS checks were carried out when new staff were employed to work at the practice.
• Newly employed staff undertook a period of role specific induction.
• There were arrangements in place for managing medicines.
• Emergency medicines and equipment were available in line with current guidance and legislation.

• The practice used published guidelines, reviews and audits to monitor how patients’ needs were assessed and the delivery of care and treatment.

• Clinical audits were carried out routinely to monitor and improve outcomes for patients.

• Patients consent to care and treatment was sought in line with current legislation and guidance.

• The practice performance for the management of some long term conditions was lower than other GP practices locally and nationally. This was due to a number of factors including a lack of patient engagement with treatment and in some cases treatment was unsuitable for some patients.

• Information was shared appropriately with other health and social care professionals to help ensure that patients received coordinated care and treatment.

• Patients said they were treated with respect and care. They said that they were very happy with the care that they received. They told us that staff were professional, welcoming and caring.
• Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or they experienced poor care or services.
• The practice had facilities and equipment to treat patients and meet their needs.
• The premises were accessible to patients with disabilities.
• Translation services were available as required.

• 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.

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

The practice SHOULD

• Review the procedures for sharing learning from when things go wrong so that locum GPs working at the practice are made aware of this learning to help secure improvements.

• Review the procedures for dealing with medical emergencies to include training for staff in the use of, and assess risks associated with the storage of oxygen at the practice.

• Review its systems for carrying out clinical audits to monitor and improve outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we looked at the five areas where we had previously found the provider to be non compliant in December 2013. The provider submitted an action plan stating they would achieve compliance by the end of March 2013. However, on our return we found the provider still did not have suitable arrangements in place to obtain, record and revise consent given by people. We reviewed patient records and found that people received individualised and well co-ordinated care, where risks and vulnerabilities were highlighted. The emergency medicines were all in date and securely stored to deal with emergencies which may reasonably be expected to arise.

We found the premises were clean and tidy and the provider had appointed an infection prevention control lead and conducted an annual infection prevention control audit. We looked at how staff were supported and found all staff had received an appraisal or were scheduled to attend their appraisal meeting within the month. Following our previous inspection the provider had introduced a number of systems to regularly assess and monitor the quality of services received by people.

During our inspection we found the provider did not have suitable arrangements in place to obtain, record and revise consent given by people. We reviewed patient files and found that they received individualised and well coordinated care, where risks and vulnerabilities were highlighted. However, on inspection of the emergency kit we found out of date medication and emergency equipment had not been serviced. This meant the provider did not have procedures in place for dealing with emergencies which are reasonably expected to arise.

The premises were clean and tidy but there was no effective system to identify, assess, prevent and control the spread of health care associated infection. We looked at how staff were supported and found not all had received appraisals or clinical supervision. There were also no effective systems in operation to regularly assess and monitor the quality of services and identify and manage risks.