All inspections: Dr B. Bekas - Care Quality Commission

We carried out an unannounced focused inspection at Dr B. Bekas on 18 September 2023. Overall, the practice is rated as inadequate.

The ratings for each key question are:

Safe - inadequate

Effective - inadequate

Responsive - requires improvement

Well-led – inadequate

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection/review

This inspection was unannounced and was completed on site.

This included:

Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
Reviewing patient records to identify issues and clarify actions taken by the provider.
Reviewing evidence from the provider.

Our findings

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 provider inadequate for providing safe services:

There was not an effective system for managing Disclosure and Barring System (DBS) checks.
Recruitment checks were not carried out in line with the regulations.
There was no induction process in place for new or temporary staff.
Staff vaccinations were not maintained in line with UK Health and Security (UKHSA) guidance.
The practice was not equipped to deal with medical emergencies.
Blank prescriptions were not kept securely or monitored in line with national guidance.
Vaccines were not appropriately stored to ensure they remained safe and effective.
There were no health and safety risk assessments or a fire risk assessment in place.
Medicines were not always prescribed safely and patients on repeat medication did not always receive the correct monitoring.
The learning form significant events was not always shared with the practice team.
There were no arrangements in place for the effective monitoring of infection, prevention and control.
There was not an effective system in place to receive and action safety alerts.

We rated the provider inadequate for providing effective services:

Patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidelines.
There was not an effective system in place to demonstrate that persons providing care or treatment to service users had the qualifications, competence skills and experience to do so safely.
The practice did not have evidence that staff had received clinical supervision to be assured that they were competent to carry out their roles.
There was no system in place to ensure that all patients who required an annual health check, were offered one and there was a backlog of patients who had not been reviewed in the previous 12 months.
The uptake for all childhood immunisations was below the World Health Organisation (WHO) targets.
The uptake for the cancer indicators was below local and national averages.

We rated the provider requires improvement for providing responsive services:

Patients reported difficulty getting through to the practice by telephone and accessing a GP appointment during the day.
There was a lack of information available to patients via the telephone system and there was nowhere else for patients to access information, including any online information.
Information of how to make a complaint was not readily available.
There was no recording or oversight of verbal complaints and therefore complaints were not used to drive improvement.
Learning form complaints was not always shared with staff.

We rated the provider inadequate for providing well-led services:

There was a lack of leadership and oversight from the provider to ensure services were delivered in a safe and effective way to patients.
The practice did not have a clear vision and credible strategy to provide high-quality sustainable care.
The practice culture did not always effectively support the delivery of high-quality sustainable care.
The overall governance arrangements and processes for managing risks, issues and performance were ineffective.
The practice did not always act on appropriate and accurate information.
Feedback from the public, staff, and external partners to sustain high quality and sustainable care was not sought or always acted upon.
There was little evidence of systems and processes for learning, continuous improvement and innovation.

We found 2 breaches of regulation. The provider must:

Provide care and treatment in a safe way to patients.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, provider should:

Take steps to improve the uptake of childhood immunisations and cancer screening.

I am placing this service in special measures. Services placed in special measures will be inspected again within 6 months. If insufficient improvements have been made such that there remains a rating of inadequate for any 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 6 months if they do not improve.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

We carried out an announced inspection at Dr B Bekas on 26 May 2021. The practice was rated good overall; however, they were rated as requires improvement for providing effective services.

The report for the May 2021 inspection can be found by selecting the ‘all reports’ link for Dr B Bekas on our website at www.cqc.org.uk.

This inspection, carried out on 23 May 2022 was a desk-based review to confirm that the practice had made the necessary improvements in the areas we identified at our previous inspection in May 2021.

We based our judgement of the quality of care at this service on a combination of:

Information sent to us from the provider.
information from our ongoing monitoring of data about services.

We have rated this practice as requires improvement for providing effective services because:

at the previous inspection we identified the following areas where improvement was required:
the practice had not met the minimum 90% uptake target for four out of the five childhood immunisation indicators
cancer screening data was lower than the Clinical Commissioning Group (CCG), average uptake and below the England average uptake.
the number of agreed care plans for people experiencing poor mental health was below the local and national averages.
at this inspection we found:
the practice had not met the World Health Organisation (WHO), uptake target for one of the childhood immunisation indicators, but had met the other four targets, achieving 100% uptake.
cancer screening data, including, breast, bowel and cervical cancers remained lower than the Clinical Commissioning Group (CCG), average uptake and below the England average uptake.
no information was provided regarding the number of agreed care plans in place for people experiencing poor mental health
there were no action plans in place to improve performance in these indicators and the practice did not provide any evidence on the day of the inspection. The practice was given further time to provide evidence of any improvement but did not do so.

We found one breach of regulations. The provider must:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection at Dr B Bekas on 14 January 2020. At this inspection we looked at the key questions, Effective and Well-led. Overall, the practice was rated as Requires Improvement. We carried out this inspection following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

As a result of findings at the January 2020 inspection, we issued the practice with a requirement notice due to a breach of Regulation 17 Health and Social Care Act (HSCA) Regulations 2014, Good Governance, in March 2020. There were no systems or processes that enabled the registered person to assess, monitor and improve the quality and safety of the services being provided.

In particular:

There was no programme of quality improvement and no clinical audits had been carried out.
Staff, including clinicians and administrative staff had not attended any SEPSIS training and therefore we could not be assured that patients attending the practice with symptoms would be followed-up appropriately.
There was no procedure in place for following-up two-week wait referrals.
The practice was not aware of their low cancer-screening data and so there was no plan or interventions in place for improving uptake.
Leaders could not evidence that there were systems and processes in place to ensure they were practicing in line with evidence-based best practice

We carried out an announced focused inspection at Dr B Bekas on 28 and 29 April 2021. At this inspection we followed up on the breach identified at our previous inspection. We inspected the key questions: Safe, Effective and Well-led.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr B Bekas on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused follow-up inspection, following the requirement notice issued in March 2020. We required the provider to establish systems or processes to ensure good governance in accordance with the fundamental standards of care. We found that the practice had complied with the requirement notice.

How we carried out the inspection

Throughout the pandemic Care Quality Commission has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

Conducting staff interviews via video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A short site visit

Our findings

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 Good overall and Requires Improvement for providing effective care. We rated the population groups Families, Children and Young People, Working age people (including those recently retired and students) and People experiencing poor mental health (including people with dementia) as Requires Improvement because:

Patients did not always receive effective care and treatment that met their needs. The practice had not met the minimum 90% uptake target for four out of the five childhood immunisation indicators, cancer screening data remained lower than the CCG average uptake and below the England average uptake of 80% and the number of agreed care plans for people experiencing poor mental health were below the local and national average. These indicators affected the population groups, families, children, and young people, working age people (including those recently retired and students), and people experiencing poor mental health. As a result, we rated these population groups as requires improvement.

As three population groups were rated as requires improvement, this meant that the effective key question was also rated as requires improvement overall.

Whilst we found no breaches of regulations, the provider should:

Increase the uptake of childhood immunisations, patients attending for cancer screening and improve the completion of care plans for people experiencing poor mental health.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions: effective and well-led.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: safe, responsive and caring.

We had previously carried out the following inspections at Dr B Bekas:

November 2015 - an announced comprehensive inspection took place. The practice was rated as requires improvement overall, requires improvement for providing safe and effective services and rated good for providing caring, responsive and well-led services.

May 2016 – an announced focused inspection took place to check if sufficient improvements had been made following the November 2015 inspection. We inspected the safe, effective and well-led domains. The practice was rated as requires improvement for delivering safe and well-led services and good for providing effective services.

May 2017 – an announced focused inspection to check if sufficient improvements had been made since the May 2016 inspection. We inspected the safe and well led- domains and rated both as good.

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 requires improvement overall and requires improvement for delivering well-led services and effective services. All of the population groups have been rated as requires improvement as the concerns found in the effective domain affected all of the population groups.

We have rated this practice as requires improvement for providing effective care because:

There was no programme of quality improvement and no clinical audits had been carried out.
Staff, including clinicians and administrative staff had not attended any SEPSIS training and therefore we could not be assured that patients attending the practice with symptoms would be followed – up appropriately.
There was no procedure in place for following-up two-week wait referrals.
The practice wasn’t aware of the low cancer screening data and so there was no plan or interventions in place for improving uptake.

We have rated this practice as requires improvement for providing well-led care because:

There was a lack of effective systems to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.
There was no business continuity plan in place at the time of inspection, although this was sent to us after the inspection.
Leaders could not evidence that there were systems and processes in place to ensure they were practicing in line with evidence-based practice.

The area where the provider must make improvements are:

Develop systems and processes to enable the registered person to assess, monitor and improve the quality and safety of services being provided.

The areas where the provider should make improvements are:

Ensure there are systems and processes in place to ensure that clinicians are practicing in line with evidence-based practice.
Continue to improve the uptake for childhood immunisations. Changed to a should as suggested and as per SpA feedback.
Introduce systems and processes to increase the number of carers identified.
Establish a regular multi-disciplinary team meeting to ensure patient care is co-ordinated.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

This inspection of Dr B. Bekas was carried out on 3 May 2017 and was to check improvements had been made since our last inspection on 24 May 2016. Following our May 2016 inspection the practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe and well-led and good for effective.

The full focused report on the inspection can be found by selecting the ‘all reports’ link for Dr B. Bekas on our website at www.cqc.org.uk.

As a result of our findings at this inspection we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the inspection on 24 May 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

At this inspection we found that the improvements had been made across all areas of concern. Overall the practice is now rated as good.

Our key findings were as follows:

Significant events were reported and fully investigated with actions identified to minimise reoccurrence. Lessons learned were shared at relevant meetings within the practice.
There was a recruitment and induction process in place for both permanent and locum staff which included, where relevant, checks on professional registration, insurance and hepatitis B immunity status. The process also ensured that checks were completed to ensure that newly appointed staff were of good character and had suitable skills, knowledge and experience.
We found there was a system in place to ensure that all equipment was safety tested and calibrated correctly.
Cleaning materials were stored securely and appropriately.
Written and verbal complaints were investigated and responded to appropriately.
There were systems in place to monitor and improve the quality and safety of the services provided. This relates to systems for investigating and learning from when things go wrong and using this learning to reduce risks to patients and improve the service.

However, there was an area of practice where the provider needs still to make improvement.

The provider should:

Ensure that copies of staff meeting minutes are easily accessible to staff.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at the practice on 24 May 2016. This inspection was carried out to check that improvements had been made following our comprehensive inspection, which was carried out on 12 November 2015. At that time we identified areas which required improvement within the safe and effective domains. These issues were:

The practice did not have robust systems in place for reporting, investigating or learning from significant events. The practice had only reported one event within the previous 12 months and there were arrangements for reviewing accidents, incidents or near misses to help improve safety.
The practice procedures for recruiting new staff were not followed. Checks including proof of identity, evidence of skills and experience were not carried out.
Relevant staff did not have a Disclosure and Barring Services (DBS) check and there was no risk assessment in place to determine that these checks were not required.
The practice did not have oxygen or an automated external defibrillator (AED) for use in the event of a medical emergency. There was no risk assessment in place to support this decision and to identify and mitigate risks to patients.
Clinical and diagnostic equipment had not been calibrated and some pieces of equipment such as the weight scales were damaged.

We issued a requirement notice under Regulation 12 of the Health and Social Care Act 2014 in relation to improvements that were required. The overall rating for the practice was requires improvement.

Additionally we found that some improvements were needed within the effective domain. The practice performance for outcomes for patients with diabetes was lower than other practices locally and nationally. The practice performance for patient uptake of cervical screening was also low and the practice had not been able to demonstrate what actions they had taken to address these issues.

We asked the practice to provide an action plan detailing how the areas for improvement were to be addressed. The practice submitted an action plan on 12 January 2016.

When we visited the practice on 24 May 2016 we reviewed the improvements made by the practice within the safe domain. We found:

Significant events were reported and four had been reported since our last inspection. However these had not been fully reviewed and there were recorded actions to help minimise their recurrence.
The practice manager told us that DBS checks had been carried out for all staff. They showed us the completed checks for a GP, two receptionists, one administrative member of staff and the practice nurse.
One nurse recently employed at the practice had not been through a thorough recruitment process. This included a lack of recruitment checks such as proof of identity and confirmation that they were registered with their professional body.
We found one blood pressure monitor in the GP’s room which had not been calibrated since 2014. We were not assured that other equipment in use at the practice had been calibrated.
The practice did not have an Automated External Defibrillator and there was no risk assessment in place to support this decision.
Written complaints were investigated and responded to appropriately. However verbal complaints and complaints were not consistently acted on and concerns arising from these were not followed up.

There were areas of practice where the provider needs to make improvements.

Importantly the provider must:

Ensure that there are appropriate systems in place to monitor and improve the quality and safety of the services provided. This relates to systems for investigating and learning from when things go wrong and using this learning to reduce risks to patients.
Ensure that appropriate checks are carried out for all newly appointed staff to determine that they are of good character and have suitable skills, knowledge and experience; and are registered with the relevant professional body if required.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr B Bekas on 12 November 2015. Overall the practice is rated as requires improvement. We found that improvements were required in providing safe and effective services.

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

Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However we saw that the practice was under reporting safety incidents and there were no arrangements for dealing with or learning from near misses.
Some risks to patients were not consistently assessed or well managed. There were systems for assessing risks including risks associated with medicines, premises and infection control. However we found that equipment required to asses and treat patients was not available such as oxygen and a defibrillator for use in dealing with medical emergencies. Some equipment we found was out of date and some had not been calibrated to ensure that it was fit for use.
The practice recruitment policies were not followed consistently and not all of the checks including employment references and Disclosure and Barring Services (DBS) checks had been carried out for staff.
Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits and reviews were carried out to make improvements to patient care and treatment.
Staff had received training appropriate to their roles. Staff performance was appraised and any further training needs had been identified and planned.
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. Complaints were investigated and responded to. However we found that not all elements of patient’s complaints were addressed or responded to in some cases.
Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
The practice had good facilities and these were accessible to patients.
There was a clear leadership structure and staff felt supported by GP and practice manager. The practice proactively sought feedback from staff and patients, which it acted on.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider MUST:

Ensure that risks to patient safety are assessed and managed. This includes reporting, investigating and learning from safety incidents and near misses, ensuring that Disclosure and Barring Service (DBS) checks / risk assessments are carried out for relevant staff and ensuring that the practice is equipped to deal with medical emergencies and equipment is fit for use.

In addition the provider SHOULD:

Improve the arrangements for following up on patients who do not attend health screening checks / flu vaccination clinics.
Ensure that investigations into complaints take account of all elements of the complaint.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Dr B. Bekas

All Inspections

18 September 2023

During an inspection looking at part of the service

23 May 2022

During an inspection looking at part of the service

29 April 2021

During an inspection looking at part of the service

14 Jan 2020

During an inspection looking at part of the service

3 May 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

24 May 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

12 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)