Background to this inspection
Updated
1 May 2019
Dr Win Hlaing Surgery is also known as Burma Hills Surgery and is a small practice offering GP services to the local community of Wokingham, Berkshire. Until February 2018, Dr Win Hlaing practiced as a single-handed GP. In February 2018, two GP partners from a neighbouring practice commenced working one day a week with Dr Win Hlaing. The practice also started to work with a larger GP partnership organisation that is based in the Midlands. On 8 April 2019, the practice registration changed to recognise the practice as a location within the much larger partnership organisation. The GPs working at the practice had also changed since the last inspection in December 2018.
Burma Hills Surgery is part of Berkshire West Clinical Commissioning Group.
The practice has core opening hours from 8.00am to 6.30pm and offers late opening on a Wednesday until 7.30pm. The practice treats patients of all ages and provides a range of medical services.
There are approximately 3,300 patients registered with the practice. The practice population has a higher proportion of patients aged 30-49 compared to the national average. According to national data there is minimal deprivation in Wokingham.
The practice comprises of four GPs (two male and two female). The all-female nursing team consists of one nurse practitioner, one practice nurse and one health care assistant with a mix of skills and experience. A practice manager and a team of five administrative staff undertake the day to day management and running of the practice. The practice now forms part of the Wokingham division of the larger partnership organisation and works closely with another practice in the area to share staffing and technological support.
The practice has a General Medical Services (GMS) contract. GMS contracts are nationally agreed between the General Medical Council and NHS England.
The practice opted out of providing the out-of-hours service. This service is provided by the out-of-hours service (Westcall) accessed via the NHS 111 service.
The practice is registered with CQC to provide the following regulated activities:
- Treatment of disease, disorder and injury
- Diagnostic and screening services
- Surgical procedures
- Family Planning
- Maternity and midwifery services.
Updated
1 May 2019
We carried out an announced comprehensive inspection at Dr Win Hlaing (Burma Hills Surgery) on 17 and 19 December 2018, as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor, on the second day of the inspection (19 December 2018) the team included a second CQC inspector.
Our judgement of the quality of care at this service is based 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.
The practice is rated as Inadequate overall.
Dr Win Hlaing is registered with the CQC as an individual. However, since February 2018 Dr Win Hlaing has been working with two GPs from a neighbouring practice as GP partners. The practice is also part of a larger GP organisation, Modality Partnership, who are in the process of amending the practice registration. We undertook this inspection because although the practice was rated good overall from an inspection carried out in September 2015 we had concerns arising from a focused inspection undertaken in June 2018. At that time, we found that some of the systems operated did not identify, assess and mitigate risks to the provision of safe care.
At this inspection we found further areas of significant concern. The practice was failing to keep patients safe because:
- Prescribing was not following current national guidelines.
- Appropriate tests were not being undertaken to support safe prescribing.
- Patients with long term conditions were not always receiving safe and appropriate care due to failures to follow up test results that indicated action was needed to improve patient treatment.
- Systems to invite patients in for immunisations and treatment were not operated effectively and patients eligible for immunisations were not always receiving them.
- Staff understanding of legislation covering consent to treatment was inconsistent. Patients were at risk of receiving care they did not consent to or not receiving appropriate care due to their age.
- The practice did not have a comprehensive programme of quality improvement activity and did not consistently review the effectiveness and appropriateness of the care provided.
- The delivery of high quality care was not assured by the leadership, governance and culture of the practice.
- Cancer screening and diagnosis rates were low compared to local and national averages.
- The practice did not have clear systems, practices and processes to keep people safe and safeguarded from harm.
- The overall governance arrangements were ineffective.
- Staff requiring supervision of their prescribing were not receiving such supervision.
However, we also found some positive areas of work within the practice:
- Patient feedback was consistently positive about being treated with care, concern and compassion.
- The appointment system was working well and patients reported no problems in accessing appointments when they needed them.
- Staff said they felt supported to do their job and received regular appraisals.
As a result of this inspection the practice has:
- Had conditions applied to the provider’s registration to reduce the risk to patients receiving care at the practice.
- Been served with a Warning Notice regarding the breach of the Health and Social Care Act 2008, Regulation 12, Safe care and treatment.
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 further 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.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice