04 September 2023
During a routine inspection
We carried out an announced comprehensive inspection at Dr Okeahialam and Partners on 1 and 4 September 2023. Overall, the practice is rated as requires improvement.
Safe - requires improvement.
Effective - requires improvement.
Caring – good.
Responsive – requires improvement.
Well-led – good.
Following a previous inspection on 17 November 2019, the practice was rated as good overall and for all key questions. In 2019, in line with CQC methodology at the time, the population group of people with long-term conditions was rated as requires improvement.
At this inspection we examined areas where the provider had been previously informed they should make improvement during the 2019 inspection. This included:
- Adding details of the Parliamentary and Health Service Ombudsman to patient complaint correspondence should a patient wish to escalate their complaint.
- Continuing to ensure all actions in relation to Infection Prevention and Control audits were completed.
- Continuing to review and improve systems for monitoring and supporting people with long-term conditions.
We found that actions had been undertaken, however more progress was still required regarding monitoring and supporting people with long-term conditions.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Okeahialam and Partners on our website at www.cqc.org.uk
Why we carried out this inspection
We carried out this inspection to follow up concerns which were reported to us.
How we carried out the inspection
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.
This included:
- Conducting staff interviews using video and telephone conferencing.
- Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
- Requesting evidence from the provider.
- A short visits to the provider sites.
- Staff questionnaires
- Requesting feedback from patients via the ‘share your experience’ link on the CQC website.
Our findings
We based our judgement of the quality of care at this service on a combination of:
- What we found when we inspected
- Information from our ongoing monitoring of data about services and
- Information from the provider, patients, the public and other organisations.
We found that:
- Patients’ needs were assessed. However, care and treatment had not always been delivered in line with current standards and evidence-based guidance. For example, we identified concerns in relation to medicines management, the diagnosis of conditions, and monitoring and follow-up of patients with long-term conditions.
- The provider had experienced the loss of 4 key members of their management team in 2022. This had proved a significant challenge to the organisation, and had impacted on the clinical and management workload of partners. Since this time, the provider had appointed new staff and restructured and reorganised the delivery of some services.
- The provider had developed specific teams such as an acute care team to increase capacity and improve care.
- The provider had a programme of quality improvement activities in place which included clinical audit.
- Child immunisation and cancer screening rates were below local and national averages and targets. We saw that the provider had recognised this and had either put into place, or was planning measures to improve these areas of underperformance.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- Some patients reported difficulty in accessing care and treatment in a timely way. We saw that the provider had put in place measures to meet the challenge of patient demand. This included the development of specific work teams, and proposed upgrades to the telephony system. We saw that overall numbers of appointments had increased by around 16% from 2019/20 to 2022/23.
- Engagement with patients was mixed. Detailed patient survey work had been undertaken, however routine engagement with patients and patient representatives was limited.
- The provider had processes in place to monitor and manage performance.
We saw areas of outstanding practice:
- The provider had a feedback button embedded in the clinical system which allowed staff to record and report feedback, incidents, and concerns immediately. This included feedback from patients. This greatly improved the collection of feedback and the opportunity to raise concerns and issues in a timely manner.
- The provider had engaged with the local patient population to identify views and concerns which acted as barriers to participating in the cervical screening programme. They had also begun to do the same for parents and guardians of children in respect of child immunisations. Findings were to be used to increase take-up.
We found one breach of regulation. The provider must:
- Ensure that care and treatment is provided in a safe way to patients.
In addition, the provider should:
- Work to improve cervical screening, breast and bowel screening rates.
- Improve childhood immunisation rates.
- Improve the uptake of learning disability health checks.
- Continue to implement measures to improve capacity.
- Put in place measures to increase and improve patient feedback mechanisms.
- Complete appraisals for staff within the required time period.
- Continue to work to improve patient access to the service.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Health Care