The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Stephen Lawrence Also known as St Mary's Island Surgery

Overall: Inadequate read more about inspection ratings

St Mary's Island Surgery, Edgeway, St Mary's Island, Chatham, Kent, ME4 3EP (01634) 890712

Provided and run by:
Dr Stephen Lawrence

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

All Inspections

23 and 25 January 2018

During a routine inspection

This practice is rated as Inadequate

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – inadequate

Are services responsive? – Inadequate

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

On 1 Dec 2015 the Care Quality Commission (CQC) inspected St Mary’s Island Surgery. The practice was rated as ‘inadequate’ for providing ‘safe’ and ‘well led’ services and ‘requires improvement’ for providing ‘effective’, ‘caring’ and ‘responsive’ services. The practice was rated inadequate overall. As a result in March 2016 the practice was placed in special measures.

The practice worked with NHS Medway CCG and NHS England while in special measures to significantly improve the level of care and treatment.

The CQC inspected again on 23, 26 & 29 September 2016. The practice had made improvements and was rated as ‘good’ for each of CQC’s key questions. As a result, the surgery was removed from special measures.

We carried out an unannounced comprehensive inspection at Dr Stephen Lawrence on 23 and 25 January 2018. We carried out the inspection in response to concerns that had been raised with us.

At this inspection we found:

  • Systems to safeguard children from abuse were not effective. The practice had not responded to requests for information concerning the health and welfare of looked after children.

  • There were no administration/reception staff working at the practice. Temporary reception staff, who had come from other practices to help, had not had an induction.

  • Correspondence was not dealt with in a timely manner, large quantities of correspondence were awaiting inputting onto patients’ records.

  • Medicine management was unsafe. Emergency medicines were out of date. The oxygen cylinder was empty.

  • Significant events had not been reported. The practice did not have an effective system for receiving and acting on safety alerts

  • GPs did not have access to the proper information technology tools to help make the best decisions for their patients’ treatment and care.

  • Patient care was not well co-ordinated, including end of life care.

  • Patients’ records and the coding of patients’ records were not up to date so staff were not always able to identify patients’ conditions and meet their needs.

  • Patients were not referred to secondary care, nor were referrals from secondary care, dealt with in a timely manner.

  • The provider was unable to demonstrate they had implemented all actions detailed in their plan to improve patient satisfaction scores.

  • The practice’s results from the 2017 annual national GP patient survey were below the national average for its satisfaction scores on caring and responsive issues

  • Although there had been an increase in the number of patients on the practice’s list who had been identified as carers we were unable to speak with staff to identify how carers were currently being identified.

  • There were failings in the practice’s compliance with the Data Protection Act 1998.

  • Care and treatment for patients with multiple long-term conditions and patients approaching the end of life was not always coordinated with other services.

  • The needs of children were not always addressed in a timely way and vulnerable adults were not always supported.

  • Patients did not always receive care and treatment from the practice within an acceptable timescale for their needs.

  • The annual national GP patient survey, relating to the practice’s responsiveness was below the national average.

  • Some complaints from patients were not acknowledged.

  • Governance arrangements were insufficient, ineffectively implemented and were compounded by the regular absence of the GP.

  • Significant issues that threatened the delivery of safe care were not identified or adequately managed.

  • Staff we spoke with said that they did not feel valued or supported by the practice.

  • There had been no recent staff meetings.

  • There was no patient participation group.

  • There was no evidence of systems and processes for learning, continuous improvement and innovation within the practice.

Following our inspection our concerns were such that on the 29 January 2018 we imposed immediate conditions on The provider’s registration with the Care Quality Commission. The conditions were:

Condition 1: By 8 February 2018 the registered person must clear the existing backlogs of prescription requests, medication reviews, referrals to and responses from secondary care, patients’ discharge notes and any other correspondence, relating to the health and care of patients. The progress of this task must be reported to the Care Quality Commission (the Commission) weekly by midday each Thursday.

Condition 2: By 8 February 2018 the registered person must implement a sustainable system to ensure prescription requests, medication reviews, referrals to and responses from secondary care, patients’ discharge notes and any other correspondence, relating to the health and care of patients are reviewed and actioned without delay. By 8 February 2018 the registered person must report to the Commission how this system has been implemented.

Condition 3: The registered provider must ensure that a suitably qualified, competent, skilled and experienced person is present at the practice to manage day to day operations to ensure a safe delivery of the service.

The provider was in breach of those conditions in that on 30 and 31January a CQC inspector called at the practice and found that on nether day was there a person on the premises who accepted responsibility for managing it.

On 31 January 2018 we issued a Notice of Proposal to cancel The provider’s registration with the Care Quality Commission under Section 17(1) (c) of the Health and Social Care Act 2008. This gave The provider 28 days in which to make written representations to Her Majesty’s Courts & Tribunals Service as to why he did not agree with any of the reasons for the notice of proposal. No representations were received.

On 2 March 2018 we issued a Notice of Decision to cancel The provider’s registration with the Care Quality Commission. This Notice gave The provider 28 days in which to make written representations to the Care Quality Commission as to why he does not agree with the Notice of Decision.

We reported our findings to Medway Clinical Commissioning Group (CCG) and NHS England. As result of our concerns the CCG attended The provider’s practice and carried out a review of aspects of care. Some evidence from that review is contained within this report.

The areas where the provider must make improvements as they are in breach of regulations are:

Good governance

Systems or processes must be established and operated effectively to ensure compliance with the requirements of the Act.

On 20 February 2018 a new provider was registered with the Care Quality Commission to provide general practice services from the St Mary’s island surgery site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23, 26 & 29 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Stephen Lawrence on 23, 26 and 29 September 2016. Overall the practice is rated as good. This inspection was a follow-up of our previous comprehensive inspection which took place in December 2015 when we rated the practice as inadequate overall. In particular the practice was rated as inadequate for providing safe and well-led services and requires improvement for providing effective, caring and responsive services. The practice was placed in special measures for six months.

After the inspection in December 2015 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

The inspection carried out on 23, 26 and 29 September 2016 found that the practice had responded to the concerns raised at the December 2015 inspection and was complying with the requirement notices issued.

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

  • There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
  • Significant improvements to risk management had been made and risks to patients were now being assessed and well managed.
  • The practice was now able to demonstrate they were following national guidance on infection prevention and control.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • The practice had introduced a system to help ensure governance documents were now kept up to date.
  • There was evidence of clinical audits driving quality improvement.
  • Staff training had been revised and records demonstrated that staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Vaccines were being managed in line with national guidance and there was now a system that stored blank prescription forms securely as well as keep a record of their serial numbers.
  • Relevant equipment had been PAT tested (portable appliance tested) to help ensure it was safe to use.
  • Records showed that staff were working with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
  • Results from the latest national GP patient survey had improved but some were below local and national averages. However, the practice was in the process of implementing their action plan to improve patient satisfaction as a direct result of analysing these results.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with and some comment cards indicated that patients found it difficult to book an appointment with a named GP. However, patients were able to book an appointment with another GP or receive a telephone consultation that suited their needs and the practice was in the process of implementing an action plan to improve patient access.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are;

  • Continue to identify registered patients who are also carers to help ensure they have access and are signposted to relevant support services.

  • Continue to implement their action plan to improve patient satisfaction results as well as access to services, and monitor the results of this activity.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

1 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Stephen Lawrence (also known as St Mary’s Island Surgery) on 1 December 2015. Overall the practice is rated as inadequate.

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

  • There was a system for reporting and recording significant events.

  • Significant issues that threatened the delivery of safe care were not identified or adequately managed.

  • Risks to patients, staff and visitors were not consistently assessed and well managed.

  • The practice was unable to demonstrate they were following national guidance on infection prevention and control.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

  • Not all staff were up to date with attending mandatory courses such as basic life support, safeguarding and infection control.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Vaccines were not managed in line with national guidance.

  • Blank prescription forms were not always stored securely and the practice was unable to demonstrate they had a system to keep a record of prescription serial numbers.

  • The practice was unable to demonstrate they had a system to help ensure all relevant equipment was PAT tested (portable appliance tested) on a regular basis.

  • Staff told us they worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. However, there were no records to confirm this.

  • The practice was below average for its satisfaction scores on consultations with doctors and nurses.

  • Information about services and how to complain was available and easy to understand.

  • Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was below local and national averages.

  • 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.

  • Appropriate recruitment checks had not always been undertaken prior to the employment of staff by the practice.

  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the Duty of Candour.

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

The provider must:

  • Revise risk assessment and management activities to include all risks to patients, staff and visitors.

  • Ensure the practice follows national guidance on infection prevention and control.

  • Revise governance processes and ensure that all documents used to govern activity are up to date.

  • Ensure all staff are up to date with attending mandatory training courses.

  • Revise medicines management procedures to help ensure Department of Health guidance is followed when manageing the storage of vaccines.

  • Revise the system to monitor and keep blank prescription forms safe.

  • Ensure that all relevant equipment is tested regularly.

  • Revise systems to help ensure records of multidisciplinary meetings, to assess and plan the on-going care and treatment of patients, are maintained.

  • Revise recruitment processes to ensure appropriate checks are undertaken prior to the employment of all staff.

  • Revise clinical audit activity to ensure improvements to patient care are driven by the completion of clinical audit cycles.

The provider should:

  • Raise staff awareness of the practice statement of purpose.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If sufficient improvements have not been made so a rating of inadequate remains 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.

Special measures will give people who use the practice the reassurance that the care they receive should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

25 July 2014

During an inspection looking at part of the service

Our inspection on 10 October 2013 found that patients had not always been protected from the risks of abuse, because the provider did not have a safeguarding policy to reflect the requirements for protecting vulnerable adults and had not provided safeguarding awareness training for the staff within the practice. The contents of the provider's whistleblowing policy did not reflect the requirements relating to the key principles regarding whistleblowing procedures and staff had not been made aware of the policy.

Our inspection also found that a system was not in place to check that professional registration for clinical staff was maintained and that a risk assessment had not been completed by the provider to consider whether Disclosure and Barring Service (DBS) checks were required for administration staff who undertook chaperone duties.

We asked the provider to take action to address these concerns. They wrote to us confirming that all required actions had been taken to comply with the regulations regarding safeguarding patients. A planned follow-up inspection was scheduled to check that the provider had achieved compliance.

At this inspection on the 25 July 2014, we found that the provider was able to demonstrate that they had met the compliance actions set to address the areas of concern identified at our previous inspection.

10 October 2013

During a routine inspection

People we spoke with were happy with the care and treatment they received at the practice. People spoke highly of the staff and one person said 'The doctor goes the extra mile, to make sure you are listened too'. We found that people's needs were assessed and care and treatment provided was discussed with patients and delivered to meet those needs. People spoke positively about their experiences of care and treatment at the practice.

We found that whilst there were child and adult safeguarding policies in place, not all the staff we spoke with were aware of their roles and responsibilities in relation to suspected abuse. The adult policy did not fit in with the local Kent and Medway safeguarding policy.

We found that people were protected from the risks associated with infection because appropriate procedures were followed by staff. The practice was in the process of carrying out the actions required by the recent infection control audit.

Medicines were kept safely, and there were processes to ensure the security of medicines and prescription pads.

There were some formal mechanisms and some documentation in place to indicate whether the practice was able to monitor or assure the quality of the service people received.