Background to this inspection
Updated
22 February 2018
Dr WJ Degun's Practice, also known as The Knares Medical Practice is situated in Basildon, Essex. The practice registers patients who live in Leigh Chapel South, Langdon Hills and surrounding areas of Basildon. The practice provides GP services to approximately 6,700 patients.
The practice is commissioned by the Basildon and Brentwood Commissioning Group and it holds a General Medical Services (GMS) contract with NHS. This contract outlines the core responsibilities of the practice in meeting the needs of its patients through the services it provides.
The practice population has a comparable number of children aged five to18 years compared to the England average and fewer patients aged over 65 years. Economic deprivation levels affecting children and older people are higher than average, and unemployment levels are lower. The life expectancy of male patients is in line with the local average and the life expectancy of female patients is higher by one year. The number of patients on the practice’s list that have long standing health conditions is comparable to average, as is the number of patients who are carers.
The practice is governed by a partnership that consists of one full-time male GP and a part-time female GP. The partnership is supported by four part-time locum GPs, four practice nurses and a healthcare assistant. Administrative support consists of a full-time practice manager, a head receptionist and a number of part-time reception and administrative staff.
The practice is open 7.30am until 6.30pm every weekday except on a Thursday, when it is open until 7.15pm. When the surgery is closed, urgent GP care is provided by Integrated Care 24, another healthcare provider. Morning surgery times start at 7.30am daily, finishing between 12.30pm to 1.40pm. Afternoon surgeries begin between 1.30pm and 4pm and continue until between 5pm and 7.15pm.
The practice has previously been inspected on 16 May 2017 and 26 June 2017. On both occasions, the practice was rated as requires improvement overall. After the June 2017 inspection, the practice was issued with a warning notice in respect of the governance at the practice. We inspected the practice again on 14 November 2017 to check that requirements of the warning notice had been met. This inspection was a comprehensive inspection to ensure the practice had made improvements and also to give revised ratings.
Updated
22 February 2018
Letter from the Chief Inspector of General Practice
This practice is rated as good overall. (Previous inspection 26 June 2017– Requires Improvement)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Dr WJ Degun’s and Dr OO Macaulay Practice, also known as The Knares Medical Practice on 26 June 2017. The overall rating for the practice was requires improvement. We issued the practice with a warning notice in relation to the governance at the practice.
We carried out a focused inspection on 14 November 2017 and we found that the practice had met the requirements of the warning notice as sufficient improvements had been made. The full comprehensive report of both the June 2017 and November 2017 inspections can be found by selecting the ‘all reports’ link for Dr WJ Degun’s and Dr OO Macaulay Practice on our website at www.cqc.org.uk.
This inspection was a comprehensive inspection carried out on 23 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulations that we identified in our previous inspection on 26 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is now rated as good.
Our key findings were as follows:
- The provider had put in place an effective action plan to make improvements.
- There was now open and transparent leadership. There were regular minuted meetings with clinicians, local practices, other providers and all practice staff.
- Staff were supported and trained. The infection control lead had received appropriate training. Staff were supported to undertake additional training relevant to their role.
- Areas of underperformance had been identified. Unverified data indicated improvement.
- All chaperones had received a Disclosure and Barring (DBS check) to assess their suitability for the role.
- Systems to learn from significant events had been improved. Risk was effectively managed 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. This was discussed with clinicians, staff, other practices and stakeholders. The practice ensured that care and treatment was delivered according to evidence- based guidelines.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- The practice had identified patients who had been identified as carers. Carers were provided with support when they needed it.
- More GPs and nurses had been recruited and patients reported that they were able to access care when they needed it.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
- The provider encouraged staff at all levels to attend neighbouring practices to review and improve their ways of working. Staff presented their analysis at a team meeting and changes were made as a result of their findings.
However, there were also areas of practice where the provider should make improvements.
The provider should:
- Review, monitor and improve antibiotic prescribing.
- Improve uptake of breast cancer screening for women aged 50-70 within six months of invitation.
- Continue to monitor and improve patient feedback in relation to GP’s explanation of tests and treatments.
- Facilitate regular meetings with the Patient Participation Group.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice