The Care Quality Commission
  • Doctor
  • GP practice

Old Road West Surgery

Overall: Good read more about inspection ratings

30 Old Road West, Gravesend, Kent, DA11 0LL (01474) 352075

Provided and run by:
Dr Abdul Halem

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

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Old Road West Surgery 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 Old Road West Surgery, you can give feedback on this service.

26 May 2021

During an inspection looking at part of the service

We carried out an announced inspection at Old Road West Surgery on 8 January 2020. The overall rating for the practice was Good, but the Caring domain was rated as Requires Improvement.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Old Road West Surgery on our website at www.cqc.org.uk.

Why we carried out this review

This was a review of information without undertaking a site visit inspection to follow up on the areas that were identified as needing improvement in our previous inspection.

How we carried out the review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our reviews differently.

This included:

  • Conducting staff interviews using video conferencing.
  • Requesting evidence from the provider.

Our judgement of the quality of care at this service is based 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 practice remains as Good overall.

The key question at this review is rated as:

Are services at this location caring? – Good

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

  • The provider had taken action to improve patient responses to the national GP survey results where they were below local and national averages. However, ongoing monitoring and some further action were required.

At this review we also found:

  • All staff were now up to date with their vulnerable adult safeguarding training.
  • The provider had taken action to improve the identification of carers. There were now 157 patients identified as carers which represents 1.7% of the practice’s registered patient population.
  • Records showed that incoming correspondence and test results were being processed in a timely manner in line with the provider’s document management protocol document dated October 2020.

The areas where the provider should make improvements are:

  • Continue to monitor national GP patient survey results and take action to improve patient satisfaction where results are below local and national averages.

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

8 January 2020

During a routine inspection

We previously carried out an announced comprehensive inspection at Old Road West Surgery on 15 August 2017. Overall the practice was rated as inadequate and was placed into special measures.

We issued warning notices in respect of identified issues and found arrangements had significantly improved when we undertook a follow up inspection of the service on 5 February 2018.

We conducted an announced comprehensive inspection on 29 November 2018. The practice was rated as requires improvement overall. It was removed from special measures and rated as Requires improvement for providing safe, caring and responsive services and Good for providing effective and well-led services. Breaches of regulation were identified. The details of these can be found by selecting the ‘all reports’ link for Old Road West Surgery on our website at www.cqc.org.uk

We carried out an announced comprehensive inspection on 8 January 2020 as part of our inspection programme and to check the practice had met the regulatory requirements.

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.

We rated the practice as Good for providing safe, effective, responsive and well-led services because:

  • Significant improvements had been made to ensure care plans were accessible at all times and included all relevant and up-to date information for patients with mental health issues.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • There were comprehensive systems to keep people safe, which took account of current best practice.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect. They involved them in decisions about their care.
  • Improvements had been made to ensure complaints were acknowledged appropriately in the absence of the practice manager.
  • The practice organised and delivered services to meet patients’ needs.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • Systems and processes to ensure good governance were effective.

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

  • Although no breaches of regulation were identified, patient responses to national GP survey results remained lower than expected for GPs listening to them, being treated with care and concern and their overall experience of their GP practice.

The areas where the provider should make improvements:

  • Continue with their plan to ensure vulnerable adult safeguarding level three training is completed as planned.
  • Monitor and assess the effectiveness of the newly implemented policy and template in relation to scanned documents being reviewed.
  • Continue to improve the identification of carers, to ensure they receive appropriate care and support.

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

Dr Rosie Bennyworth BS BMedSci MRCGP
Chief Inspector of General Practice

29 November 2018

During a routine inspection

This practice is rated as requires improvement overall. (Previous rating August 2017 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? - Good

We previously carried out an announced comprehensive inspection at Old Road West Surgery on 15 August 2017. Overall the practice was rated as inadequate and was placed into special measures.

We issued warning notices in respect of identified issues and found arrangements had significantly improved when we undertook a follow up inspection of the service on 5 February 2018. The details of these can be found by selecting the ‘all reports’ link for Old Road West Surgery on our website at

Following this inspection, the provider appointed a new Partner and made an application to CQC to change their CQC registration from a registered individual to a registered partnership. The application was supported by the CCG and was in transit when the newly appointed Partner resigned and the provider reverted to their previous legal entity.

We therefore conducted an announced comprehensive inspection on 29 November 2018 to check the practice has met the requirements of the regulations and re-evaluate the decision for placement into special measures.

At this inspection we found:

  • The practice had significantly improved its formal systems to underpin how significant events, incidents and concerns were monitored, reported and recorded.
  • The practice had made significant improvements and had clear systems to manage risk so that safety incidents were less likely to happen. For example, infection prevention and control and fire safety procedures.
  • The practice had significantly improved its systems for the appropriate and safe handling of medicines.
  • The practice's disease registers had been embedded and now contained all the relevant patients presenting with the clinical condition.
  • The practice had systems for sharing information with staff and other agencies. However, care plans were not always accessible.
  • Patient records for those requiring mental health checks, did not always contain evidence of physical health checks documented.
  • Care and treatment was planned and delivered in a coordinated way.
  • 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.
  • Planned changes had been conducted to their appointment system to ensure it was meeting patients’ needs.
  • The practice had improved its system for handling complaints and concerns. However, acknowledgment response times when the practice manager was absent needed addressing.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Most patients we spoke with found the appointment system easy to use and reported that they could access care when they needed it. However, national GP patient survey results did not reflect this.
  • Governance arrangements had significantly improved to ensure they were always sufficient and effectively implemented.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure that care and treatment is provided in a safe way for service users.

The areas where the provider should make improvements are:

  • Continue to monitor and ensure the system for recording the use of local anaesthetic is effective.
  • Continue with their plan to improve how carers are identified and offered support.
  • Improve the system for acknowledging the receipt of complaints in the practice managers absence.
  • Continue to monitor and carry out their plan to address low national GP patient survey results.

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

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

5 February 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Old Road West Surgery on 15 August 2017. Overall the practice was rated as inadequate and was placed into special measures. Practices placed in special measures are inspected again within six months of publication of the last inspection report.

A breach of the legal requirements was found because care and treatment was not being provided to patients in a safe way and the practice had not assessed the risks to the health and safety of service users. Where risks had been identified these had not been mitigated. Additionally, the practice did not have systems or processes established and operating effectively to assess, monitor and improve the quality and safety of the services provided.

As a result, the provider was not assessing, monitoring and improving the quality and safety of the services provided and mitigating the risks related to the health, safety and welfare of service users and others. Therefore, Warning Notices were served in relation to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

  • Regulation 12

  • Regulation 17 Good Governance.

Following the comprehensive inspection, we discussed with the practice what they would do to meet the legal requirements in relation to the breach and how they would comply with the legal requirements, as set out in the Warning Notices.

We undertook this announced focused inspection on the 5 February 2018, 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 15 August 2017. The practice was not rated as a consequence of this inspection, as the practice is in special measures. It will be inspected again, with a view to assessing the practice’s rating when the timescale for being placed into special measures has passed.

This report only covers our findings in relation to those requirements. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Old Road West Surgery on our website at www.cqc.org.uk

Our key findings were as follows:

  • The practice had improved its formal systems to underpin how significant events, incidents and concerns were monitored, reported and recorded. However, further improvements were still required.

  • There were systems, processes and practices to minimise risks to patient safety. However, further improvements were still required in order to help ensure all risks identified were actioned.

  • The system to keep all clinical staff up to date and check their understanding of current evidence based guidance and standards, had improved.

  • The practice's disease registers had been established and now contained all the relevant patients presenting with the clinical condition. However, these were a work in progress and required further embedding.

  • Improvements had been made to help ensure that staff had the skills and knowledge to deliver effective care and treatment.

  • The practice had improved how they shared the information with the out of hours provider.

  • Care and treatment was planned and delivered in a coordinated way.

  • The practice had improved how they obtained consent from patient's consent for minor surgery.

  • An assessment had been conducted of their appointment system to ensure it was meeting patients’ needs.

  • The practice had improved its system for handling complaints and concerns. However, further improvements were still required to help ensure complainants were responded to appropriately.

The practice had made improvements to its overarching governance framework. However, further improvements were still required in order to help ensure they were always effective.

There were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure care and treatment is provided in a safe way to patients.

  • Ensure systems and processes to ensure good governance in accordance with the fundamental standards of care are effective.

In addition the provider should:

  • Improve the daily checklist proforma for cleaning schedules.

  • Improve policies in the locum induction pack to ensure they are up to date.

  • Improve the way in which staff are involved with the development of practice specific policies.

  • Improve staff development in order to ensure they are aware of their roles and responsibilities.

  • Improve the management of complaints to help ensure they are processed effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

15 August 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Road West Surgery on 15 August 2017. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

  • There was no established and effective system to ensure the safe management of medicines.
  • The practice was tidy but some areas of the premises required repair. The practice had not conducted an annual infection prevention control audit. Checklists were completed with staff confirming cleaning had been undertaken. However, there were no detailed cleaning schedules to show where, when and how items were cleaned.
  • There were insufficient procedures for assessing, monitoring and managing risks to patient and staff safety.
  • The practice had insufficient arrangements in place to respond to emergencies and major incidents. Best practice guidance had not been followed.
  • We found some of the practice’s disease registers had not been validated to include the relevant patients with medical conditions. Therefore, the Quality and Outcome Framework data was not representative of the care and treatment provided to some of the practice’s patients.
  • The practice did not provide evidence of clinical audits having been conducted and used to inform quality improvement.
  • There was no induction pack for the locum GPs defining roles and responsibilities. Some clinical staff had not received annual appraisals, but we found evidence of them accessing appropriate training and personal development opportunities.
  • Administrative staff had not received specific training and clinical oversight to screen and prioritise clinical information.
  • Patients were not routinely offered the convenience of choose and book services. This was left to the discretion of the clinician.
  • The practice had identified 0.5% of their patient list to be carers.
  • Patients we spoke with reported difficulties making an appointment. The practice did not demonstrate an understanding of their population profile. They had not conducted an assessment of their appointment system and whether it was meeting their patients’ needs.
  • Information about how to complain was available. Complaints were investigated and responded to appropriately. However, we found no evidence of learning or sharing of outcomes with staff and other stakeholders.
  • The lead GP had a vision of how they intended services to be provided.
  • Changes to personnel had left roles vacant and the risks associated with this had not been addressed.

The areas where the provider must make improvement are:

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

The areas where the provider should make improvement are:

  • Employ a consistent approach to choose and book services for the convenience of patients.
  • Improve the identification of carers.
  • Improve the identification of learning from complaints.

On the basis of the ratings given to this practice at this inspection. I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice