We carried out an announced comprehensive follow up inspection on 22 November 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC previously inspected the service on 18 May 2018 and asked the provider to make improvements regarding the safe care and treatment of patients (specifically in relation to infection prevention and control protocols; and emergency medicines provision). At that time, we also asked the provider to make improvements regarding good governance arrangements (in relation to managing safeguarding risks and risks associated with the premises and emergency equipment).

We checked these areas as part of our 22 November 2018 comprehensive inspection and found they had been resolved.

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

The provider, Dr Dannis Wing Kuen Tang, provides private GP services from West End Medical Centre to both adults and children. The provider is registered with the Care Quality Commission (CQC) to carry on at the practice location the regulated activities of Treatment of Disease Disorder or Injury and Diagnostic & Screening Procedures.

We received 31 completed Care Quality Commission comment cards all of which were positive about the staff at the practice and the services received. We did not speak with patients directly at the inspection.

Our key findings were:

• The service had acted since our last inspection to ensure safe care and treatment was provided in relation to safeguarding patients, staff pre-employment checks, infection prevention and control protocols; and in relation to the availability of emergency medicines and equipment.
• The service had acted since our last inspection to ensure good governance in relation to identifying and acting on risks associated with fire safety, lapsed staff training and out of date or missing protocols.

• The service reviewed the effectiveness and appropriateness of the care it provided. It had also acted to ensure that care and treatment was now being delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Services were provided to meet the needs of patients.
• Patient feedback for the services offered was consistently positive.
• The service had acted since our last inspection such that management and governance arrangements assured the delivery of high-quality and person-centred care.

There were areas where the provider could make improvements and should:

• Review protocols to ensure that periodic water temperature monitoring is undertaken in accordance with the service’s recent Legionella risk assessment.
• Review fire safety protocols to ensure that fire instructions are appropriately displayed throughout the premises.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 18 May 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The provider, Dr Dannis Wing Kuen Tang, provides private GP services from West End Medical Centre to both adults and children. The provider is registered with the Care Quality Commission (CQC) to carry on at the practice location the regulated activities of Treatment of Disease Disorder or Injury and Diagnostic & Screening Procedures.

We received 40 completed Care Quality Commission comment cards all of which were very positive about the staff at the practice and the services received. We did not speak with patients directly at the inspection.

Our key findings were:

• There was a system in place for the reporting and investigation of incidents and significant events, although there was no written incident policy.
• Systems and processes were in place to keep people safe. However, these systems were not operated effectively to ensure care and treatment to patients was provided in a safe way.
• Recruitment checks were undertaken prior to employment. However, the most recent recruit’s DBS check was undertaken by a previous employer.
• The provider sought to deliver care and treatment in line with current evidence based guidance. However, there were gaps in their knowledge of some guidelines. Non-clinical staff received on the job training from the provider but had had no recent formal training in safeguarding, Basic Life Support, fire safety, infection control or information governance.
• Quality improvement and monitoring was exercised through clinical audit and patient feedback.
• There were formal processes for employed staff to receive an appraisal.
• The practice had no written consent policy in place, no consent decisions were recorded in patient notes and the provider had not received training in and had limited knowledge of the Mental Capacity Act 2005.
• Staff we spoke with were aware of their responsibility to respect people’s diversity and human rights.
• Patients were able to access services from the practice within an appropriate timescale for their needs.
• There was a policy and procedures were in place for handling complaints and concerns which were in line with recognised guidance.
• The provider lacked sufficient management support and this impacted on their capacity to lead effectively to consistently deliver high-quality, sustainable care.
• There was no formal governance structure, policies and procedures were undated and there was limited evidence of their regular systematic review and updating.
• The arrangements for identifying, recording and managing risks, issues and implementing mitigating actions were not operated effectively.

We identified regulations that were not being met and the provider must:

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

You can see full details of the regulations not being met at the end of this report.

In addition, there were areas where the provider could make improvements and should:

• Review the need for a written incident policy to underpin the documentation already in place.
• Review the need for a chaperone policy and arrange for information on the availability of a chaperone to be on display to patients.
• Review whether the practice should arrange its own DBS check of the administrative staff member.
• Review the facilities for those patients who are hard of hearing.

It was not practicable to visit this single handed practice during surgery hours, so we were not able to speak people using the service. However, we saw substantial written feedback from an annual survey of people's views which indicated that people were satisfied with the service. People remarked on "the high level of service" and the “attention and care of the doctor."

People were provided with sufficient information that enabled them to make informed decisions about their treatment. Information was made available to people in Chinese where this was their primary language.

People’s needs were appropriately assessed and treatment planned in a way that ensured people’s safety and welfare.

Care and treatment was provided by staff that were appropriately qualified and kept themselves up-to-date with their professional development.

The doctor regularly assessed the quality of aspects of the service through audits and actively sought annual feedback from people who use the service. There was a good response rate to questionnaires which showed that people were satisfied with the practice.

For this location it was not practicable to undertake a visit when patients were on site. West End Medical Centre is run by a single-handed doctor seeing all the patients at this location. The visit was announced to ensure that we could speak to Dr Tang and not interrupt his appointment schedule and thus disrupt patient care. We saw evidence that people were satisfied with the service but were unable to speak to any patients on this occasion.