- GP practice
Dr Tony Nasah Also known as Dipple Medical Centre
All Inspections
18 September 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
On 8 March 2017 we carried out a comprehensive inspection as a follow up to the practices first inspection on 29 June 2016 where they were placed in special measures. In March 2017 we found the practice had made improvements and had improved from an overall rating of inadequate to requires improvement. The practice was rated as requires improvement in March 2017 for providing caring and responsive services and rated as good for providing safe, effective and well-led services. The full report for the June 2016 and March 2017 inspections can be found by selecting the ‘all reports’ link for Dr Tony Nasah on our website at www.cqc.org.uk.
We carried out a focused inspection of the practice on 18 September 2017 to establish whether the improvements towards caring and responsive services had been made. We found the practice had made appropriate improvements for providing responsive services; overall the practice is rated as good with requires improvement for providing caring services.
Our key findings across all areas we inspected were as follows:
- Patients satisfaction data from the national GP patient survey, published in July 2017, had positive and negative variation. The practice were performing in line with local and national averages for their responsive data however they were performing below local and national averages for some aspects relating to the caring domain.
- The practice had created an action plan to improve their patient satisfaction.
- The practice had conducted internal patient surveys to monitor patient satisfaction. 64 out of 100 survey questionnaires were completed of which all had positive feedback.
- The practice had recruited two GPs and a nurse to increase appointment availability and to allow clinicians more time when discussing patients care.
- Patients we spoke with on the day of the inspection were positive towards their care they received at the surgery.
- Staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.
Actions the practice SHOULD take to improve:
- Continue to monitor national GP patient survey data and identify where improvements can be made.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
8 March 2017
During a routine inspection
Letter from the Chief Inspector of General Practice
On 29 June 2016, we carried out a comprehensive announced inspection. We rated the practice as inadequate overall. The practice was rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring and responsive services. As a result of the inadequate rating overall the practice was placed into special measures for six months.
A warning notice was issued for the provider for good governance. The concerns related to the safe recruitment of staff, appropriate staff training and support, management and learning from significant incidents, safe management of medicines and clinical performance. The practice submitted an action plan in respect of the regulatory breaches identified.
Practices placed into special measures receive another comprehensive inspection within six months of the publication of the report, so we carried out an announced comprehensive inspection at Dr Tony Nasah on 8 March 2017 to check whether sufficient improvements had been made to take the practice out of special measures. At this inspection we also looked at whether the practice had complied with the warining notice and we found that the improvements had been actioned.
Our key findings across all the areas we inspected were as follows:
- We saw staff were confident reporting significant incidents and these were investigated, learning shared and acted upon.
- Patient safety and medicines alerts information was shared and appropriate changes to patient’s medicines had been made.
- Staff had appropriate recruitment checks and those undertaking chaperone duties had undertaken DBS checks.
- Medicine management arrangements in place kept patients safe.
- Risk assessments had been conducted, actions identified and addressed to mitigate risks to patients.
- The practice had arrangements in place to respond to emergencies.
- Data from the practices performance over the past 12 months and the Quality and Outcomes Framework (QOF) showed improvements.
- The practice had established a culture of administrative and clinical audits to assess practice performance and ensure care was being delivered in line with current evidence based guidance.
- The clinical team had defined roles and responsibilities. They had the skills, knowledge and experience to deliver effective care and treatment.
- All staff had received appraisals and personal development plans.
- The practice received 60 comment cards which were positive about the commitment and care they received from the practice team.
- Patients reported improved levels of satisfaction with their GP in the national GP patient survey published July 2016.
- The practice had identified 2% of their registered patients to be carers and informed them of service available to them such as annual flu vaccinations.
- Practice provided a range of services from telephone consultations, extended hours an access to the GP hub every evening and weekends for GP, practice nurse and healthcare assistant services.
- Patients reported improved satisfaction with the GPs at the practice in the national GP patient survey.
- Appointments were available with GPs and the practice nurse on the day of the inspection and the following day with the healthcare assistant.
- Information about how to complain was available for patients. The practice acknowledged, investigated and responded to complaints. Learning from complaints was shared with staff and other stakeholders during meetings.
- The practice had published values and was clear about their future plans for development of the service.
- There was visible leadership within the practice and established governance systems. Risks to patients and staff were identified and acted on.
- The practice acted on feedback from patients and had patient representation at their patient participation meetings.
However there was an area of practice where the provider should make improvement:
- Improve patient satisfaction rates as highlighted in the national GP patient survey.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
29 June 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Tony Nasah on Wednesday 29 June 2016. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
- There was a system in place for reporting and recording significant events but no policy, independent discussion oversight or cascading learning to staff from analysis and investigation. Some staff were not sufficiently aware of how to identify a significant event.
- Systems were not established to ensure all clinicians were kept up to date with national guidance and guidelines.
- Patient safety and medicine alerts were shared amongst the clinical team but not revisited to ensure appropriate changes to medicines had been undertaken.
- Clinical staff had not been appropriately trained in safeguarding children and vulnerable adults.
- Effective recruitment procedures were not being followed in relation to recruitment checks on new members of staff. Those staff carrying out chaperone duties had not received a disclosure and barring service check. There was no risk assessment in place as to why one was not required.
- The practice appeared clean and tidy. However an annual infection control audit had not been conducted at the practice. The appointed infection control lead had not received training to undertake the role and there was an absence of documentation to demonstrate when, where and how rooms and equipment had been cleaned.
- There was insufficient clinical oversight and actioning of blood test results during the absence of the lead GP.
- Some risk assessments had been conducted to mitigate the risks to patients. However, there was no environmental risk assessment, assessment of control substanaces hazardous to health or legionella.
- There was insufficient staffing provision to cover in the absence of the practice nurse and delays in responding to enquiries when the practice manager was unavailable.
- The practice had arrangements in place to respond to emergencies.
- Data from the Quality and Outcomes Framework (QOF) and the National Cancer Screening Programme showed patient outcomes were below the local and national averages. The practice were unable to provide an explanation for their poor clinical performance in some areas and there was no improvement plan in place.
- The practice did not have any quality improvement system in place to assess and monitor the services provided to ensure care and treatment was delivered in line with current evidence based guidance and inform quality improvements.
- The practice nurse had not been appropriately authorised to administer childhood vaccinations through the use of Patient Group Directions. Nursing staff were unable to demonstrate they had the skills, knowledge and experience to deliver some aspects of effective care and treatment. Training records were also unavailable on the day of the inspection.
- There was no evidence of appraisals and personal development plans for all staff.
- Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. However, patients reported low levels of satisfaction with their GP in the national GP patient survey published in January 2016.
The areas where the provider must make improvements are:
- Ensure there is a practice policy defining significant incidents and actions to be taken. Support and provide training to staff on the recognition, reporting and the recording of significant incidents. Ensure independent scrutiny and identify, disseminate and monitor lessons learnt to ensure they are embedded into processes.
- Take action to address identified concerns with infection prevention and control procedures and training.
- Ensure recruitment arrangements include all necessary employment checks for all staff.
- Ensure staff receive appropriate training, supervision and appraisal to fulfill their roles and responsibilities (including covering in the absence of colleagues) and retain evidence of training and qualifications.
- Ensure clinical oversight and actioning of test results during the absence of the lead GP.
- Ensure that staff carrying out chaperone duties have a disclosure and barring service check in place or a risk assessment is undertaken as to why one is not required.
- Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
- Improve the governance at the practice to ensure that there are effective systems in place for assessing and monitoring risks and the quality of the service provision through a quality improvement process. This includes QOF performance.
- Implement a system to respond to and act on patient feedback from the national GP patient survey.
- Ensure the correct authorisation of PGDs to enable the nursing team to administer vaccinations.
- Ensure appropriate risk assessments are conducted to mitigate the risks to patients. For example, an environmental risk assessment, assessment of control substanaces hazardous to health and legionella.
The areas where the provider should make improvement are:
- Revisit patient safety alerts to ensure safe prescribing.
- Follow up on non attendance by patients for cancer screenings.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will 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 their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice