Archived: Berwick Surgery

Updated 2 May 2017

Berwick Surgery is based in a converted semi-detached house, located in a residential area of Rainham. The practice provides GP primary care services to approximately 4,900 people. Primary medical care is provided under a personal medical services (PMS) contract within NHS Havering Clinical Commissioning Group (CCG). The practice is registered with the Care Quality Commission (CQC) to care out the following regulated activities: treatment of disease, disorder or injury, maternity and midwifery services and family planning, diagnostic and screening procedures and surgical procedures.

There are two male GP partners. One of the senior partners is the Clinical Director for Havering CCG. The GP partners do 11 clinical sessions between them from Monday to Friday. They are supported by locum GPs who do an additional four GP sessions between Monday and Friday. The practice employs one female part time nurse prescriber and one female part time healthcare assistant. There is one practice manager and seven part time administrative staff.

The practice opens between 8.00am and 6.30pm Monday to Friday. The practice is closed between 12.00pm and 1.00pm for lunch but the telephone lines remain open for patients. Appointments are from 8.30am to 11.30am every morning and from 4.00pm to 6pm in the evening. Between 11.30am and 12.30pm, all clinical staff carry out telephone consultations. Out of hours the service is provided by a different provider between 6.30pm and 8am and can be accessed by calling the practice out of hours telephone number which is on the practice website and practice leaflet.

Information taken from the Public Health England practice age distribution shows the population distribution of the practice was similar to that of other practices in England. The life expectancy of male patients was the same as the CCG and national average of 79 years. The female life expectancy at the practice was 85 years, which is higher than the CCG average of 84 years and national average of 83 years.

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.

Updated 2 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berwick Surgery on 1 March 2016. The overall rating for the practice was Inadequate. The full comprehensive report on the 1 March 2016 inspection can be found by selecting the ‘all reports’ link for Berwick Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 February 2017 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 1 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Inadequate.

Our key findings were as follows:

• The practice had some systems in place to minimise risks to patient safety. However, these were not always clearly defined or embedded.

• The arrangements for managing medicines, including vaccinations were adequate to ensure patient safety.

• Staff were aware of current evidence based guidance. However not all patients had their needs assessed and treatment planned for effectively.

• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However they had not received training in Information Governance.

• There was very limited or no monitoring of people’s outcomes of care and treatment. A higher than average number of patients with long term conditions were exception reported with limited/no efforts made to monitor this or ensure reasonable efforts were made to ensure these patients were reviewed.

• A female locum GP was available for four sessions per week.

• There was no evidence of quality improvement processes including clinical and non- clinical audits and local benchmarking.
• There was an ostensive leadership structure in place however in practice this was unclear and unstable due to the imminent dissolution of the GP partnership which was responsible for the practice.

At the previous inspection we told the practice they should:

• Review facilities for disabled people and people who are hard of hearing and advertise that translation services were available.

At this inspection we found a hearing loop had now been installed. The practice had an interpreting service and we saw a sign in reception informing patients about this. Facilities for people with mobility restrictions remained limited. We were told this was due to space limitations in the building and that this would remain under review.

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

Importantly, the provider must:

• Ensure appropriate steps are taken to ensure the outstanding issues identified in the most recent infection control audit are addressed.

• Ensure an adequate business continuity plan was in place to be followed in the event of a major incident.

• Improve care planning processes to ensure the health, safety and welfare of patients.

• Ensure patients with long term conditions received appropriate care and treatment by taking all reasonable steps to ensure these patients were effectively identified and reviewed.

• Ensure there is a programme of quality improvement including clinical audits to improve patient outcomes.

• Ensure staff receive training on Information Governance.

• Ensure systems and processes are in place at the practice, in particular regarding vision and strategy, governance, staffing, practice policies (specifically adult safeguarding), performance awareness, continuous improvement and leadership.

In addition the provider should:

• Review and formalise the induction process.

On the basis of the ratings given to this practice at this inspection, and the concerns identified at the inspection on 1 March 2016, this practice will remain in special measures. This will be for a further period of six months. This will allow time for the new provider to address the concerns identified. We will inspect the practice again within the next 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

Updated 2 May 2017

The provider had resolved some of the concerns for safety, effective and well-led identified at our inspection on 1 March 2016 which applied to everyone using this practice, including this population group. However a number of concerns remained unresolved. Therefore the population group ratings remain inadequate.

Updated 2 May 2017

The provider had resolved some of the concerns for safety, effective and well-led identified at our inspection on 1 March 2016 which applied to everyone using this practice, including this population group. However a number of concerns remained unresolved. Therefore the population group ratings remain inadequate.

Updated 2 May 2017

The provider had resolved some of the concerns for safety, effective and well-led identified at our inspection on 1 March 2016 which applied to everyone using this practice, including this population group. However a number of concerns remained unresolved. Therefore the population group ratings remain inadequate.

Updated 2 May 2017

The provider had resolved some of the concerns for safety, effective and well-led identified at our inspection on 1 March 2016 which applied to everyone using this practice, including this population group. However a number of concerns remained unresolved. Therefore the population group ratings remain inadequate.

Updated 2 May 2017

The provider had resolved some of the concerns for safety, effective and well-led identified at our inspection on 1 March 2016 which applied to everyone using this practice, including this population group. However a number of concerns remained unresolved. Therefore the population group ratings remain inadequate.

Updated 2 May 2017

The provider had resolved some of the concerns for safety, effective and well-led identified at our inspection on 1 March 2016 which applied to everyone using this practice, including this population group. However a number of concerns remained unresolved. Therefore the population group ratings remain inadequate.