The Portland Road Practice is a GP surgery which provides a primary medical service to patients in the Notting Hill, Kensington and Shepherds Bush areas within the Royal Borough of Kensington and Chelsea. The practice currently has about 7500 patients on its list. The service is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures; maternity and midwifery services; surgical procedures; and treatment of disease, disorder or injury
We carried out an announced inspection of the service on 14 May 2014. The team, led by a CQC inspector, included a GP, a practice manager specialist advisor and an expert by experience.
We spoke with seven patients and received comments cards from six others during our inspection. All but one made positive comments about The Portland Road Practice and the service provided. They were generally happy they could get an urgent appointment but some patients expressed their dissatisfaction with the long wait for routine appointments.
The service to all population groups was generally effective, caring and responsive. The practice was effective in promoting best practice and had arrangements in place to monitor, review, and improve outcomes for people. Patients told us staff were caring and treated them with dignity and respect. The practice understood the needs of its patients and was responsive to them. There was good collaborative working between the provider and other health and social care services. However, there was scope for improvement in the waiting times for non-urgent appointments and in ensuring patient confidentiality.
There were inadequate arrangements in place to ensure the service was safe:
- The infection control arrangements in place did not fully protect patients from the risk of infection. The standards of cleanliness were inadequate and the arrangements to maintain appropriate standards of hand hygiene were not sufficiently robust. We found dust in a number of areas and a lack of general cleanliness in other areas. The practice had a cleaning schedule but the checklist for this was had not been completed since October 2013 and did not cover all areas. The regulations were not being met in relation to cleanliness and infection control.
- There were a number of potential risks relating to safety of the premises. One of the consulting rooms on the first floor had a back door which was unlocked and had no signage that the room was in use. The door opened outwards onto the stairway and there was no signage warning of this, which could put anybody passing on the stairs at risk. There was no regular testing of the fire alarm system between annual checks and no fire evacuation drills had taken place. There was no up to date record of portable appliance testing and no evidence of gas boiler servicing. The regulations were not being met in relation to safety and suitability of premises.
- There was not a robust recruitment policy and procedure in place. We saw no evidence of identity checks before recruitment. On records we looked at there was only one reference for one member of staff and no references for another. For non-clinical staff there was no documented risk assessment of which staff needed to be subject to a criminal record check. We were told the need for checks had been considered but limited progress had been made in following this up at the time of the inspection. The regulations were not being met in relation to requirements for workers.
- Patients records were not always kept securely. There was an unlocked filing cabinet in the cleaner’s cupboard, which was accessible to unauthorised people and contained identifiable patient records and x-rays in torn plastic bin liners. The computer server room was unlocked and some patient records were stored in the room. We observed one consulting room left unattended with the door open while the GP saw a patient downstairs. The computer was on and the security smart card was left on the desk. The regulations were not being met in relation to security of records.
The leadership, management and governance arrangements did not ensure the service was sufficiently well led. Communication within the practice on management and operational issues was not as effective as it could be. It was not clear how lessons learned from incidents were communicated to staff or how identified areas for improvement had been followed up to ensure lessons learned were implemented. It was not clear how recommended controls identified from the practice’s health and safety risk assessment were communicated within the practice and followed up and implemented. In addition, the systems in place to identify, assess and manage other risks to the health, safety and welfare of people who use the service and others were not effective. The regulations were not being met in relation to assessing and monitoring the quality of service provision.