Archived: St Philips Medical Centre

Updated 22 June 2017

St Philips Medical Centre provides primary medical services through a General Medical Services (GMS) contract. The practice is located within the London Borough of Westminster in central West London but is contracted to provide GP services by NHS Camden Clinical Commissioning Group. The services are provided from a single location within premises leased from the London School of Economics (LSE). There are historical reasons for this location as it grew out of a former University of London health centre. Although most patients are students at LSE, the practice is also contracted to provide NHS services to the local population. There are about 10,800 patients registered with the practice, with a high turnover as many are postgraduate students who move away from the area after their year of study is complete. We were told there are also patients who registered with the practice when living in the UK who now live abroad but who have retained their registration and are still supported by the practice. It was unclear, however, how these patients were supported.

The practice is open between 8:30am to 6:30pm Monday to Friday. Appointments were from 9:30am to 12:30pm every morning and from 1:30pm to 6:30pm daily. The practice also runs walk-in clinics daily between 11am and 12 noon and 3pm to 4pm for emergency treatment. In addition, pre-bookable appointments can be booked and provided within 48 hours.

At the time of our inspection, there was one permanent GP (the principal GP - male), and eight locum (non-principal GPs - all female) amounting to 3.4 whole time equivalent (WTE) GP staff. They were supported by an external primary care management consultant appointed shortly before the inspection to help the practice achieve compliance with the regulations. The former acting practice manager had left the practice shortly before the inspection. There were also four full-time and one part- time administrative staff at the practice. A full time practice nurse had been appointed in December 2016.

There are also arrangements to ensure patients receive urgent medical assistance when the practice is closed. Out of hours services are provided by a local provider. Patients are advised to call 111 who will direct their call to the out of hours service to provide telephone advice or make a home visit. The practice also provides information to patients about a local NHS Walk-In Centre which was open between 8am and 8pm Monday to Friday and 10am to 8pm at weekends.

The inspection was carried out to follow up a comprehensive inspection we carried on 2 August 2016 when we found the practice was not meeting the fundamental standards of quality and safety in several areas. We rated the practice as Inadequate overall. Specifically, we found the practice to be inadequate for well-led services and requires improvement for providing caring and responsive services. We placed the service in special measures. We carried out an announced comprehensive inspection at St Philips Medical Centre on 12 November 2015. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. We inspected the practice again on 2 August 2016. The overall rating for the practice was again inadequate and the practice was placed in special measures for a further period of six months and we served two warning notices on the practice for breaches in Regulation 12, Safe care and treatment and Regulation 17, Good governance. The full comprehensive reports on the November 2015 and August 2016 inspections can be found by selecting the ‘all reports’ link for St Philips Medical Centre on our website at www.cqc.org.uk.

Our inspection on 20 April 2017 was carried out as a follow up to the 2 August 2016 inspection to check whether the provider had met the requirements of the two warning notices and whether improvements had been made following the second period of special measures.

Updated 22 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Philips Medical Centre on 12 November 2015. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. We inspected the practice again on 2 August 2016. The overall rating for the practice was again inadequate and the practice was placed in special measures for a further period of six months. The full comprehensive reports on the November 2015 and August 2016 inspections can be found by selecting the ‘all reports’ link for St Philips Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the second period of special measures and was an announced comprehensive inspection on 20 April 2017. Overall the practice is again rated as Inadequate due to ongoing non-compliance.

Our key findings were as follows:

• Although the practice carried out investigations when there were unintended or unexpected safety incidents, there was limited documentary evidence that it had taken the action it said it would take in its action plan in response to our previous inspections to communicate lessons learned from incidents to all practice staff and document the discussion and action agreed. No formal minuted practice meetings had been initiated to facilitate this at the time of our latest inspection.
• The provider had addressed the majority of concerns identified at our previous inspections relating to deficiencies in the systems and training for safeguarding, infection control, medicines management, dealing with medical emergencies and ensuring the safety of medical equipment. There were now systems, processes and practices to keep patients safe and minimise the risk of harm.
• Action had been taken to improve recruitment processes, especially in relation to pre-employment checks.
• The practice could not demonstrate that it used information about its performance to monitor and improve the quality of care. For example, the practice no longer fully participated in the Quality and Outcomes Framework and had not set up its own systems for monitoring its management of long term conditions.
• There was still limited evidence of a regular multidisciplinary approach to patient care and treatment.
• The practice carried out clinical audit and there was now evidence of completion of the full audit cycle to show improved patient outcomes.
• The practice promoted good health and prevention and provided patients with advice and guidance. However, there was no system in place to ensure there were practice initiated care plans in place for older people (aged 75+) and at risk groups such as those with chronic mental health issues.
• Patients were positive about their interactions with staff and said they were treated with compassion, dignity and respect. However, the practice did not have an effective system for proactively identifying patients who were carers to offer them additional support.
• There was limited documentary evidence that learning from complaints had been shared with staff.
• Staff felt supported in their roles and gaps identified previously in key areas of the training and appraisal they received had been addressed.
• There was limited progress in implementing systems to monitor and improve the quality and safety of the services provided.

Importantly, the provider must:

• Ensure there are effective arrangements in place to assess, monitor and improve the quality and safety of the services provided, including the introduction of formal governance arrangements and further development of the systems for assessing the quality of the experience of service users in receiving those services.

In addition the provider should:

• Document in all cases the discussion and action agreed in communicating lessons learned from incidents and complaints to practice staff.
• Develop a written policy for the management of controlled drugs.
• Complete and record on personnel files the retrospective review currently in progress of staff pre-employment documentation.
• Introduce care plans for patients who would benefit from coordinated care and multidisciplinary input, for example patients over 75 and patients with chronic mental health issues.
• Foster regular participation in multidisciplinary working to co-ordinate patient care.
• Ensure locum (non-principal) doctors are informed of the outcome of hospital referrals or the results of tests they initiated.
• Review systems to improve the identification of carers and provide support.
• Develop a more robust planning process to address identified patient needs and determine the way services are delivered to meet all patients’ needs.
• Develop the practice vision and values further and ensure they are communicated to staff and patients.

This service was placed in special measures for a second consecutive period in October 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing effective and well-led services. CQC is taking further action against the provider, Dr Rajan Olof Magnus Naidoo, in line with its enforcement policy, subject to a right of appeal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 June 2017

The provider is rated as inadequate for the care of people with long-term conditions.

• Longer appointments and home visits were available for patients with long-term conditions when needed. However, the practice did not provide patients with a personalised care plan or run a structured call-recall programme to check that their health and care needs were being met.
• There was no up to date nationally reported data to show whether there had been any improvement in outcomes for patients with diabetes where previously indicators showed QOF performance was worse than the CCG and national averages.
• There was limited multidisciplinary case working with other health and social care professionals to case manage patients in this group, although the practice did work with the CCG’s Diabetes Integrated Care Unit to optimise the care of patients with type 2 Diabetes.

Updated 22 June 2017

The provider is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safe, caring and responsive services. The issues identified as requiring improvement in these services affected all patients in this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, children and young people who had a high number of A&E attendances.
• Childhood immunisation rates for the vaccinations given were mixed with some being below standard and some above standard in relation to 90% targets, although the number of eligible children on the register was low.
• Appointments were available outside of school hours and there were two walk in clinics daily for urgent appointments which patients in this group could access.
• The practice’s uptake for the cervical screening programme was significantly below CCG and national averages.

Updated 22 June 2017

The provider is rated as inadequate for the care of older people.

• Older people did not have care plans where necessary.
• The practice participated in a Camden Federation home visiting scheme to avoid unplanned admissions of frail / elderly patients.
• There was no up to date nationally reported data to show whether there had been any improvement in outcomes for patients for conditions commonly found in older people previously reported as below CCG averages. For example, low QOF performance for chronic obstructive pulmonary disease (COPD); mental health; osteoporosis and coronary heart disease (CHD). The practice was unable to supply its own evidence of its recent performance, although there were few patients with these conditions.
• Longer appointments and home visits were available for older people when needed.

Updated 22 June 2017

The provider is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safe, caring and responsive services. The issues identified as requiring improvement in these services affected all patients in this population group.

The profile of patients at the practice was predominantly students and the services available were mainly geared to the needs of this group.

• No extended opening hours were offered for appointments but we were told the practice would see patients after working hours if they were unable to come in before 6.30pm.
• Patients could now book and order repeat prescriptions online via the practice’s website.
• Health promotion advice was offered and some health promotion material was available at the practice.
• Patients had access to health assessments and checks. These included health checks for new patients and, although patients aged 40-74 did not attend for NHS health checks, just over a third of those eligible had received some form of health screening. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.

Updated 22 June 2017

The provider is rated as inadequate for the care of people experiencing poor mental health (including people with dementia).

• There was no up to date nationally reported data to show whether there had been any improvement in outcomes for patients where previously mental health related indicators showed QOF performance was below the CCG and national averages.
• There were no care plans produced within the practice or a formal recall system for reviewing people experiencing poor mental health. The majority of such patients who resided at a local supported housing project had received an annual GP consultation where weight, blood pressure and a range of blood tests were carried out.
• The practice worked in conjunction with care workers and community psychiatric nurses to encourage diabetic patients at the project to improve compliance with medication, diet and other interventions.
• The practice liaised with the university’s student mental health support services.
• There were currently no patients who had been diagnosed with dementia registered at the practice.

Updated 22 June 2017

The provider is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safe, caring and responsive services. The issues identified as requiring improvement in these services affected all patients in this population group.

• At the time of the inspection there were no patients with a learning disability registered ith the practice.
• There was limited multidisciplinary case working with other health and social care professionals to case manage vulnerable patients.
• The practice had one registered patient who was currently street homeless and cared for 17 patients in a residential project for vulnerable or former street homeless people. The practice had worked with social workers, support workers and other services in delivery care to these patients.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and had received relevant safeguarding training.