Balfour Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A Bansal Practice on 24 May 2016. Overall the practice is rated as inadequate.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, although reviews and investigations were completed there was limited evidence of learning and some investigations were not as thorough as they could be.
• Although some risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.
• There were no systems in place for some areas of medicines management. For example, patients prescribed high risk medicines or those requiring regular monitoring were not being monitored. Blank prescription forms and pads were not securely stored and there were no systems in place to monitor their use.
• The practice had high rates of anti-bacterial prescribing.
• There was a system in place for staff to be aware of patient and medicines related safety alerts, however no action was taken once the alerts had been received.
• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Urgent appointments were available the same day.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• There was no information displayed telling patients how to complain. The complaints investigations were not fully documented and for some did not fully address the extent of the complaint. Learning from complaints was minimal.
• Staff felt supported by one of the partners and able to raise concerns .
• Data showed most patient outcomes were low compared to the national average. Although some clinical audits had been carried out in previous years there were no clinical audits completed in the last 12 months and no other quality improvement systems in place.
• The practice was aware of performance related data but there was no evidence that this information had been used to improve patient outcomes.
• The practice had a number of policies and procedures to govern activity which were in the process of being reviewed and updated but staff were not aware of them or their content.
• The governance systems in place were not sufficient to ensure safe, effective, responsive care and treatment.

The areas where the provider must make improvements are:

• Introduce robust governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
• Carry out quality improvement activities for example, clinical audits including re-audits to ensure improvements have been achieved.
• Introduce robust medicines management systems for: the review of patients prescribed high risk medicines and those requiring monitoring; the security and monitoring of prescription paper and pads; dealing with alerts relating to medicines.
• Take action to address high levels of anti bacterial prescribing.
• Take action to address identified concerns with infection prevention and control practice.
• Investigate safety incidents thoroughly and ensure that patients affected receive reasonable support and a verbal and written apology and that learning is disseminated appropriately.
• Make information relating to complaints easily accessible. Investigate complaints thoroughly and ensure there is a clear audit trail of the investigation.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure that a legionella risk assessment takes place and complete any actions identified from the assessment in a timely manner.

In addition the provider should:

• Ensure that practice policies are up to date and that staff are aware of their content and that they are readily available.
• Improve the performance of the practice in relation to the clinical outcomes of patients measured by the Quality and Outcomes Framework.
• Ensure that there is a plan in place to respond to and act on patient feedback.
• Improve the system for the identification of carers and offer them appropriate support and guidance.

I am placing this service in special measures. Services 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 service 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 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