Archived: Keyhealth Medical Centre

Updated 16 November 2017

Keyhealth Medical Centre is located in Waltham Abbey, Essex. It provides GP services to approximately 6,200 patients living in the locality. It is situated next to a supermarket and patients can use the parking facilities. The practice shares its premises with another GP practice and other community services.

Operon Health Limited runs Keyhealth Medical Centre and has been registered since May 2017 and provided services at the practice since December 2016. 

The director and only permanent GP works at the practice one day a week, the remainder of the week he works away from the practice and accesses the systems remotely from an office. There are three long-term locums engaged, four nurse practitioners and three practice nurses. Nurses are engaged on a self-employed basis.

The provider is supported by a full-time practice manager who has been working at the practice since June 2017. They are supported by reception and administrative staff, a number of whom have been recruited since the new provider took over the practice.

The practice is open between 8am until 6.30pm Monday to Friday. Appointments are from 9am to 1.50pm every morning and 3pm to 6.20pm daily. Appointments for the hub, which is open on the weekends and a Friday evening, can be booked at reception.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Keyhealth Medical Centre on 22nd August 2017. Overall the practice is rated as inadequate.

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

• There was not a transparent approach to safety. The system for learning from and actioning significant events was not effective.
• Searches were not being routinely undertaken to identify patients who may be at risk as a result of Medicine and Healthcare products Regulatory Agency (MHRA) alerts.
• There were not adequate systems in place to manage and respond to pathology results.
• Not all staff were trained in adult or child safeguarding. The safeguarding vulnerable adults’ policy did not identify a lead member of staff.
• The practice manager had experience of dealing with patients who had experienced issues with drug and alcohol misuse and utilised skills to involve patients in their care.
• Not all chaperones were trained, DBS checked or risk assessed as to their suitability to the role.
• The practice maintained appropriate standards of cleanliness and hygiene, although actions identified in the infection control audit had not been completed.
• Recruitment checks were not consistently applied.
• The system in place to ensure that clinical staff were following NICE guidance was not effective.
• The practice did not monitor the use of prescription stationery around the practice, although prescription stationery was stored securely.
• Staff had not received training in health and safety, infection control or basic life support.
• Staff did not have the skills and knowledge to support the delivery of effective care.
• There were not effective systems in place to share information with other providers.
• Patient feedback was variable about the care received at the practice. National GP patient survey results published in July 2017 showed that the practice was performing in line with CCG and national averages in respect of consultations with the nurse, and in line with or below CCG and national averages in respect of consultations with the GPs.
• There were no processes in place to support carers. 0.9% of patients who were carers had been identified.
• There were 20 patients on the learning disabilities register and two had received a health check in the last year.
• The practice did not monitor inadequate cervical smear rates. The nurse was not aware of any failsafe procedures which sought to ensure an effective sample was taken.
• Patients said there was a lack of consistency and presence of GPs and that they experienced difficulties obtaining appointments.
• Information about how to complain was not easily available to patients.
• The practice team was not strong. There was a lack of presence and leadership by the lead GP and the administration workforce as a whole were not settled or embedded into their roles. Clinical staff were transient: nurses were self-employed and all GPs, aside from the lead GP, were locums.

The areas where the provider must make improvement are:

• Ensure effective systems and processes are established in relation to good governance in accordance with the regulations and fundamental standards of care.
• Ensure care and treatment is provided in a safe way to patients
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure the issues highlighted in the national GP patient survey are addressed in order to improve patient satisfaction, including concerns relating to appointment access and consultations with GPs.

The areas where the provider should make improvement are:

• Complete actions identified as required in the infection control audit.
• Update the safeguarding adults’ policy to identify the lead clinician responsible for safeguarding.
• Improve the identification of carers in order to provide them with appropriate support.
• Make available information about how to make a complaint, the availability of chaperones and the changes to the provider.

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 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.

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

Updated 16 November 2017

The practice is rated as inadequate for the care of people with long-term conditions. The provider has been rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring services. The ratings apply to all patients using this service, including this population group.

• Whilst the practice had evidenced some improvement in outcomes for people with long term conditions since they had taken over the practice, outcomes continued to be below the local and national average
• There were no meetings of nurses to discuss patients who had long term conditions. There were not effective systems to share information with other providers when concerns were identified with patients who had long-term conditions.
• The lead GP held a surgery for one morning per week. This time was protected to review complex patients with long-term conditions.
• There was a lack of regular GPs working at the practice, and patients raised concern about the lack of continuity of care.

• Pathology results were not managed effectively.

Updated 16 November 2017

The practice is rated as inadequate for the care of families, children and young people. The provider has been rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring services. The ratings apply to all patients using this service, including this population group.

The ratings apply to all patients using this service, including this population group.

• Unverified data for 2016/2017 showed that the practice’s uptake for the cervical screening programme was 76%. Verified data relating to CCG and national averages was not yet available. The practice did not monitor inadequate cervical smear rates. The nurse was not aware of any failsafe procedures which sought to ensure an effective sample was taken.
• Administrative staff were not trained in safeguarding children. There was no evidence of safeguarding children training for one GP locum engaged at the practice.
• There were not effective systems to share information with other providers when concerns were identified with children and young people.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 16 November 2017

The practice is rated as inadequate for the care of older people. The provider has been rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring services. The ratings apply to all patients using this service, including this population group.

• Staff had not received training in safeguarding vulnerable adults. The safeguarding vulnerable adults’ policy did not provide details of the lead member of staff.
• There were not effective systems to share information about older people who may need palliative care as they were approaching the end of life.
• There were a lack of regular GPs working at the practice, and patients raised concern about the lack of continuity of care.

• Pathology results were not being managed effectively.

Updated 16 November 2017

The practice is rated as inadequate for the care of working age people (including those recently retired and students). The provider has been rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring services. The ratings apply to all patients using this service, including this population group.

• Appointments ran from 9am until 6.20pm every weekday evening.
• Appointments with a GP, nurse or healthcare assistant were available at the GP hub on a Friday evening and on weekends.
• There was a range of health promotion and screening available that reflected the needs of this population group.
• Health and well-being checks were available with the nurse.

Updated 16 November 2017

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The provider has been rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring services. The ratings apply to all patients using this service, including this population group.

• The practice did not work with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Staff had not received training in safeguarding vulnerable adults.
• Staff were aware of the mental capacity act. A GP locum who worked at the practice had a special interest in supporting patients who were experiencing poor mental health.

Updated 16 November 2017

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider has been rated as inadequate for providing safe, effective and well-led services and requires improvement for providing caring services. The ratings apply to all patients using this service, including this population group.

• There were 20 patients on the learning disabilities register. The practice had completed health checks for two of these patients in the last year.
• The practice manager had experience of dealing with patients who had experienced issues with drug and alcohol misuse. We observed them utilising their skills to support relevant patients to access the practice, using sensitivity and discretion.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 58 patients as carers on its systems which was 0.9% of the patient population. The practice did not offer any additional services for carers.
• End of life care was not delivered in a coordinated way as there was a lack of systems to share information with other providers.
• Staff had not received training in safeguarding vulnerable adults.