This practice is rated as Inadequate. (Previous rating August 2017 and May 2018 – Inadequate)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Inadequate

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at the Staunton Group Practice on 2 October 2018. Following a previous comprehensive inspection in August 2017, the practice had been placed in special measures as we had noted significant safety concerns. We carried out a focussed inspection in November 2017 and a further comprehensive inspection in May 2018, at the end of the special measures period, when we found there had been insufficient improvement and identified more concerns which put patients’ safety at risk. Accordingly, we imposed an urgent suspension of the provider’s registration, with effect from 9 May 2018 to 23 October 2018. During that period, a caretaker practice was put in place by NHSE (London) commissioners to provide the service. The reports of the previous inspections can be found by selecting the ‘reports’ link for Staunton Group Practice on our website at  www.cqc.org.uk/location/1-573879781.

At this inspection on 2 October 2018 we found:

• Although some action had been taken since our previous inspections, it was insufficient to address all the safety and governance concerns noted, or to improve the effectiveness of the service. Changes made had been implemented by the caretaker practice with minimal involvement by the Staunton partners. We were not assured the practice had effective systems in place to keep patients safe and to protect them from risk of abuse or harm.
• The practice could not provide evidence that health and safety risk assessments had been carried out.
• No protocol had been established to manage patients’ records transferred from other practices, to ensure complete medical histories were maintained.
• Clinical audits carried out by the caretaker practice had identified significant issues relating to prescribing practice.
• There was no evidence that clinical audit by the practice was driving improvement. For example, an audit carried out in August 2018 had identified the need for further staff training, but this was not programmed before February 2019.
• The system for identifying and managing significant events and for handling patients’ complaints remained ineffective. Staff could not access records for us to review.
• The practice could not provide evidence that all staff had received training or appraisals.
• The practice’s results from the national GP Patient survey relating to the service being caring and responsive were in some cases significantly below local and national averages. The practice had taken insufficient action to address the concerns.

We again found the practice had made insufficient improvements and that patients would remain at significant risk should the suspension lapse and the practice’s registration be reinstated. Accordingly, we re-imposed the urgent suspension of its registration from 24 October 2018 until 24 April 2019, intending to escalate our enforcement action to cancel the practice’s CQC registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We had previously carried out an announced comprehensive inspection at the Staunton Group Practice on 26 July 2017 and 1 August 2017. We rated the practice as inadequate and it was placed in special measures with effect from 19 October 2017. We identified concerns over safety and governance at the practice. We served warning notices under regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The report of the comprehensive inspection can be found by selecting the ‘reports’ link for

Staunton Group Practice on our website at http://www.cqc.org.uk/location/1-573879781. The practice sent us a plan of the action it intended to take to meet the requirements of the regulations.

We carried out this focussed inspection on 8 November 2017 looking at the identified breaches set out in the warning notices, under the key questions Safe, Effective, Responsive and Well-led. At the inspection, we reviewed the action plan and found that the practice had made some improvements sufficient for us to withdraw the warning notices. Further changes were planned for implementation by 31 December 2017. The improvements need to become embedded and a number of issues remain to be addressed, so we have served requirement notices. We have not reviewed the ratings for the key questions or for the practice overall. We will consider the practice’s ratings when we carry out a full comprehensive inspection at the end of the period of special measures.

• The practice had reviewed and introduced new systems for handling safety alerts, significant adverse events, and work was ongoing to refine the systems.
• The practice had commenced work on consolidating its records and reviewing procedures relating to child protection and adult safeguarding. The practice would be seeking support and guidance under the special measures arrangements regarding use of appropriate records tools to ensure that patient safety was maintained.
• The practice had introduced a system for monitoring patients’ uncollected prescriptions. This needed further review to ensure it operated effectively.
• The practice had re-established a process to monitor patients referred for two-week secondary consultations, but this needed further improvement to be fully effective.
• An infection control audit had been carried out and actions it had identified had been addressed.
• All staff were now up to date with mandatory training requirements and overdue appraisals had been completed.
• The practice had revised its procedures to ensure that clinicians were aware of relevant and current evidence-based guidance and standards.
• The backlogs of documents to be scanned onto patients’ records and those in GPs’ Docman systems, which we had noted at the comprehensive inspection, had been cleared.
• The practice was recruiting additional clinical staff to improve patients’ access to the service. It had appointed two new administrators and was reviewing the appointments system.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Ensure that information is appropriately shared with other healthcare providers.
• Ensure that patients’ uncollected prescriptions are monitored on a regular basis.
• Ensure that blank prescription pads and forms are kept securely in accordance with good practice guidelines.
• Continue to review and identify means of improving patients’ access to the service.

This practice was placed in special measures on 19 October 2017. The practice will be kept under review and a comprehensive inspection will be carried out at the end of the special measures period. If necessary we shall 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 the registration or to varying the terms of the registration within six months if the practice does not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action.

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 on 11 May 2016. Overall the practice is rated as good.

We carried out an announced comprehensive inspection of the practice on 25 August 2015, when we found breaches of legal requirements. We served two requirement notices relating to the breaches. We also found aspects of care relating to patients' telephone access and the appointments system which required improvement.

Following the inspection, the practice wrote to us to say what it would do to meet the legal requirements in relation to the breaches of regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to Safe care and treatment and Fit and proper persons employed.

We undertook this focussed inspection on 11 May 2016 to check that it had implemented its action plan and to confirm that it now met the legal requirements. This report covers our findings in relation to those requirements and to the improvements needed to provide a responsive service. We found that the practice had taken appropriate action to meet the requirements of the two notices.

We saw that improvements had been made regarding the appointments system, with extended hours being introduced. This included appointments being available during weekday evenings and on Saturdays.

We found that there remained problems regarding patients having easy access to the service by telephone, due to ongoing technical issues. The problems with the telephone system were being monitored by the practice and steps had been taken to improve this aspect of the service. Data showed that most of the patients who had responded recently to the Friends and family Test would recommend the practice. We have revised the overall rating for the practice, which is now good. However, we have again rated the practice as requires improvement for providing a responsive service, as we would like to see the progress sustained and for further improvement to be made.

The provider should –

• Continue working to sustain improvement in relation to patients’ telephone access to the service and the appointments system.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Staunton Group Practice on our website at www.cqc.org.uk.

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 on the 25 August 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Patients’ needs were assessed and care was planned and delivered in line with best practice current guidance.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks, safeguarding training and infection prevention and control.

• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments. Patients reported ongoing difficulties contacting the practice by telephone.
• Information about services and how to complain was available and easy to understand.

• The practice responded well to complaints, comments and suggestions made by patients and monitored quality and performance, introducing appropriate changes where needed.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• The practice had a number of policies and procedures to govern activity, but a number of these were overdue a review.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

We were told that a previous practice manager, who had been in post for many years, had left since the practice had registered in 2013 and that their replacement had also left at short notice November 2014. Since then the practice had found it challenging to bring governance documentation and staff records up to date. This had led to difficulties in monitoring staff training requirements and reviewing governance policies. We saw that the practice was actively taking steps to address these concerns, but there remained areas where the practice needs to make improvements.

The practice must –

• Ensure that all staff receive training in adult safeguarding and child protection appropriate to their role and that evidence is available for inspection.

• Ensure that staff receive appropriate training in infection control and undertake regular infection control audits and that evidence is available for inspection.
• Ensure that appropriate pre-employment checks are carried out.

In addition, the practice should –

• Ensure that all its governance policies and the business continuity plan are reviewed and updated regularly.

• Ensure that annual appraisals of staff are carried out.

• Review and update staff records to include evidence of appropriate pre-employment checks being carried out, that ongoing refresher training had been provided and that annual appraisals are conducted.

• Arrange for all electrical equipment to be PAT tested or carry out a suitable risk assessment regarding the use of such equipment.

• Continue with work to improve the operation of the telephone system to increase patient access to the service and appointments.

Professor Steve Field

CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We spoke with seven patients, a member of the practice's Patient Participation Group (PPG), and the practice manager. The registered manager and the operations officer were also present during parts of the inspection. We had a tour of the premises and spent time observing staff interaction with patients. Patients spoke positively about the service. One patient said, "The staff are good". They told us that their privacy and dignity was respected. Patients told us staff talked to them in language they could understand. They told us that emergency appointments were easy to make but routine appointments were not so easy. Patients told us that they were not told about the delays which they often encountered. We suggested that the provider may find to take note of patients' concerns.

We found the practice clean and tidy. We also noted that emergency equipment and drugs were available. We checked that staff had attended various training courses including safeguarding. We saw the provider had policies and procedures on safeguarding and complaints. However, we noted that the complaints policy did not specify the time frame in which a complaint would be investigated. We also noted that the provider had not provided appraisals for some staff.

This practice is rated as inadequate overall. (Previous inspection August 2017 – Inadequate)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Inadequate

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection of the Staunton Group Practice (the practice) on 2 and 4 May 2018. The practice had been placed in special measures with effect from 19 October 2017, following our previous comprehensive inspection in August 2017. We had identified concerns over safety and governance at the practice. We served warning notices under regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The report of the comprehensive inspection can be found by selecting the ‘reports’ link for Staunton Group Practice on our website at . The practice sent us a plan of the action it intended to take to meet the requirements of the regulations.

We carried out a focussed inspection of the practice on 8 November 2017 looking at the identified breaches set out in the warning notices, under the key questions Safe, Effective, Responsive and Well-led. At the inspection, we reviewed the action plan and found that the practice had made some improvements sufficient to meet the requirements of the warning notices. However, further actions were due for implementation by 30 November 2017 and 31 December 2017. We therefore served requirement notices under regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found:

• The practice did not have effective systems in place to ensure that people were protected from abuse.
• The practice did not have effective systems in place to ensure that significant events were identified, investigated appropriately and learned from.
• The practice’s process for managing patients’ cervical smear tests did not ensure that patients with positive test results were followed up appropriately.
• The practice did not have effective systems in place to ensure that safety alerts were appropriately actioned.
• We found evidence of unsafe prescribing due to medicines reviews for patients on high risk medicines not being carried out. We saw examples of medicines reviews not being fully documented on patients’ notes.
• The practice did not have appropriate arrangements to monitor blank prescription forms and pads.
• We found records of over 600 patients who were previously registered at other practices had not been consolidated with their records at the practice, meaning their medical histories were incomplete. The practice could not therefore ensure that care provided to them met their needs.
• We saw evidence of unsafe practice, with emergency drugs and equipment stored in unlocked rooms, accessible to patients and visitors.
• Infection prevention and control practices did not keep patients, staff and contractors protected from safety risks.
• The process for arranging patients’ two-week referrals, in cases of suspected cancer, did not ensure that care was delivered in a way that met patients’ needs. The practice had placed on patients the responsibility to organise their hospital appointments, rather than the practice or hospital doing so on their behalf. This put patients at risk of not accessing a timely appointment with secondary care.
• The practice had not planned its services to meet the needs of the practice population. Patients continued to find telephone access difficult. Routine appointments were not available for 3-to-4 weeks.
• Structures, processes and systems were not consistently effective to support good governance and management.
• Safety documentation, such as risk assessments, which we had seen during previous inspections, were not available for us to review.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

This service was placed in special measures in October 2017. Insufficient improvements have been made and we have rated the practice as inadequate for the five key questions, providing safe, effective, caring, responsive and well-led services. We identified significant safety concerns and therefore took action in line with our enforcement procedures to urgently suspend the provider’s registration from 9 May 2018 until 23 October 2018. During that period, the service will be operated by another provider. The service will be kept under review and if needed could be escalated to further urgent enforcement action. Another inspection will be conducted within six months and if there is not enough improvement we may move to close the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice