The Care Quality Commission
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Five Elms Medical Practice

Overall: Requires improvement read more about inspection ratings

Five Elms Road, Dagenham, Essex, RM9 5TT (020) 8517 1175

Provided and run by:
Dr Ndalai Majiyebo Abaniwo

Important: The provider of this service changed - see old profile

All Inspections

25 February 2020

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Five Elms Medical Practice on 6 November 2019 as part of our inspection programme.

The inspection looked at the five key questions of Safe, Effective, Caring, Responsive and Well-Led. Following the November 2019 inspection, we rated the provider as requires improvement overall. The key questions of Caring, Responsive and Well-Led were rated requires improvement, key question Safe as good and key question Effective as inadequate.

The inspection report for the November 2019 inspection can be found by selecting the ‘all reports’ link for Five Elms Medical Practice on our website at https://www.cqc.org.uk/location/1-572070226/reports.

We issued a warning notice for breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. This inspection was an announced focused inspection undertaken on 25 February 2020 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches identified within the warning notice.

At this inspection we found:

  • Policies, procedures and/or protocol had been reviewed and amended to show that staff had the skills, knowledge and experience to deliver effective care, support and treatment.

As per our published inspection methodology, a further full comprehensive inspection visit will be carried out within six months of the publication of the November 2019 inspection report, to monitor the work the practice has started to produce the required improvements to the service.

Details of our findings and the evidence supporting them are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief inspector of Primary Medical Services and Integrated Care

6 November 2019

During a routine inspection

We carried out an announced comprehensive inspection at Five Elms Medical Practice on 13 September 2018 as part of our inspection programme. At this inspection we rated the provider as requires improvement for the key questions of caring and responsive, which lead to an overall rating of requires improvement.

At this time no breaches of regulatory requirements were identified. The reports for all the previous inspections for Five Elms Medical Practice can be found by selecting the ‘all reports’ link for Five Elms Medical Practice on our website at

This inspection was an announced full comprehensive inspection undertaken on 6 November 2019.

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.

This provider remains rated as requires improvement overall

We rated the practice as good for safe service because:-

  • There were systems and processes in place to ensure patients were kept safe .
  • Staff had information they need to deliver safe care and treatment.
  • The practice had a system in place to record significant events. Learning from these events was discussed with members of staff.

We rated the practice as requires improvement for caring, responsive and well-led services because:

  • The most recent National GP Patient Survey results revealed mixed scores for the practice.
  • The practice conducted in-house surveys, which identified areas of their service which required action to improve patient satisfaction.
  • Not all complaints were dealt with in a timely manner and learning from complaints was not shared with all staff.
  • The governance structure of the practice meant the management team did not have complete oversight of possible risks to practice.

We rated the practice as inadequate for effective services because:

  • The practice did not have adequate systems in place governing the recording, monitoring and following up of inadequate screening results.

These areas affected all population groups, so we rated all population groups as requires improvement.

The areas where the provider must make improvements are:-

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

Specific details on action required are listed at the end of this report. A warning notice was issued to the provider following this inspection undertaken on 6 November 2019. This was to ensure that the provider was aware of our concerns and that action was taken quickly to address these concerns and mitigate risks to patients.

The areas where the provider should make improvements are:

  • Review staffing levels at the practice to ensure that there is sufficient capacity to complete tasks in a timely manner.
  • Undertake regular health and safety risks assessments.
  • Continue with programme of recall to improve on the uptake of childhood immunisations.
  • Continue to monitor and act upon in-house and National GP Patient Survey results to achieve positive patient satisfaction results.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

During a routine inspection

This comprehensive inspection was undertaken on 13 September 2018 following an extended period of special measures; the practice is still rated as requires improvement overall (previous rating October 2017 – requires improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Good

We carried out an announced comprehensive inspection of this practice on 5 April 2016 when we rated the service as inadequate in all key questions and inadequate overall. Following the publication of the inspection report, the practice was placed in special measures for a period of six months.

We carried out a further announced comprehensive inspection on 14 February 2017 which highlighted that insufficient action had been taken by the practice in relation to improving access which continued to be reflected in the national GP patient survey satisfaction scores. We also found that staffing levels were inadequate such that the service continued to be rated as inadequate for providing responsive services. The service was rated as good for safe services and requires improvement for effective, caring and well-led services. Although the overall rating was revised to requires improvement, the service remained in special measures because of the inadequate rating for responsive services.

We carried out a further announced comprehensive inspection on 10 October 2017 which again highlighted insufficient action had been taken in relation to national GP patient survey satisfaction scores and staffing levels, such that the service continued to be rated as inadequate for responsive services. Overall the practice was still rated as requires improvement (good for safe and effective services and requires improvement for caring and well-led). In line with our enforcement powers we issued two Warning Notices in relation to Regulation 17: good governance and Regulation 18: staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service remained in special measures.

We carried out a further announced comprehensive inspection on 13 September 2018 to review the breaches of regulation identified at the inspection in October 2017 and to ensure the service had made improvements in line with the Warning Notices we had issued.

At this inspection we found that the practice had taken actions to bring about improvements and had complied with the Warning Notices.

Key findings:

  • The practice had taken positive action to improve appointments access and although patient satisfaction scores around access were still below local and national averages, there was a clear trend of improving patient satisfaction. Patients told us they were able to access care when they needed it.
  • Additional clinical and non-clinical staff had been recruited and there was now a process in place to plan for staff absences.
  • The practice had employed a female GP which meant that patients who had a preference in this regard could now choose to book an appointment with a female GP.
  • The practice had systems in place to safeguard patients from abuse.
  • There were systems in place to share information with other agencies to enable them to deliver safe care and treatment.
  • The practice had systems to manage risk 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. It ensured that care and treatment was delivered according to evidence based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Continue to improve uptake rates for child immunisations.

  • Continue to monitor patient satisfaction levels with a view to identifying where further improvements to the service can be made.

  • Develop written business plans to support the delivery of the practice strategy to deliver high quality, sustainable care and monitor progress of these plans.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

10 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We had previously inspected Five Elms Medical Practice on 5 April 2016, when we had rated the service as inadequate in all key questions and inadequate overall. Following the publication of the inspection report, the practice was placed in special measures for a period of six months. The report from the April 2016 inspection can be found by selecting the ‘Reports’ link for Five Elms Medical Practice on our website at http://www.cqc.org.uk/location/1-569174460.

We carried out a further announced comprehensive inspection on 14 February 2017. We had concerns that the practice had not taken sufficient action to address issues highlighted in the national GP patient survey and had not made suitable arrangements to provide suitable GP cover during periods when either the lead GP, or the long term locum GP was absent from the practice. This meant there remained a rating of inadequate for responsive. Although the overall rating for the service was revised to requires improvement, the practice remained in special measures as it had not made the sufficient improvements to achieve compliance with the regulations. The report from the February 2017 inspection can be found by selecting the ‘Reports’ link for Five Elms Medical Practice at http://www.cqc.org.uk/location/1-2871346124.

This inspection was undertaken following the extended period of special measures and was an announced comprehensive inspection on 10 October 2017. We found that although the practice had brought about improvements to clinical outcomes for patients, it had failed to take sufficient action to address issues highlighted in the national GP patient survey and had failed to ensure that suitable arrangements were in place to provide suitable GP cover over a two week period when the lead GP was absent from the practice. Overall the practice is still rated as requires improvement.

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Our key findings were as follows:

  • Patient satisfaction levels were still significantly below local and national averages. Comment cards received and the views of patients we spoke with on the day aligned with these findings.
  • The practice had not made effective arrangements to cover a period when the lead GP was absent which meant that patients continued to experience difficulties accessing GP appointments..
  • There was a leadership structure in place but there was lack of clarity about authority to make decisions.
  • Processes to monitor prescriptions awaiting collection were not always being followed.
  • The practice had recently engaged with the Royal College of General Practitioners’ ‘Peer Support Programme’ for practices placed in Special Measures. This provided access to expert professional advice, support and peer mentoring from experienced, senior GPs, practice managers and nurse practitioners with specialist expertise in quality improvement.
  • Quality Outcomes Framework (QOF) data for 2016/2017 showed that outcomes for patients with long term health conditions had improved and were now in line with local and national averages. Exception reporting rates had been reduced for all clinical indicators and were now comparable to or lower than CCG and national averages. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
  • Evidence showed that patient safety alerts were being received and acted upon.
  • The practice had carried out two competed cycle audits to drive improvement in patient outcomes.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Continue to seek and act on feedback from patients on the services provided, for the purposes of continually evaluating and improving such services.
  • Take action to ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are available to meet patient needs.

In addition the provider should:

  • Consider including contact details for all members of staff in the business continuity plan so that staff can be easily contacted in an emergency.
  • Consider arrangements in place to support patients who wish to see a female GP.
  • Continue to review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

This service was placed in special measures in August 2016 and this arrangement was extended for a further six months in May 2017. Insufficient improvements have been made such that there remains a rating of inadequate for responsive and an overall rating of requires improvement. Therefore we are taking 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

14 February 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Five Elms Medical Practice on 5 April 2016. The practice was rated inadequate for safe, effective, caring, responsive and well led. The practice was given an overall inadequate rating and placed in special measures The full comprehensive report on the 20 April 2016 inspection can be found by selecting the 'all reports' link for Five Elms Medical Practice on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 14 February 2017. Overall the practice is rated as requires improvement.

Our key findings were as follows:

  • Levels of patient satisfaction around access to the service and involvement in planning and making decisions about care and treatment were still significantly below local and national averages although there were improvements in all areas compared to the April 2016 inspection.
  • The practice had been unable to make effective arrangements in place to cover periods of GP absence although there was evidence of actions taken to mitigate the impact of lost GP sessions.
  • Although data from the Quality Outcomes Framework showed patient outcomes were generally comparable to the national average, there were areas where performance was significantly below the national average, including those for patients diagnosed with dementia.
  • At our last inspection in April 2016 we found that the practice had not undertaken any completed clinical audit cycles and there was no clear audit strategy in place. At this inspection we found that the practice had developed an audit plan for 2016/17 and had undertaken four clinical audits, including one completed audit.
  • The practice had recently begun to promote online access to services.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice had good facilities and was well equipped to treat patients and meet their needs
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
  • There was a clear leadership structure and staff said they felt increasingly supported by management. The practice had begun to seek feedback from staff and patients but processes had not been fully established.
  • The provider was aware of and complied with the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Continue to seek and act on feedback from patients on the services provided, for the purposes of continually evaluating and improving such services, including improving access to the practice and patient satisfaction around involvement in planning and making decisions about care and treatment.
  • Take action to ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are available to meet patient needs.

In addition the provider should:

  • Ensure the practice business continuity plan is available to staff, including whilst off-site.
  • Continue to monitor Quality Outcomes Framework performance to improve performance in relation to the management of long-term conditions and ensure exception reporting rates are closely scrutinized.
  • Consider further ways of promoting online access to services, including a review of the practice website and leaflet.
  • Continue to review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
  • Review arrangements to support patients with impaired hearing.

This service was placed in special measures in August 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing responsive services. 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 six months, and if there is not enough improvement we will move to 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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice