Dr Ildiko Spelt - Care Quality Commission

Background to this inspection

Updated 21 February 2017

The practice is known as Dr Ildiko Spelt and is situated in Clacton On Sea, Essex. The practice is one of 40 practices in the North East Essex Clinical Commissioning Group (CCG) area. They provide primary care services to their patients via a PMS contract. There are approximately 7700 patients registered at the practice with a higher percentage of patients being over 60 years of age. The practice is located in an area of low deprivation with low ethnicity concerns.

The practice lead GP is an individual provider. There are two full-time salaried GPs and they are supported by a locum GP. There is a mixture of male and female GPs. The GPs are supported by three practice nurses, and three health care assistants. There is a practice manager, an assistant practice manager, an office manager and eight administrative/receptionist support staff members who undertake various duties. All support staff at the practice work a range of part-time hours.

The practice is open between 8.30am and 7.30pm on a Monday, 8.30am and 8pm on Tuesdays and Wednesdays and 8.30am to 6.30pm on Thursdays and Fridays. They are closed at weekends. On Mondays and Tuesdays the practice provides walk in sessions where patients did not need to make an appointment to be seen between 8.30am and 10am. The GPs have morning and afternoon sessions daily and there are three late evening sessions each week until 8pm. The practice has opted out of providing 'out of hours’ services which is now provided by Care UK, another healthcare provider. Patients can also contact the NHS 111 service to obtain medical advice if necessary.

We inspected this practice on 25 June 2014 at a time when we did not rate practices. They were non-compliant with the regulations and we issued compliance actions for Regulation 10 (assessing and monitoring the quality of service provision), Regulation 21 (requirements relating to workers) and Regulation 23 (supporting workers) of the Health and Social Care Act (Regulated Activities)

Regulations 2010. The practice was issued with compliance actions for improvement.

The practice was given time to make the required improvements and they wrote to us in March 2015 to confirm completion of the improvements required. We then carried out a comprehensive inspection on 23rd June 2015 to rate the practice in line with new methodology and to ensure the required improvements had been made. We found that not all of the improvements had been made. We rated the practice inadequate for safe, effective and well-led and requires improvement for caring and responsive. These ratings meant the report was inadequate overall and the practice was placed in special measures on 05 November 2015. At the inspection in June 2015 we identified some immediate concerns in relation to the regulations for care and treatment, governance and staffing.

Therefore in September 2015 we issued warning notices to the provider to make improvements in these areas within three months of the date of those notices. This was in addition to being placed into special measures. We carried out an announced focused inspection at Dr Ildiko Spelt on 21 December 2015 in order to check the practice had complied with the concerns raised within our warning notices. This inspection was focused on the issues identified in the warning notices and to check whether the practice had taken the necessary action for improvement. We found that the warning notices had been complied with. The practice then remained in special measures.

We then carried out a comprehensive inspection on 28 June 2016, in-line with our GP inspection policy for practices in special measures to check that continuous improvements from the December inspection had been implemented and maintained and to re-rate the practice.

Overall inspection

Requires improvement

Updated 21 February 2017

Letter from the Chief Inspector of General Practice

We previously carried out a comprehensive inspection at the practice on 25 June 2014 at a time when the Care Quality Commission did not rate practices. We found a number of concerns at the practice and issued them with compliance actions to improve.

We then carried out a comprehensive inspection on the practice on 23 June 2015 using our new inspection methodology to rate the practice and to check whether the improvement areas identified in the June 2014 inspection had been actioned. At this inspection in June 2015 we found that the areas for improvement had not been satisfactorily actioned and consequently we rated the practice overall as inadequate and specifically inadequate for safe, effective and well-led services and requires improvement for caring and responsive services. The practice was placed into special measures on 05 November 2015.

At the inspection in June 2015 we identified some immediate concerns in relation to the regulations for care and treatment, governance and staffing. We issued warning notices to the provider to make improvements in these areas within three months of the date of those notices. This was in addition to being placed into special measures.

We carried out an announced focused inspection at Dr Ildiko Spelt on 21 December 2015 in order to see whether the practice had complied with the concerns raised within our warning notices. The inspection on 21 December was therefore focused on identifying whether the improvements in relation to the warning notices had been achieved.

Our key findings across the areas we inspected were as follows:

The practice had a system in place to act on patient safety and medicine alerts. An audit trail was in place which reflected that patients affected by the alerts had been identified and appropriate reviews had taken place, followed up by an audit process to ensure that systems were effective.
The practice had an effective system in place to monitor and review those patients on high-risk medicines. This included identifying those affected and ensuring that they received a review in line with guidance and regular blood tests where required.
The fridge used at the practice for the storage of vaccinations and medicines was being effectively monitored. A system was in place to record fridge temperatures that included the action to take when they fell below the recommended ranges for the storage of medicines.
Emergency medicines in use at the practice were being monitored to ensure they did not expire. Records were being kept of the checks made.
The practice had undertaken a health and safety risk and legionella risk assessment and the risks were being reviewed regularly.
A system was in place to record, investigate and analyse significant events and safety incidents. Information was shared with staff to identify improvement opportunities and learning cascaded. Records were being maintained on appropriate forms and in minutes of team meetings and an audit trail was in place that reflected that action had been taken in a timely manner.
A complaints manager was in place and records had been kept of all complaints affecting the practice. These were analysed and investigated and staff were involved in identifying where improvements might be achieved. There was clinical and managerial oversight of the complaints and an annual review was taking place to identify themes and trends.
The practice had responded to patient feedback by undertaking a patient survey. This included seeking the views of patients about the appointment system.
A member of the nursing staff had received training to carry out consultations for minor illnesses and was going through a period of supervised assessment to ensure they were competent to carry out the role unsupervised.
Clinical members of staff undertaking reviews of patients on blood thinning medicines had received appropriate training and were receiving ongoing supervision and support from a GP who had also received an appropriate level of training. Written policies and protocols were in place to support staff.
All staff had now received an annual appraisal and an assessment of their competency. A system was in place to identify the training that staff should undertake to meet the needs of the patients at the practice and this was being monitored.
The leadership at the practice had improved. The provider was working more closely with the practice manager and the quality of the systems in place were being monitored and improved to ensure patients received appropriate care and treatment.

We found that the warning notices issued after the inspection in June 2015 had been complied with to a satisfactory standard. The practice then remained in special measures for a period of six months from 05 November 2015 when a further comprehensive inspection was carried out.

A further comprehensive inspection at Dr Ildiko Spelt was undertaken on 28 June 2016 to check whether the practice had maintained and made further improvements identified at the July 2015 inspection and those contained within the requirement notices specified at that time. We found that the majority of the improvements had been made.

Our key findings across all the areas we inspected were as follows:

There was effective management of the procedures in place for reporting and documenting safety events and incidents. The provider was aware of and complied with the requirements of the duty of candour.
Patient and staff risks were well managed, this included; premises, equipment, medicines, and infection control.
Patient care was planned and provided to reflect best practice using recommended current clinical guidance.
Patients commented about the care received at the practice during the inspection and told us they were treated with dignity and respect. Members of the practice patient participation group told us they were involved with practice development.
There was a procedure to process, record, and investigate complaints and share findings. Any lessons learned from complaints were shared with staff members to ensure recurrence was reduced.
The practice had introduced walk-in surgeries twice each week where no appointments were required, to improve patient satisfaction in relation to the unavailability of appointments.
There were urgent appointments and available on the day they were requested.
The practice had suitable facilities and equipment to treat patients and meet their needs.
The practice maintained satisfactory standards of cleanliness and hygiene.
The leadership structure at the practice was clear and staff members told us they were supported by management.
Medicine was stored securely and within the expiry date for safe use.
Information regarding how to complain was available at the practice, on the practice website, and available in an easy to read format.
Patient satisfaction rates were lower than local and national averages across the majority of the areas reported in the national GP patient survey published in January and July 2016. We did not find any evidence that the practice had effectively responded to patient feedback or made any improvements.
The number of carer’s identified at the practice was low.

The areas where the provider must make improvements:

Provide improved access via the telephone for patients.
Provide improved access to appointments in the practice.
Implement a system to act on feedback about the practice to improve current low patient satisfaction.

The areas where the provider should make improvements:

Review all policies and procedures to ensure they are all updated with practice specific guidance.
Improve the system in place to identify patients who are carers and provide them with appropriate support.

This service was placed in special measures in November 2015. Insufficient improvements have been made such that there remains a rating of inadequate for providing responsive services. The practice will now remain in special measures for a further six months. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

People with long term conditions

Requires improvement

Updated 21 February 2017

The practice is rated good for safe and effective services, requires improvement for caring, and well-led services, and inadequate for responsive services. The issues identified by these ratings affected all patients including this population group.