The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Ildiko Spelt Also known as The Great Clacton Medical Practice

Overall: Requires improvement read more about inspection ratings

Great Clacton Surgery, 17 North Road,, Clacton On Sea, Essex, CO15 4DA (01255) 224600

Provided and run by:
Dr Ildiko Spelt

Important: The provider of this service changed. See new profile

All Inspections

28 June 2016

During a routine inspection

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

21 December 2015

During an inspection looking at part of the service

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 as inadequate for safe, effective and well-led and requires improvement for caring and responsive. They were rated as inadequate overall and 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 and act 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 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. A system was in place to ensure that changes of dosage were reviewed by a clinical member of staff with sufficient training and experience to do so. Written policies and protocols were in place to support staff.
  • The practice had now responded to the compliance actions issued by the Care Quality Commission from the inspection in June 2014.
  • 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 will remain in special measures for a period of six months from 05 November 2015 when a further comprehensive inspection will be carried out.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

23 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ildiko Spelt on 23 June 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice was rated as inadequate for providing safe, effective and well-led services. It was rated as requires improvement for providing caring and responsive services. It was rated as inadequate for providing services to older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).

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

  • Staff understood and fulfilled their responsibilities to raise safety concerns but learning identified as a result of investigations was not being routinely cascaded to staff or recorded.
  • There was an inconsistent approach to recording meetings and they were not being used to cascade issues affecting the practice such as complaints, significant events, safeguarding and action taken to improve safety or the services provided.
  • There was no health and safety risk assessment in place as required by legislation.
  • Systems in place to monitor emergency and high-risk medicines were not robust. Fridge temperatures were not being monitored nor action taken when temperatures exceeded the levels required for the safe storage of medicines.
  • The practice monitored their prescribing patterns and managed repeat prescriptions effectively.
  • Nurses and health care assistants were carrying out clinical roles without appropriate training or supervision. They were not supported with written protocols or procedures.
  • National patient safety and medicine alerts were not being monitored or acted upon appropriately.
  • Staff had received safeguarding and chaperone training. Clinical staff had received training in the treatment of long-term conditions.
  • Control measures used to mitigate the risk of legionella were not being recorded.
  • Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
  • Recruiting processes had improved since our inspection in June 2014 but not all staff had received appraisals.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • The appointments system was the subject of patient dissatisfaction and there was no system in place to obtain feedback about their concerns or to assess the effectiveness of improvements.
  • The practice held some governance meetings and issues were discussed at ad hoc meetings but minutes of meetings taking place were not being consistently recorded.
  • The practice had not sought a broad range of feedback about the services provided particularly in relation to the appointment system.

The areas where the provider must make improvements are:

  • Ensure clinical staff receive appropriate training, supervision and appraisal including to enable them to carry out minor illness consultations and manage changes in warfarin dosages.
  • Implement a robust system for the management of national patient safety and medicine alerts.
  • Ensure patients taking high-risk medicines are monitored effectively and in line with relevant guidance.
  • Implement a system for monitoring fridge temperatures including the action to take in the event that the temperature falls outside of the required temperature range.
  • Record when action is taken in relation to the control measures identified to reduce the risk of legionella.
  • Implement a system to monitor emergency medicines and equipment and maintain records.
  • Undertake a health and safety risk assessment and maintain records when action is taken to mitigate risks.
  • Implement systems to monitor and assess the quality of the services provided by the practice which includes feedback from patients and staff on areas for improvement as well as audits.
  • Ensure there is clinical oversight of complaints raised by patients and that records adequately reflect the learning identified and how and when it is cascaded to staff members.
  • Ensure audits are undertaken, including completed clinical audit cycles.
  • Ensure that clinical staff undertaking patient consultations and the monitoring of patients on warfarin medicine have appropriate protocols, procedures and guidance to carry out their role.

On the basis of the ratings given to this practice at this inspection, and the concerns identified at the previous inspection in June 2014, I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further 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. Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

25 June 2014

During a routine inspection

Dr Ildiko Spelt (The Great Clacton Medical Practice) provides primary medical services to approximately 7700 patients living in the Clacton-on-Sea and surrounding area in Essex.

We found that the practice is caring but improvements were required to ensure that the practice is safe, effective, responsive and well-led.

Services are available for older people (over 75s), people with long-term conditions, mothers, babies, children and young people. There are also services for people in vulnerable circumstances who may have poor access to primary care, people experiencing poor mental health and working age people and those recently retired (aged up to 74).

The practice has had some staffing issues over the last nine months that have affected their performance and governance of systems and processes. A new practice manager was employed in February 2014 and was, at the time of our inspection, undergoing a complete review of the systems and processes in place at the practice.

We found that the practice did not have satisfactory processes in place when employing new staff. The recruitment policy was not being followed and therefore the practice was unable to assure us that staff had been through a robust recruitment process.

Staff were not adequately supported through an effective system of supervision and appraisal. Nursing and other staff were not monitored to assess their competency to carry out their role.

The practice did not have systems in place to assess and monitor the quality of the services they provide, which is contrary to the regulations. There was an absence of a clear approach to clinical and non-clinical audits, although some were taking place. Patients and staff were not asked for their feedback about the services they provide. Incidents, adverse events and complaints were not analysed to identify areas for improvement. There were limited opportunities to discuss areas for improvement and learning at the practice because staff meetings were informal and not used in a structured way.

Dr Ildiko Spelt (The Great Clacton Medical Practice) provides primary medical services to approximately 7700 patients living in the Clacton-on-Sea and surrounding area in Essex.

We found that the practice is caring but improvements were required to ensure that the practice is safe, effective, responsive and well-led.

Services are available for older people (over 75s), people with long-term conditions, mothers, babies, children and young people. There are also services for people in vulnerable circumstances who may have poor access to primary care, people experiencing poor mental health and working age people and those recently retired (aged up to 74).

The practice has had some staffing issues over the last nine months that have affected their performance and governance of systems and processes. A new practice manager was employed in February 2014 and was, at the time of our inspection, undergoing a complete review of the systems and processes in place at the practice.

We found that the practice did not have satisfactory processes in place when employing new staff. The recruitment policy was not being followed and therefore the practice was unable to assure us that staff had been through a robust recruitment process.

Staff were not adequately supported through an effective system of supervision and appraisal. Nursing and other staff were not monitored to assess their competency to carry out their role.

The practice did not have systems in place to assess and monitor the quality of the services they provide, which is contrary to the regulations. There was an absence of a clear approach to clinical and non-clinical audits, although some were taking place. Patients and staff were not asked for their feedback about the services they provide. Incidents, adverse events and complaints were not analysed to identify areas for improvement. There were limited opportunities to discuss areas for improvement and learning at the practice because staff meetings were informal and not used in a structured way.

25 June 2014

During an inspection