Archived: Dr Paul Unyolo Also known as Talke Pits Clinic

Updated 28 July 2016

Dr Paul Unyolo is registered with the Care Quality Commission as an individual provider.

The provider operates from purpose built premises at Talke Pits Clinic within the NHS North Staffordshire Clinical Commissioning Group area. The provider holds a General Medical Services contract with NHS England. At the time of our inspection 3,774 patients were registered at the practice.

As part of our pre-inspection checks we found that the provider had entered into a new commissioning arrangement as a partnership. We have instructed the provider that they must reflect this by registering as a new provider as a legislative requirement.

The practice has been in special measures since December 2015 following a Care Quality Commission (CQC) inspection in September 2015. At the September 2015 inspection concerns were identified in a number of areas including significant event handling, safeguarding, application of national clinical guidance and handling of complaints. We told the practice they must take action in the way in the way they deal with safeguarding processes, handle complaints and deal with risks within the practice. At our most recent inspection, whilst we saw there had been improvement in a number of areas not enough progress had been made in how complaints were investigated and responded to. Also how risks within the premises were known and mitigated.

Demographically the practice area is of similar deprivation to the national average, although this is higher than the CCG average. The average age range of patients at the practice broadly follows the national average, with the exception of having 4% more patients aged over 65 years.

As well as providing the contracted range of primary medical services, the practice provides additional services including:

• Minor surgery

• Avoiding unplanned admission to hospital

• Learning disability health checks.

The practice is open on Monday, Tuesday, Wednesday and Friday from 8am to 6:30pm.and Thursday from 8am to 1pm. During these times telephone lines and the reception desk are staffed and remain open. Extended appointments are offered on Monday evening from 6:30pm to 8pm and Thursday 7:30am to 8am. On a Thursday afternoon calls are transferred to the locality out-of-hours service who provide medical cover under a separate agreement. The practice has opted out of providing cover to patients outside of normal working hours. These out-of-hours services are provided by Staffordshire Doctors Urgent Care Limited.

Staffing at the practice includes:

• Three GPs (two female, one male)

• One female advanced nurse practitioner.

• One female practice nurse.

• One female practice healthcare assistant.

• A practice manager and team of six administrative/reception staff.

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Paul Unyolo on 30 September 2015. A total of four breaches of legal requirements were found. After the comprehensive inspection, the practice was rated as inadequate overall and placed into special measures.

We issued three warning notices in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safe care and treatment.

• Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safeguarding service users from abuse and improper treatment.

• Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Receiving and acting on complaints.

We also issued a requirement notice in relation to:

• Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Fit and proper persons employed.

We undertook an announced comprehensive inspection on 18 May 2016 to check that the practice now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Paul Unyolo on our website at www.cqc.org.uk .

Our key findings were as follows:

• The practice had made improvements to the way it reported and recorded significant events and strengthened systems to keep vulnerable patients safe.

• While the practice had made some improvements to their process for handling complaints, these were not sufficient to meet recognised guidance and contractual obligations for GPs in England. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Responsibility for some safety issues had been classed as the responsibility of others without understanding or knowledge of the level of risk involved.

• We saw examples of when care was not delivered in line with current evidence based guidance.

• The capability and appropriate knowledge of the leadership team within the practice was not clearly evident.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

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

Importantly, the provider must:

• Implement and operate a consistent and effective system for receiving and acting on medicines alerts affecting patient safety.

• Assess, monitor and mitigate the risks to patients and others at risk from actions detailed in the practice legionella risk assessment.

• Assess, monitor and improve the quality of services provided in relation to the care and treatment reflecting nationally recognised guidance.

• Operate an effective system for receiving, handling and responding to complaints.

• Implement and operate an effective system for receiving and issuing blank prescriptions.

• Display Care Quality Commission (CQC) inspection ratings conspicuously within the practice premises.

In addition the provider should:

• Implement a consistent system for checking that monitoring for patients, who take long term medicines on a shared care basis, has been provided before the medicines are issued.

• Review the capability of leadership within the practice.

• Improve the identification of patients who may be carers.

• Ensure relevant staff have completed recognised training in safeguarding vulnerable adults.

• Mitigate outstanding actions in the practice infection control audit.

This service was placed in special measures on 17 December 2015. Insufficient improvements have been made such that there remains a rating of inadequate for well-led services.

The levels of concern identified at this inspection met the threshold for us to escalate our previous enforcement action in line with our enforcement and decision making policies. We have not issued a notice of proposal to cancel the provider’s registration as they submitted an application to cancel their individual registration with CQC.

We have received a new partnership provider application to provide services at the practice. This application will be assessed in line with legal requirements.

The practice will remain in special measures and will be kept under review and if needed could be escalated to urgent enforcement action. Another inspection will be conducted within six months or sooner if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 July 2016

The practice is rated as good for caring services and this includes this population group. The practice was rated as inadequate for well-led services and requires improvement for safe, effective and responsive services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• We saw that the monitoring of some patients with diabetes did not reflect nationally recognised guidance.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 July 2016

The practice is rated as good for caring services and this includes this population group. The practice was rated as inadequate for well-led services and requires improvement for safe, effective and responsive services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

• The practice had strengthened their procedures for safeguarding children and had joined up working with health visitor and school nurses.

• The practice offered same day access for all children with illness.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice’s uptake for the cervical screening programme was 78% compared with the CCG average of 80% and national average of 82%.

Updated 28 July 2016

The practice is rated as good for caring services and this includes this population group. The practice was rated as inadequate for well-led services and requires improvement for safe, effective and responsive services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice operated a register of patients who were housebound and a practice nurse when required would home visit and provide health assessment and vaccinations.

Updated 28 July 2016

The practice is rated as good for caring services and this includes this population group. The practice was rated as inadequate for well-led services and requires improvement for safe, effective and responsive services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 28 July 2016

The practice is rated as for caring services and this includes this population group. The practice was rated as inadequate for well-led services and requires improvement for safe, effective and responsive services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

• We saw that the monitoring of some patients with enduring poor mental health did not reflect nationally recognised guidance.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Performance for indicators for patients who were diagnosed with dementia was lower than local and national averages. For example, 76% of patient had received a care review in the previous year compared with the CCG and national averages of 84%. Of note this was a significant improvement from the previous year’s performance.

Updated 28 July 2016

The practice is rated as good for caring services and this includes this population group. The practice was rated as inadequate for well-led services and requires improvement for safe, effective and responsive services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice offered all patients with a learning disability an annual health check.