Barking Medical Group Practice

We carried out an announced inspection at Barking Medical Group Practice. A remote clinical records review was undertaken on 11 March 2022, a site visit was completed on 9 March 2022 and interviews with staff were held remotely on 7 & 8 March 2022. Overall, the practice is rated as Requires Improvement.

Safe – Inadequate

Effective - Requires Improvement

Caring – Requires Improvement

Responsive - Requires Improvement

Well-led - Requires Improvement

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Barking Medical Group Practice on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection as part of our risk based approach to reviewing and inspecting services.

How we carried out the inspection

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 inspections differently.

This inspection was carried out in a way which aimed to enable us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing.
• Requesting staff feedback using surveys.
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

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 have rated this practice as Requires Improvement overall.

We found:

• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse as staff had not received appropriate level of training and criminal background and other recruitment checks were not completed at the time of appointment for all staff.
• Immunisation status was not checked for all staff in respect of common communicable diseases.
• Risks associated with fire, legionella and substances hazardous to health had not been adequately assessed or mitigated.
• Electronic and clinical equipment had not been calibrated or appropriately checked to ensure it was safe to use since 2020.
• Appropriate training including basic life support training had not been completed by all staff in line with current guidelines and appraisals for staff lacked detail.
• The provider had expired medicines in their supply of emergency medicines and some of the recommended medicines were not present and their absence had not been risk assessed. Some patients taking one class of medicines were not being regularly reviewed and we did not have confidence the practice was taking timely action in response to medicines safety alerts.
• Reviews of clinical records indicated that systems to identify those at risk of developing long term conditions and preventing the over prescribing of inhalers were not effective.
• The practice had not met targets for cervical screening and childhood immunisation, though the practice outlined action taken to increase uptake after the pandemic.
• Some patient feedback about care and treatment and access was negative or below average; particularly in respect of access to appointments and the practice telephone system. However, the practice had taken steps to try and improve access.
• Governance systems and processes needed to improve particularly in respect of areas related to risk management and patient safety.

However, we also found that:

• The practice demonstrated a commitment to learning and improvement through its training of medical students and quality improvement activities.
• Complaints were acted upon and feedback had been sought from patients and used to make improvements.
• The practice was aware of challenges to delivering a good quality service and had plans in place to address health inequalities and conditions that were more prominent among their population. Action had been taken where concerns had been raised and staff had been proactive in supporting their most vulnerable patients during the pandemic.
• Staff reported feeling well supported.

We found breaches of regulations. The provider must:

• 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 provider should:

• Continue to work to improve the uptake of screening and immunisations.
• Take action on the basis of survey feedback generated to improve satisfaction with care and treatment provided by clinical and non-clinical staff and undertake more patient engagement.
• Review systems related to the reporting and management of significant events with a view to making improvements.

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