Archived: Soho Square General Practice

We carried out an announced comprehensive inspection at Soho Square General Practice on 31 October 2019 as part of our inspection programme.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 7 March 2019.

On that inspection we found;

• Patients on high risk medicines were monitored and blood tests were undertaken however there was no evidence that the appropriateness of the ongoing prescribing was being reviewed.
• The standard of cleaning in some rooms was not up to healthcare premises standards.
• The practice did not always learn and make improvements when things went wrong.
• Low childhood immunisation and of cervical screening uptakes.
• Some performance data was significantly below local and national averages.
• No long term conditions training for the locum nurse.
• The practice did not always have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• The overall governance arrangements were ineffective.
• The practice did not always have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

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 have rated this practice as good overall and good for all population groups.

We found that:

• The practice had an effective system for managing patients on medicines that needed monitoring.
• Staff involved in treating patients with long term conditions had the appropriate training for this role.
• The monitoring and the standard of cleaning had improved.
• Quality Outcomes Frameworks (QOF) had improved since the last inspection.
• Local managers had improved the processes for managing risks, quality improvement and the dissemination of learning from incidents.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way. However, the patient participation group felt better access to a Chinese speaking GP would be helpful considering the patient population.
• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
• The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was an open culture and staff felt supported in their roles, all staff had received annual appraisals.

Whilst we found no breaches of regulations, the provider should:

• Ensure staff had the appropriate authorisations to administer medicines (including Patient Group Directions or Patient Specific Directions).
• Continue to review systems to monitor and improve cancer screening rates and look at ways to improve this.
• Review the arrangements for having a GP who spoke Mandarin and Cantonese to better serve this patient group.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Soho Square General Practice on 7 March 2019.

At the last inspection in May 2018 we rated the practice as Inadequate overall. Previous reports on this practice can be found on our website at: Soho Square General Practice .

At this inspection we followed up on breaches of regulations identified at a previous inspection on 10 May 2018.

On that inspection we found;

• There was no innovation or service development and improvement was not a priority among staff and leaders.
• There was no clinical oversight of the largely locum clinical staff.
• Staff could not demonstrate effective cleaning of some clinical equipment.
• Staff did not always follow practice policy when there was a break in the vaccine cold chain.
• Feedback from the patient participation group (PPG) stated that the practice did not listen to patients views and continuity of care was poor due to the high use of locums.

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 have rated this practice as Requires improvement overall.

We rated the practice as Requires improvement for providing safe services because:

• Not all patients on high risk medicines were monitored in line with current guidance.
• The standard of cleaning in some rooms was not up to healthcare premises standards.
• The practice did not always learn and make improvements when things went wrong.

We rated the practice as Inadequate for providing effective services because:

• Low childhood immunisation rates.
• Low uptake of cervical screening.
• Some performance data was significantly below local and national averages.
• No long term conditions training for the locum nurse.
• Patients on high risk medicines were monitored and blood tests were undertaken however there was no evidence that the appropriateness of the ongoing prescribing was being reviewed.

We rated the practice as Requires improvement for providing well-led services because:

• While the practice had made some improvements since our inspection on 10 May 2018, there were still areas that could be improved. Such as; the practice did not always have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• The overall governance arrangements were ineffective.
• The practice did not always have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The GP national survey results rated the practice above the national average in most areas.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

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

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to review systems to monitor and improve the uptake for childhood immunisations.
• Review the level of safeguarding training required for clinical and non-clinical staff.
• Continue to review systems to monitor and improve the uptake for cervical cytology.
• Ensure that consultation rooms are cleaned in line with current national guidance.
• Review recruitment policies and procedures and ensure that the appropriate records are kept.
• Review the systems for the dissemination of safety alerts and the logging of any actions taken and improve the complaints log to provide sufficient information and ensure wider learning from complaints is shared.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care