Archived: West End Clinic

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West End Clinic on 19 July 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, there was insufficient attention to issuing acute prescriptions. Administrative staff would issue prescriptions for medicines under instruction from the GP to then review and sign. Other staff had permissions to issue prescriptions without completing relevant independent prescribing courses.
• Staff were clear about reporting incidents. However a thorough investigation of significant events and analysis was not undertaken and appropriate action taken to prevent them from happening again. Incidents reported were not linked to review of the relevant policy or procedure as part of the investigation process.
• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had a leadership structure, with insufficient leadership capacity and limited formal governance arrangements.

Areas identified to support improvement are:

• To review and introduce effective processes for recording, acting on and monitoring significant events, incidents and near misses.
• Take action to address identified concerns with prescribing of medicines and ensure patient group directives are in date and signed by an authorised person.  Prescription processes need to comply with NHS Protect security of prescriptions and all prescriptions tracked through the practice.
• Carry out clinical audits including re-audits to ensure improvements have been achieved.
• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• All staff to complete training in infection prevention and control and information governance.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

• Review and implement a system to record actions taken in response to  National Institute for Health and Care Excellence (NICE) and other best practice guidelines.
• Provide information about chaperones to patients in individual consultation and treatment rooms.
• Review the system for recording communication relating to complaints with people and ensure it is not documented within the patient record.
• Maintain adequate records of training and indemnity arrangements for locum staff.

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 service from operating. Special measures will give people who use the service the reassurance that the care they get should improve.

We identified regulatory breaches within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection.  They are Regulation 12 Safe care and treatment; Regulation 17 Good Governance and Regulation 18 Staffing. The Care Quality Commission is unable to take enforcement action against the provider regarding these breaches as they are registered with us as partnership but should be registered as a sole provider. Immediate steps are being taken by the provider to rectify the situation by submitting a registration application to become a sole provider.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice