You are here

Archived: St Philips Medical Centre Inadequate

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Inadequate

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

Inspection areas

Safe

Requires improvement

Updated 22 June 2017

The practice is rated as requires improvement for providing safe services. 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. However, there are still areas where improvements should be made.

  • The practice had now implemented systems, processes and practices to keep patients safe and minimise the risk of harm.
  • Staff demonstrated that they understood their responsibilities and all had now received training on safeguarding children and vulnerable adults relevant to their role.
  • Further action had been taken to improve recruitment processes, especially evidence of pre-employment checks. The practice provided evidence of appropriate documentation for recently recruited staff and was undertaking a retrospective review of documentation for previously appointed staff which was nearing completion at the time of our inspection.
  • The practice had arrangements in place to manage controlled drugs but there was no written policy for this.
  • The practice had adequate arrangements to respond to emergencies and major incidents.
  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. When things went wrong outcomes and actions were recorded in incident reports but there still was limited documented evidence that lessons were shared to make sure action was taken to improve safety in the practice.

Effective

Inadequate

Updated 22 June 2017

The practice is still rated as inadequate for providing effective services and improvements must be made. The practice had addressed some of the concerns identified at our previous inspections in relation to staff training and appraisal and the completion of clinical audits. However, there are still areas where improvements must be made.

  • There was no formal process for disseminating NICE guidelines to all GPs working at the practice to ensure guidelines were implemented for the practice as a whole.
  • There were no practice initiated care plans in place for patients over 75 or for patients with chronic mental health issues.
  • The practice did not systematically use QOF information to review performance and improve quality and there were no alternative arrangements in place.
  • The practice carried out clinical audit and since our previous inspection had completed a number of audits through the full audit cycle.
  • There was some participation in multidisciplinary working to co-ordinate patient care. However, there were no regular multidisciplinary meetings and they were held on a case by case basis.
  • There were now arrangements in place for all staff to receive mandatory training and additional learning and development and appraisals had been completed for all staff due them.
  • Locum (non-principal) doctors were still not systematically informed by the principal GP of the outcome of hospital referrals or the results of tests they initiated.
  • 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.
  • The practice’s uptake for the cervical screening programme was also much lower than CCG and national averages.

Caring

Requires improvement

Updated 22 June 2017

The practice is rated as requires improvement for providing caring services, as there are still areas where improvements should be made.

  • Data from the national GP patient survey showed patients were broadly happy with how they were treated and the care they received. However, of 371 survey forms distributed, only 25 (7%) were returned, so it was difficult to draw meaningful conclusions from the data.
  • All of the patients we spoke with said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • There was some information for patients about the services available. Written health promotion information at the practice was limited but on-line information was now available on the practice’s website, introduced since our previous inspection.

  • Staff treated patients with kindness and respect, and maintained confidentiality.

  • The practice provided emotional and bereavement support. Carers were signposted to the local CCG carers support services. However, the practice had not taken action we said it should take to proactively identify patients who were carers to determine their specific support needs.

Responsive

Requires improvement

Updated 22 June 2017

The practice is rated as requires improvement for providing responsive services, as there are still areas where improvements should be made.

  • The practice sought to respond to patients’ needs and maintain the level of service provided. However, there was still no formal planning system to address identified needs in determining the way services were delivered.
  • There was evidence of limited coordination of care and treatment with other services.
  • Patients could get information about how to complain in a format they could understand. However, there was limited documentary evidence that learning from complaints had been shared with staff.
  • The practice now had its own website which enabled patients to book appointments and request repeat prescriptions on line.

Well-led

Inadequate

Updated 22 June 2017

The practice is still rated as inadequate for being well-led and improvements must be made. Limited progress had been made in implementing action to address concerns and there was insufficient improvement since our previous inspection.

The provider had not taken action we said they must take to ensure there were appropriate 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.

  • There had been limited progress in developing further the practice vision and values or articulating them to staff or patients.
  • The process of change the provider had initiated at our previous inspection had not been progressed significantly and governance arrangements remained limited. It remained the case that the principal GP’s approach to the management of the practice did not provide the rest of the clinical team with a full opportunity to share responsibility for clinical quality and standards. Plans we were told of previously to hold regular, minuted practice team meetings had not yet been implemented. Most communication continued to be through undocumented, informal, one to one meetings or cascade briefing.
  • Given the size of the patient list, the governance structure in the practice did not promote best management practice.
  • There was still a limited approach to obtaining the views of people who used the services. The practice took account of and acted on complaints and responses to the NHS friends and family test. The planned patient participation group, to engage patients in decision making and the identification of improvements in service delivery, was now in the early stages of development but was not yet up and running at the time of our latest inspection.
  • The practice had initiated the systematic identification and review of patients on the practice register who had moved away from the practice vicinity, for example when they left the university or moved abroad, to check whether they should remain on the practice list.
Checks on specific services

People with long term conditions

Inadequate

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.

Families, children and young people

Requires improvement

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.

Older people

Inadequate

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.

Working age people (including those recently retired and students)

Requires improvement

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.

People experiencing poor mental health (including people with dementia)

Inadequate

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.

People whose circumstances may make them vulnerable

Requires improvement

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.