Archived: Dr Joseph

We carried out an announced comprehensive inspection at Dr Joseph Surgery Centre on 16 and 21 January 2019

At this inspection we followed up on breaches of regulations identified at a previous inspection on 31 August 2017.

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 inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
• There were inadequate systems to assess, monitor and manage risks to patient safety.
• Staff did not have the information they needed to deliver safe care and treatment and this posed a serious risk of harm to patients
• Patients were put a serious risk of harm as a result because the practice did not have systems for the appropriate and safe use of medicines
• The practice did not have a system to learn and make improvements when things went wrong.
• Patients were put at serious risk of harm because national safety alerts were not being actioned and implemented by the practice.
• There were ineffective systems to assess, monitor and manage risks to patient safety.
• Recruitment checks were not carried out in accordance with regulations (including for agency staff and locums).
• The practice did not have a health and safety or premises risk assessment to ensure the building is safe for use by staff and patients.

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

• The evidence of summaries of patient problems within patients’ records being incomplete and failure to appropriately clinically code patients, take action for medicine safety alerts. or follow up patient referrals and identify a serious clinical event demonstrated the practice did not have the systems and processes in place to assess and meet patients immediate and ongoing needs or regularly review and update their care and treatment.
• There was limited monitoring of the outcomes of care and treatment. Clinical coding is required to provide accurate quality and outcomes framework (QOF) results. The lack of Clinical coding of patients healthcare needs meant that the QOF figures may not be a true reflection of the practice population healthcare needs. (Quality and Outcomes Framework (QOF) was a voluntary incentive scheme for GP practices in the UK. The scheme financially rewards practices for managing some of the most common long-term conditions e.g. diabetes and implementing preventative measures. The results were published annually.)
• The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
• Staff did not work together and with other organisations to deliver effective care and treatment.
• Staff were not consistent and proactive in helping patients to live healthier lives

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

• The practice did not have clear and effective processes for identifying, managing and mitigating risks to patients and staff.
• The practice did not act on or maintain appropriate and accurate patient information.
• The overall governance arrangements were ineffective.
• Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.

These areas affected all population groups so we rated all population groups as inadequate.

We rated the practice as requires improvement for providing caring services because: -

• Staff treated did patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people. However, we found some patients were not given appropriate and timely information to cope emotionally with their care, treatment and condition.
• Patients were not always provided with the necessary information to enable them to be fully involved in decisions about care and treatment.
• Although the GP survey showed some improvements from the August 2017 report, the 2018 GP survey results were considerably lower than the CCG and national averages.

The practice was rated requires improvement for providing a responsive service because: -

• The findings in safe, effective and well led have impacted on the practice’s ability to provide a responsive service.
• The evidence of summaries of patient healthcare needs within patients’ records being incomplete and failure to appropriately clinically code patient’s full diagnosis demonstrated the practice did not have the systems and processes in place to fully understand the needs of the patient population groups and respond to them appropriately.
• The practice did not have the ability to organise and deliver a service to meet patient needs.

On the basis of our findings we made an application to Barkingside Magistrate’s Court on 25 January 2019 to urgently cancel the provider’s registration under section 30 of The Health and Social Care Act 2008 on the basis that there were breaches of the 2014 Regulations which presented serious risks to people's life, health or well-being.

The provider’s registration was cancelled with immediate effect subject to the providers right to appeal.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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