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Archived: St Philips Medical Centre Inadequate

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Reports


Inspection carried out on 20 April 2017

During a routine inspection

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 carried out on 2 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Philips Medical Centre on 2 August 2016. This was to follow up a comprehensive inspection we carried out on 12 November 2015 when we found the practice was not meeting the fundamental standards of quality and safety in a number of areas. Overall the service was rated as inadequate and placed in special measures.

St Philips Medical Centre drew up a special measures turnaround action plan to improve its performance in response to the findings of the previous inspection. At the follow up inspection we reviewed the practice’s progress in implementing this plan. The practice had made improvements in some areas but much of the action plan remained to be implemented. Overall, it had not addressed sufficiently concerns identified at our previous inspection and we identified additional concerns at our latest inspection. Overall the practice is rated as inadequate as insufficient improvement has been made.

Specifically, we found the practice to be inadequate for providing, safe, effective, and well-led services, and requires improvement for providing caring and responsive services.

The concerns which led to a rating of inadequate in safe, effective, and well-led apply to all population groups using the practice. Therefore, all population groups have been rated as inadequate.

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 lessons learned were communicated throughout the practice to ensure that safety was improved. No minuted practice meetings had been put in place to facilitate this.

  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. There were continuing deficiencies in the systems and training for safeguarding, infection control, medicines management, dealing with medical emergencies and ensuring the safety of medical equipment.

  • Action had been taken to improve recruitment processes, especially in relation to pre-employment checks, but not all the actions required had been implemented in full.

  • There was still limited evidence of a multidisciplinary approach to patient care and treatment.

  • The practice carried out clinical audit but there was no evidence of completion of the full audit cycle to improve patient outcomes.

  • The practice promoted good health and prevention and provided patients with advice and guidance. However, the practice had not introduced care plans for older people and at risk groups.

  • There was limited documentary evidence that learning from complaints had been shared with staff.

  • Staff felt supported in their roles but there were continuing gaps in key areas of the training and appraisal they had received.

  • There was limited progress in implementing systems to monitor and improve the quality and safety of the services provided.

The areas where the provider must make improvements are.

  • Ensure care and treatment is provided in a safe way, through further improvements in the safety of infection control processes, medicines management and emergency and medical equipment.

  • Ensure continuing gaps in staff training in safeguarding, infection control, and medical emergencies are addressed and completion of the induction process.

  • Ensure patients are fully protected against the risks associated with the recruitment of staff, in particular in the recording of recruitment information and in ensuring all appropriate pre-employment checks are carried out and recorded prior to a staff member taking up post. Where Disclosure and Barring Scheme (DBS) checks are not carried out for some staff, this should be risk assessed and documented to evidence why.

  • Ensure patients are protected from abuse and improper treatment through the completion of Disclosure and Barring Scheme (DBS) checks for staff who carry out chaperoning duties or risk assess the need and put in place mitigating arrangements.

  • Put in place a formal process for disseminating NICE guidelines to all GPs working at the practice to ensure guidelines are implemented for the practice as a whole.

  • Ensure there are 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.

  • Review the system in place for the use and storage of liquid nitrogen to ensure that the practice is fully compliant with the guidance, including a risk assessment for Control of Substances Hazardous to Health (COSHH).

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.

  • Introduce care plans for patients over 75 and patients with chronic mental health issues.

  • Make more systematic use of the information collected for QOF to review performance and improve quality.

  • Introduce a programme of quality improvement including clinical audits and re-audits to ensure improvements in patient outcomes have been achieved improve.

  • Foster greater 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 in February 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe, effective and well-led services. I have decided to place the service in special measures for a further period to allow the provider more time to implement planned improvements. The service 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 urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 12 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Philips Medical Centre on 12 November 2015. Overall the practice is rated as Inadequate.

Specifically, we found the practice to be inadequate for providing safe, effective, and well-led services and requires improvement for providing caring and responsive services.

The concerns which led to a rating of inadequate in safe, effective, and well-led apply to all population groups using the practice. Therefore, all population groups have been rated as inadequate.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

  • Although the practice carried out investigations when there were unintended or unexpected safety incidents, there was no documentary evidence that lessons learned were communicated throughout the practice to ensure that safety was improved.

  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. There were deficiencies in the systems and training for safeguarding, infection control, medicines management, dealing with medical emergencies and ensuring the safety of equipment.

  • There were shortcomings in the practice’s recruitment processes.

  • There was limited evidence of a multidisciplinary approach to patient care and treatment.

  • The practice carried out clinical audit but there was no evidence of completion of the full audit cycle to improve patient outcomes.

  • The practice promoted good health and prevention and provided patients with advice and guidance. However, the practice had not introduced care plans for older people and at risk groups.

  • There was no evidence that learning from complaints had been shared with staff.

  • Staff felt supported in their roles but there were gaps in key areas of the training they had received.

The areas where the provider must make improvements are.

  • Ensure care and treatment is provided in a safe way, through improvements in the safety of infection control processes, medicines management and emergency and electrical equipment.

  • Ensure gaps in staff training in safeguarding, chaperoning, infection control, medical emergencies and fire safety are addressed and evidence of all training completed is documented in staff records, including completion of the induction process.

  • Ensure patients are fully protected against the risks associated with the recruitment of staff, in particular in the recording of recruitment information and in ensuring all appropriate pre-employment checks are carried out and recorded prior to a staff member taking up post. Where Disclosure and Barring Scheme (DBS) checks are not carried out for some staff, this should be risk assessed to evidence why.

  • Ensure patients are protected from abuse and improper treatment through the completion of Disclosure and Barring Scheme (DBS) checks for staff who carry out chaperoning duties.

  • Put in place a formal process for disseminating NICE guidelines to all GPs working at the practice to ensure guidelines are implemented for the practice as a whole.

  • Ensure there are 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.

In addition the provider should:

  • Communicate lessons learned from incidents and complaints to all practice staff and document the discussion and action agreed.

  • Arrange for the practice’s policy on safeguarding to include details of local agencies to contact for further guidance if staff have concerns about a patient’s welfare, and ensure staff have ready access to these details.

  • Introduce care plans for patients over 75 and patients with chronic mental health issues.

  • Make more systematic use of the information collected for QOF to review performance and improve quality.

  • Carry out clinical audits and re-audits to improve patient outcomes.

  • Foster greater 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.

  • Design the service to meet all patients’ needs.

  • Develop a more robust planning process to address identified patient needs and determine the way services are delivered.

  • Develop practice vision and values further and ensure they are communicated to staff and patients.

I am placing this practice in special measures. Practices 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 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 by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice