Archived: Dr Selwyn Dexter Also known as North West London Medical Centre

Updated 19 April 2017

Dr Selwyn Dexter, North West London Medical Centre, provides GP primary medical services to approximately 2,510 patients living in the London Borough of Westminster and Westminster Clinical Commissioning Group (CCG). The Borough of Westminster has a diverse population being home to some of the wealthiest people in Britain alongside a high proportion of people living in poverty.

The practice team is made up of one male lead GP providing 12 sessions per week, a practice nurse, a Health Care Assistant, a practice manager and three administrative staff.

The practice is open between 9am-6.30pm on Monday, Wednesday, Thursday and Friday; 9am-7.30pm on Tuesday; and 8am-4pm on Saturday and Sunday. Appointments are from 9.30am-11.30am and 4pm-5.30pm on Monday, Wednesday, Thursday and Friday; 9.30am-11.30am and 4.pm-7.30pm on Tuesday; and 8am-4pm on Saturday and Sunday. Weekend appointments are for urgent care and emergencies only and the practice operates a walk-in service. The lead GP provides the GP services for the urgent care service on Sundays and a locum GP provides this service on Saturdays.Home visits are provided for patients who are housebound or too ill to visit the practice.

The practice has a Personal Medical Services (PMS) contract (PMS is one of the three contracting routes that have been available to enable the commissioning of primary medical services).The practice is registered with the Care Quality Commission to provide the regulated activities of maternity and midwifery services; diagnostic and screening procedures; treatment of disease, disorder or injury.

The practice provides a range of services including maternity care, childhood immunisations, chronic disease management and travel immunisations.

Updated 19 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Selwyn Dexter, North West London Medical Centre on 1 September 2016 and 3 September 2016. Our visit on 3 September was arranged following the inspection on 1 September to gather further information about the weekend urgent care service provided at the practice. Overall the practice is rated as inadequate. The practice was rated inadequate for providing safe, effective and well led services; and requires improvement for responsive and caring.

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

• Staff understood and fulfilled their responsibilities to raise concerns, however when things went wrong lessons learned were not always actioned to support improvement.

• Infection control and medicines management procedures within the practice required improvement.

• Patient outcomes were hard to identify as there was limited reference made to audits or quality improvement.

• Data showed some patient outcomes were low compared to the national average and knowledge of and reference to national guidelines were inconsistent.

• The practice had no clear leadership structure and limited formal governance arrangements.

• The practice was not proactively identifying patients who were also carers.

• The practice had not proactively sought feedback from patients.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Translation services were not advertised or routinely used for patients.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.

• The practice did not have an overarching governance framework to support the delivery of high quality care and good outcomes for patients.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration. Special measures give people who use the service the reassurance that the care they get should improve.

Following our inspection, we received information from NHS England of the provider’s notice to NHS England and the local Clinical Commissioning Group (CCG) in Central London to retire and resign from practice on 31 March 2017. The provider will therefore not be placed into special measures.

If the provider had remained registered with CQC, we would have set out the following list of ‘musts’ and ‘shoulds’ for their action:

The areas where the provider must make improvements are:

• Develop effective systems and processes to ensure safe care and treatment including actioning learning from significant events; medicines management in relation to stock control; and implementation of infection control procedures including infection control audits.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines. Carry out clinical audits including re-audits to ensure improvements have been achieved. Seek and act on patient feedback.

The areas where the provider should make improvement are:

• Take action to improve the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan; and the practice performance for long term conditions, with particular focus on diabetes indicators.

• Consider ways to improve the practice uptake for cervical screening and performance for childhood immunisations.

• Review the security arrangements for treatment and consulting rooms when these are not in use.

• Ensure all clinical staff have received appropriate training in the Mental Capacity Act and requirements of the Duty of Candour.

• Ensure all staff who act as chaperones have been appropriately trained to provide this role and advertise this service for patients within the practice.

• The provider should improve its identification of patients who are carers and the support offered to them by the practice.

• Advertise the translation service within the practice to inform patients this support is available to them as required.

• Consider improving communication with patients who have a hearing impairment.

NHS England and Central London CCG have taken into account the number of patients registered with the provider and where they live, as well as the availability of alternative nearby practices. There are 29 other GP surgeries within one mile of North West London Medical Centre, all of which are currently accepting new patients. Arrangements have been made with local practices for patients to register with these alternative practices.

All patients will be advised of the provider’s decision to discontinue the service provided at North West London Medical Centre and will be provided with information on how to register with a new GP and how to seek further advice and assistance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 April 2017

The practice is rated as inadequate for the care of people with long-term conditions. The provider was rated as inadequate for safe, effective and well-led and requires improvement for responsive and caring. The issues identified as inadequate overall affected all patients including this population group.

• There were unclear leadership roles for chronic disease management within the practice.

• Performance for diabetes related indicators were below the national averages. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol was 5 mmol/l or less, was 68% which was below the national average of 81%; and the percentage of patients with diabetes, on the register, who received a foot examination, was 53% which was below the national average of 88%.

• Longer appointments and home visits were available when needed.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 April 2017

The practice is rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for safe, effective and well-led and requires improvement for responsive and caring. The issues identified as inadequate overall affected all patients including this population group.

• Childhood immunisation rates for the vaccinations given were below the national averages.

• The practice’s uptake for the cervical screening programme was 70%, which was comparable to the CCG average of 74% and below the national average of 82%.

• 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.

• Appointments were available outside of school hours and the premises were suitable for families, children and young people.

Updated 19 April 2017

• The practice is rated as inadequate for the care of older people. The provider was rated as inadequate for safe, effective and well-led and requires improvement for responsive and caring. The issues identified as inadequate overall affected all patients including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 19 April 2017

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). The provider was rated as inadequate for safe,effective and well-led and requires improvement for responsive and caring. The issues identified as inadequate overall affected all patients including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 19 April 2017

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The provider was rated as inadequate for safe, effective and well-led and requires improvement for responsive and caring. The issues identified as inadequate overall affected all patients including this population group.

• Performance for some mental health related indicators were below the national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan was 50% against a national average of 88%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 100% which was above the national average of 84%.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 19 April 2017

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). The provider was rated as inadequate for safe,effective and well-led and requires improvement for responsive and caring. The issues identified as inadequate overall affected all patients including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.