Archived: Dr Stephen Fletcher Also known as St Andrew's Medical Centre

Updated 21 May 2015

Dr Stephen Fletcher, also known as St Andrew’s Medical Centre provides primary care services to approximately 3,800 patients living in the Willesden area, in the London Borough of Brent. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of: Maternity and midwifery services; Treatment of disease, disorder or injury; Diagnostic and screening procedures.

The practice holds a General Medical Services (GMS) contract with NHS England for delivering primary care services to the local community. The practice has a higher proportion of male and female patients aged 20 – 39 compared with the England average. In contrast the number of patients, male and female aged over 60 years of age is lower than the England average. There is a higher deprivation score and unemployment rate for the practice population compared to local and national Clinical Commissioning Group (CCG) averages.

The practice team comprises of one full time male GP principal, one part time male locum GP who covers five clinical sessions, one part time female practice nurse who works 28 hours per week and a team of five part time administration staff led by a full time practice manager. The practice is temporarily operating from this address having been required to move from their original premises at 125 High Road Willesden in April 2014. Initially the practice had moved into short term temporary premises at a local GP practice in Willesden whilst a rodent issue was addressed. The original premises were then deemed unfit to provide medical services by NHS England because of health and safety concerns, which led to the move to the current temporary premises. Clinical and reception staff moved in May 2014 followed by the rest of the administration team in October 2014, where they remain until permanent premises and practice arrangements are secured.

The opening hours are 9.00am to 6.30pm Monday and Thursday, 8.00am to 6.30pm Tuesday, 8.00am to 4.30pm Wednesday and 9.00m to 6.00pm Friday. There is no access to the practice each Thursday between 12.30pm to 2.00pm as this time is allocated for staff meetings and training. An alternative provider supplied the out of hour’s service.

Updated 21 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Stephen Fletcher at Greenhill Park Medical Centre on 28 October 2014. The practice was temporarily operating from this address having been required to move from their original premises at 125 High Road Willesden due a rodent issue and then the building being deemed unfit to provide medical services by NHS England.

At the time of our inspection the administration team had only recently moved into the Greenhill Park Medical Centre and many administration records were held in storage waiting to be unpacked when space to accommodate the volume was accessible. As a result, we carried out a second inspection on 30 March 2015 to review documents and information that had not been available at the time of our first visit.

Overall the practice is rated as requires improvement.

Specifically, we rated the practice as ‘requires improvement’ for providing safe, responsive and well led services, ‘inadequate’ for providing effective services and ‘good’ for providing caring services. We rated the practice as ‘requires’ improvement for providing services for older people, people with long term conditions, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health.

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

• The practice had insufficient leadership capacity.
• There were some procedures for monitoring and responding to risk. For example, infection control audits were carried out and clinical staff had received up to date safeguarding training.
• Disclosure and Barring Service (DBS) checks had not been completed for all administration staff who may be called upon to act as a chaperone.
• Procedures were in place for recording and reporting significant incidents.

• The practice followed current best practice guidelines when planning patient care.
• Patients said they were treated with kindness, dignity and respect.
• Patients were generally satisfied with the appointment system but dissatisfied with the late running of appointments.
• The practice gathered feedback from patients through the Friends and Family Test and the National GP patient survey, however they did not have a patient participation group.

The areas where the provider must make improvements are:

• Improve uptake rates of cervical screening.
• Improve uptake rates of child immunisations.
• Ensure that the care plan programme for frail elderly patients or complex need patients is achieved.
• Notify the CQC of any change that affects registration including location change.

In addition the provider should:

• Ensure Disclosure and Barring Service (DBS) checks are undertaken for all administration staff who may be required to undertake chaperone duties at the practice.
• Ensure all staff who undertake chaperone duties are suitably trained.
• Document in patient records when a chaperone has been involved.
• Review staff recruitment files to ensure that they are consistently maintained.
• Take action to address late running of appointments. This had occurred fairly regularly at the practice and affected patients’ experience of the service.
• Provide clear information for patients about the length of any likely delays to appointments and changes to service provision.
• Review practice information leaflets to ensure that up to date information is provided including current staff, practice appointment arrangements and on line services.
• Formalise the practice vision and values and share these with patients and staff.
• Review all protocols and policies in place to ensure that they are accurate and up to date.
• Ensure that all staff members receive an annual appraisal and support to develop in their role.
• Pro-actively recruit and engage Patient Participation Group (PPG) members.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 May 2015

The practice is rated as requires improvement for the care of people with long-term conditions.

The practice nurse performed annual reviews of patients with long term conditions during pre-bookable appointments, although since the move to the current premises the opportunity for regular review of these patients had been restricted. For patients with diabetes, the practice nurse arranged retinal screening and podiatry service referrals as required. The practice held multi-disciplinary (MDT) meetings with district nurses, health visitors, locality integrated care-coordinator and palliative care nurses to discuss the care plans of complex needs patients.

The provider was rated overall as requires improvement. The concerns that led to these ratings apply to everyone using the practice, including this population group.

Updated 21 May 2015

The practice is rated as requires improvement for the care of families, children and young people.

The practice nurse was trained to provide family planning service including oral contraceptive medicine checks and injections for contraception. There was a weekly ante-natal service and post-natal reviews were performed in conjunction with the first set of baby vaccinations. The post- natal review included assessment for post-natal depression. The practice offered childhood immunisations in line with national guidance, although uptake rates were low. Child immunisation uptake rates for 2013-2014 were at one year between 55-60%, at two years between 50-69% and five years between 51-89% depending on the vaccine.

The provider was rated overall as requires improvement. The concerns that led to these ratings apply to everyone using the practice, including this population group.

Updated 21 May 2015

The practice is rated as requires improvement for the care of older people.

Home visits were available for patients who were unable to attend the practice due to immobility or illness. The practice offered joint injections for patients with arthritis. The practice had commenced a care plan programme of frail elderly or complex need patients who were at high risk of admission or re-admission to hospital, however the number of completed care plans was low. The GP’s made twice weekly visits to patients in a local care home for regular review and management.

The provider was rated overall as requires improvement. The concerns that led to these ratings apply to everyone using the practice, including this population group.

Updated 21 May 2015

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students).

The practice had not met the needs of its working population. They did not offer extended hours appointments to allow patients who work easy access to appointments outside of working hours. The practice did not have a website for patients to directly log into the on line appointment booking system or to submit repeat prescription requests. There was a facility to book appointments and request repeat prescriptions online through NHS Choices for patients who were registered users but this service was not publicised by the practice. The practice offered NHS Health Checks for patients over 40 years of age without chronic conditions.

The provider was rated overall as requires improvement. The concerns that led to these ratings apply to everyone using the practice, including this population group.

Updated 21 May 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). Patients with mental health issues received regular review and the practice had links with the community mental health team (CMHT) to support the needs of this patient group. Urgent referrals to CMHT were made on the same day. The practice used the Improved Access to Psychological Therapies (IAPT) service to support patients suffering with anxiety and depression. Patients were signposted to other support services where required.

The provider was rated overall as requires improvement. The concerns that led to these ratings apply to everyone using the practice, including this population group.

Updated 21 May 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

The practice kept a register of patients with learning difficulties. They were offered annual health checks with the practice nurse and any issues identified were passed to the GP for review. There were 13 patients on the learning disabilities register and nine annual checks had been completed. People with alcohol or drug misuse problems were supported through referral to the local drugs and alcohol team.

The provider was rated overall as requires improvement. The concerns that led to these ratings apply to everyone using the practice, including this population group.