Archived: The Stanmore Surgery

Updated 10 August 2017

Stanmore Surgery is located in Stanmore, Middlesex. The practice provides care to approximately 2300 patients. The practice is registered as a sole provider with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; diagnostic and screening procedures; family planning services and maternity and midwifery services.

The practice has a General Medical Services (GMS) contract and provides a full range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning and sexual health services.

The practice is staffed by two part time GPs, one male principal GP and one locum GP who provide a combination of eleven sessions a week. The practice also employs two part-time practice nurses and one healthcare assistant who work a combination of two days a week and a total of nine hours a week. The practice has one part time practice manager working ten hours a week and an assistant practice manager also working ten hours per week. The rest of the practice team consists of three part time administrative staff consisting of medical secretaries and reception staff.

The practice is open between 8am and 6pm on Monday, Tuesday, Thursday and Friday and between 8am and 1pm on Wednesday. Extended hours appointments are offered on Monday between 7am and 8am. Outside of these hours, the answerphone redirects patients to their out of hours provider.

The practice had been previously inspected and areas for improvement were found.

Updated 10 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of The Stanmore Surgery on 25 May 2016. The practice was judged to be inadequate and placed in special measures. After this inspection the practice wrote to us to say what action they would take to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment.

This announced comprehensive inspection was carried out on the 6 June 2017 to check that action had been taken by the practice to make the improvements required from the inspection in May 2016.

Overall the practice is rated as inadequate from this inspection as it has failed to address a number of issues identified in the previous inspection and further issues were identified.

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. However we found that some incidents that had occurred had not been recorded and investigated as significant events.

• Where an incident had been recorded the practice had not carried out an analysis of the event and recorded learning points that had been identified to show that the practice was fostering a culture of learning and improvement.

• Risks to patients were not assessed and managed.

• Outcomes for patients who use services were not improving, for example latest unpublished QOF data showed the practice was currently achieving only 56% of the overall points available to them.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

• We were not assured that there was discussion and leadership around best practice and clinical guidelines at practice level.

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

• The practice did not have information on display that informed patients about language interpretation services available.

• The practice had a number of policies and procedures to govern activity, but these were not being followed.

• Though the practice had a leadership structure, there was insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvement are;

• Ensure care and treatment is provided in a safe way to patients.

• Ensure appropriate standards of hygiene for premises and equipment.

• Ensure effective systems and processes to ensure good governance in accordance with the fundamental standards of care

In addition the provider should:

• Develop a system that obtains patients views on improving the service and review areas where the practice have scored below average from the national GP survey results.

• Provide information or notices advising that formal translation services are available for patients who did not have English as a first language who require translation services.

This service was placed in special measures in May 2016. Insufficient improvements have been made such that there remains a rating of inadequate for safe, effective and well led Therefore we are taking 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

Updated 10 August 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 caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Performance for diabetes related indicators was below other practices. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 58% compared to the CCG average of 78% and the national average of 78%. Exception reporting for diabetes was 8% which was below the CCG average of 9% and the national average of 12%.

• Longer appointments and home visits were available when needed.

• Structured annual reviews were not undertaken to check that patients’ health and care needs were being met.

Updated 10 August 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 caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for premature babies and their families following discharge from hospital.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 10 August 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 caring and responsive. The concerns which led to these ratings apply to everyone using the practice, 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 10 August 2017

• The practice is rated as inadequate for 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 caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice was not proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group as there was limited access to the practice nurse.

Updated 10 August 2017

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for safe, effective, responsive and well led and requires improvement for caring and responsive.

The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Performance for mental health related indicators was comparable to other practices. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 30% compared to the CCG average of 91% and the national average of 89%.Exception reporting was 0% which was below the CCG average of 8% and the national average of 13%.

Updated 10 August 2017

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for safe, effective, responsive and well led and requires improvement for caring and responsive.

The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice identified 10 patients with learning disability on the register however, there was no recall system in place, and only one patient had been reviewed.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.