We carried out a review of the data available to us about Dr WJ Degun's and Dr OO Macaulay Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Dr WJ Degun's and Dr OO Macaulay Practice, you can give feedback on this service.
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:
However, there were also areas of practice where the provider should make improvements.
The provider should:
Chief Inspector of General Practice
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. Specifically the practice was rated as inadequate for providing well-led services, requires improvement for safe and effective and good for caring and responsive. The full comprehensive report on the June 2017 inspection 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.
As a result of the issues identified on the day of the inspection we took enforcement action against the provider and issued them with a warning notice in relation to the governance at the practice. The practice was required to be compliant with the warning notice by 10 November 2017.
This inspection was an announced focused inspection carried out on 14 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the warning notice that we issued after 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.
Our key findings were as follows:
Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection at Dr WJ Degun’s and Dr OO Macaulay Practice, also known as The Knares Medical Practice on 16 May 2016. At that time, the overall rating for the practice was requires improvement. It was rated as requires improvement for providing safe, effective and well-led services, and good for caring and responsive. The full comprehensive report of the 16 May 2016 inspection 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 an announced comprehensive inspection carried out on 20 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 May 2016. So that we could provide a rating for the practice, we inspected all domains and key questions. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice continues to be rated as requires improvement following our most recent inspection.
Our key findings across all areas we inspected were as follows:
The areas where the provider must make improvements are:
An area where the provider should make improvements is:
Continue to identify more patients who are carers and provide them with appropriate support.
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr WJ Degun's Practice on 16 May 2016. Overall the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
Significant events were recorded although this was brief and showed little evidence of review and shared learning.
Risks at the premises were not always assessed and well managed. These included an effective health and safety risk assessment, the risk associated with legionella and the security and issue of prescription stationery.
Recruitment checks were not always robust in relation to employment checks.
Not all staff acting as chaperones had received a disclosure and barring service check. Although this role was primarily undertaken by nurses who had received a disclosure and barring service check, there had been occasions where non-clinical staff performed this role. Although the practice manager had considered some of the measures that were in place to mitigate the risk, there was no detailed, written risk assessment.
There was not a robust system in place to ensure that patients on high risk medicines were receiving regular blood tests. Outcomes for patients were in line or below national and local averages. Where the practice reflected low performance data, we were told that clinical staff were not routinely updating patient records.
Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was variable, with patients responding positively about the care they received from the practice.
Practice staff had received safeguarding training for vulnerable adults and children. However, the system did not clearly identify to all clinicians those patients identified as the subject of safeguarding concerns.
There were care plans with pictorial aids to enable patients with learning disabilities to be involved in their care. All patients with learning disabilities had received an annual health check, although carers were not routinely identified.
The premises were modern and well equipped to ensure services were accessible including a lift and a car parking space for patients who had a disability.
There were a range of services available on site including ultrasound, phlebotomy and counselling.
A health visitor, midwife and COPD nurse held weekly clinics at the practice.
There was not an open, transparent relationship between all staff who worked at the practice. Not all staff had received appraisal.
Records did not always an accurate, complete representation of patient’s care, treatment and decisions made.
The practice was not aware of the most recent national GP patient survey data, although they had taken some steps to make improvements to access, including opening one late night and one Saturday on alternate weeks.
The areas where the provider must make improvements are:
Ensure the security and adequate tracking of prescription pads through the practice.
Ensure staff are fit for the role for which they are employed by making appropriate pre-employment checks.
Ensure all staff acting as chaperones receive a DBS check or a risk assessment as to whether or not one is not required.
Undertake a legionella risk assessment.
Improve the system in place for the reviewing and monitoring of patients taking high risk medicines.
Take steps to improve access and respond to the issues raised in the national GP patient survey.
Ensure patient records represent an accurate, complete representation of patient’s care and treatment and decisions made.
In addition the provider should:
Put in place a robust protocol to manage safety alerts received at the practice.
Ensure all staff receive appraisal.
Promote open, transparent discussion and involvement with all people who work at the practice.
Chief Inspector of General Practice
The practice demonstrated they had suitable arrangements to co-operate with other providers to provide care and protect people's health, safety and welfare when more than one provider was involved in care and treatment.
There were effective recruitment processes were in place to ensure appropriate checks had been undertaken before staff had begun to work for the practice.
Both paper and electronic records held at the practice were accurate, appropriately maintained and kept securely.