Background to this inspection
Updated
30 August 2018
Bayswater Medical Centre operates from 46 Craven Road, London W2 3QA. The practice has access to six consulting rooms, three are located on the ground floor and three in the basement. The basement is accessible by stairs.
The practice provides NHS primary care services to approximately 7,500 patients and operates under a Personal Medical Services (PMS) contract (an alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract). The practice is part of NHS West London Clinical Commissioning Group (CCG).
The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder or injury, maternity and midwifery services, family planning and surgical procedures.
The practice staff comprises of a principal GP (eight sessions per week), a male and female salaried GP (totalling 11 sessions per week) and a regular male locum GP (four and a half sessions per week). The clinical team is supported by two healthcare assistants (1.7 WTE) and a locum practice nurse one day a week. There is a full-time practice manager, who is a non-clinical partner and the registered manager for its CQC registration, and five administration/reception staff.
The practice is open between 8am and 6:30pm Monday to Friday. Extended hours appointments are available on Tuesday from 6.30pm to 8pm and Saturday from 9am to 1pm. The practice offers on-line services, which include appointment booking and repeat prescriptions which can be accessed through the practice website. Patients also have access to two GP hub services offering appointments from 6pm to 9pm Monday to Friday and from 8am to 8pm on Saturday and Sunday.
The practice population is in the fourth most deprived decile in England, on a scale of one to 10 with one being the most deprived and 10 being the least deprived. People living in more deprived areas tend to have greater need for health services. Data shows that 39% of patients at the practice area were from Black and Minority Ethnic (BME) groups. The highest proportion of the practice population was in the 15 to 44-year-old age category.
Updated
30 August 2018
We carried out an announced comprehensive inspection at Bayswater Medical Centre on 4 June 2015. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. A second announced comprehensive inspection was undertaken on 3 February 2016 following the period of special measures. Although the practice had made improvements there were still concerns and the practice was rated as requires improvement. We carried out a third announced inspection on 27 July 2017. Although the practice had addressed the issues of our previous inspection we found new concerns and the practice remained rated as requires improvement. The full comprehensive report of the June 2015, February 2016 and July 2017 inspections can be found by selecting the ‘all reports’ link for Bayswater Medical Centre on our website at www.cqc.org.uk.
This inspection, on 10 May 2018, was an announced comprehensive inspection to confirm that the practice was now meeting the requirements that we had identified in our previous inspection on 27 July 2017. Upon publication of our previous report we asked the provider, under Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, to send us a written report of the action they would take to achieve the requirements of the Health and Social Care Act 2008, associated regulations and any other legislation we had identified they were in breach of. This was required by 20 October 2017. The provider failed to return the action plan despite reminders being sent. The provider only provided an action plan when it was requested following the announcement of this inspection.
This report covers our findings in relation to the requirements of our previous inspection and any improvements made since our last inspection.
The practice is now rated as Inadequate overall.
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires Improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Inadequate
At this inspection we found:
- The provider had failed to submit CQC statutory notification requirements within the required timescale.
- We found that the practice had not addressed all of the findings of our previous inspection and additional concerns were found.
- Risks to patients were not assessed and well managed including legionella, equipment, fire safety, and infection control.
- Clinical staff we spoke with were able to demonstrate how they assessed needs and delivered care and treatment in line with current legislation, standards and guidance.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- Leaders did not consistently have the knowledge or capacity to prioritise safety and quality improvement. There was a poor track record in terms of maintaining improvement and the practice was reactive rather than proactive.
- We found there was a lack of systems and processes established and operated effectively to ensure compliance with requirements to demonstrate good governance.
- There was no evidence of regular structured or formalised clinical or practice meetings. The practice were unable to evidence how learning from significant events, patient safety alerts, clinical guidance and complaints was shared with staff.
The areas where the provider must make improvements are:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
- Amend the safeguarding children policy so it is practice-specific.
- Review best practice in relation to the recognition, diagnosis and early management of sepsis and consider if the practice can appropriately assess all patients, including children, with suspected sepsis.
- Continue to review and monitor patient outcomes in relation to childhood immunisations and the cervical screening programme.
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 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 a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice