Archived: Dr Helen Clark Also known as The Beechcroft Medical Centre

Updated 27 April 2017

Beechcroft Medical Centre is located in Wembley, Middlesex and holds a General Medical Services (GMS) contract and is commissioned by NHSE London. The practice is staffed by two GP partners, both female who work full time doing eight and seven sessions a week respectively. The practice also employs one full time practice manager, one nurse practitioner, one practice nurse, a healthcare assistant (HCA), three reception staff, a medical secretary and an administrator.

The practice is open between 8.30am and 6.30pm on Monday, Tuesday, Thursday and Friday and open between 8.30am and 2.00pm on Wednesday. Outside of these hours the answerphone redirects patients to their out of hours provider. Commuter appointment slots are offered from 6.30pm to 8.45pm on Thursday. Extended surgery hours are offered on Monday from 6.30pm to 7.00pm.

The practice has a list size of 5000 patients and is located in an area where the majority of the population is working age. Approximately 63% of the practice population was in paid work or full time education.

The practice provides a wide range of services including treatment of disease, disorder or injury, diagnostic and screening procedures, maternity and midwifery services and surgical procedures. The practice provides care to two nursing homes in the area and provides one clinical session a week for ward rounds to approximately 50 patients. The practice is also a teaching practice and takes medical students.

The practice was inspected on 20 December 2013 and was found to have breached the regulation on suitability of staffing. The practice had failed to perform all the required recruitment checks to ensure that staff were suitable to work at the practice. In particular, the service had not carried out criminal record checks for all clinical staff employed at the practice. A follow up inspection was carried out on 26 June 2014 and the practice was found to have met this standard.

Updated 27 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beechcroft Medical Centre on Thursday 10 February 2016. Overall the practice is rated as inadequate.

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

• Procedures for reporting, recording, taking appropriate action and sharing learning from significant event analysis (SEAs) were inadequate.

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, those relating to fit and proper persons employed, recruitment checks, staffing, safeguarding, chaperoning, infection control, health and safety, equipment, medicines management, dealing with emergencies and patient referrals.

• Risk assessments were poorly recorded and any risks identified were not actioned.

• There was little evidence that audits were driving improvement.

• The appointment system was not effective. Patients did not receive timely care when they needed it as they were unable to book appointments online and they experienced long waiting times to get through to the surgery by telephone to book routine or emergency appointments.

• The practice failed to make every reasonable effort to recruit a male GP to the practice.

• The practice had limited formal governance arrangements.

The areas where the provider must make improvements are:

• Develop and implement a vision and strategy to improve services for patients and ensure governance processes are in place to monitor safety and risk.

• Introduce processes for reporting, recording, acting on, sharing and monitoring significant events, incidents and near misses and ensure staff are aware of and comply with the requirements of the Duty of Candour in the event of a notifiable safety incident.

• Ensure systems and processes to safeguard adult and children from abuse are established and operated effectively and all staff receive up to date safeguarding training.

• Take action to address identified concerns with infection prevention and control practice and in relation to premises and equipment, maintain standards of hygiene appropriate for the purposes for which they are being used.

• Put systems in place for the secure storage of prescription pads and the monitoring of their use.

• Ensure recruitment arrangements include all necessary employment checks for all staff and undertake a risk assessment on the need for a Disclosure and Barring Service (DBS) check for staff providing a chaperone service. Ensure staff are trained and aware of their responsibilities when acting as a chaperone.

• Ensure annual testing of all electrical equipment and calibration of clinical equipment are carried out and the premises are properly maintained with comprehensive risk assessments carried out in order to identify any shortfalls and take remedial action. For example, in relation to treatment rooms.

• Ensure sufficient numbers of suitably qualified staff are deployed to meet people’s care needs and ensure fit and proper persons are employed in clinical roles.

• Ensure appropriate arrangements are in place for managing medical emergencies including: availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site and staff training in basic life support.

• Ensure signed Patient Group Directions (PGDs) allowing the practice nurse to administer medicines in line with legislation are up to date.

• Ensure a comprehensive business continuity plan is in place for major incidents.

• Carry out clinical audits including re-audits to ensure improvements have been achieved.

• Ensure an induction programme is in place that prepares staff for their role and ensure staff participate in mandatory training including information governance and are provided with appropriate policies and guidance to carry out their roles in a safe and effective manner and ensure they receive regular appraisal of their performance.

• Ensure the GP actions all referrals in a timely manner.

• Ensure privacy is maintained at the reception desk and dignity is maintained during examinations, investigations and treatments.

• Ensure all clinical staff understand the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.

The areas where the provider should make improvement are:

• Improve processes for making appointments over the phone and online.

• Ensure they respect people’s preferences in relation to who delivers their care and treatment such as a male GP.

This provider cancelled their registration at the end of October 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 April 2017

The provider is rated as inadequate for safe, effective, responsive and well led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were some examples of good practice:

• The practice had a recall system in place that resulted in them achieving high QOF targets for long term conditions. For example;

• The percentage of patients with diabetes on the register, in whom the last blood pressure reading measured in the last 12 months was 140/80 mmHG or less was 81%, compared to a national average of 78%.

• Longer appointments and home visits were available when needed but patients did not receive timely care.

• All these patients had a named GP, care plans in place and an annual review to check their health and medicines needs were being met. However, we found the GP was not actioning referrals in a timely way.

• The practice was unable to demonstrate how they worked with relevant health and social care professionals to deliver a multidisciplinary package of care for those with complex needs including palliative care patients.

Updated 27 April 2017

The practice is rated as inadequate for safe, effective, responsive and well led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were some examples of good practice:

• The practice was unable to demonstrate what systems were 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.

• Childhood immunisation rates for vaccinations given to under two year olds ranged from 30% to 42% and this was lower than the CCG average that ranged from 44% to 68%. Childhood immunisation rates for the vaccinations given to five year olds ranged from 16% to 80% and this was lower than the CCG average ranging from 55% to 81%.

• Access to appointments was inadequate and we saw patient complaints highlighting problems with accessing appointments when they were required, including a patient waiting for two weeks for an antenatal referral.

• 58% of patients described their experience of making an appointment as good compared to the CCG average of 66% and national average of 73%.

• The practice held bimonthly meetings with the health visitors but the practice was unable to provide evidence to show examples of joint working with midwives or school nurses.

• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 81%.

• The mother and baby facilities at the practice were inadequate.

Updated 27 April 2017

The practice is rated as inadequate for safe, effective, responsive and well led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were some examples of good practice:

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were higher than national average for example;

• The percentage of patients with atrial fibrillation who were currently treated with anticoagulation therapy was 100%, compared to a national average of 98%.

• Longer appointments and home visits were available for older people when needed but patients were unable to access timely care.

• Evidence to show how the practice worked with multi-disciplinary teams including palliative care team in the case management of older people and end of life care was not provided on request.

• The practice was unable to identify how many carers were registered with the practice and provide evidence of what support was available to them.

Updated 27 April 2017

The practice is rated as inadequate for safe, effective, responsive and well led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were some examples of good practice:

• The age profile of patients at the practice is mainly those of working age, students and the recently retired but the services available did not fully reflect the needs of this group.

• Although the practice offered telephone consultations, extended opening hours and commuter clinics, access to appointments were inadequate as patients were unable to access treatment in a timely way.

• Data published in 2014/2015 showed 67% of patients were satisfied with the surgery’s open hours compared to the CCG average of 71% and national average of 74%.

• Patients could book request prescriptions and appointments online but there were issues regarding online patient access.

• Health promotion advice was offered but there was limited accessible health promotion material available through the practice.

Updated 27 April 2017

The practice is rated as inadequate for safe, effective, responsive and well led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were some examples of good practice:

• The practice had a recall system in place that resulted in the achievement of high QOF targets for patients experiencing poor mental health. For example;

• Data showed that 97% of patients with mental health problems had a comprehensive care plan documented in the last 12 months and this was comparable to a national average of 88%.

• 82% of patients diagnosed with dementia had their care reviewed face to face in the last 12 months and this was comparable to a national average of 84%.

• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health but not always those with dementia.

• It carried out advance care planning for patients with dementia.

• The practice was unable to demonstrate what system was in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 27 April 2017

The practice is rated as inadequate for safe, effective, responsive and well led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, there were some examples of good practice:

• The practice did not provide evidence to show how many patients living in vulnerable circumstances including those with a learning disability were on the register.

• The practice did not provide evidence to show how it worked with multi-disciplinary teams in the case management of vulnerable people.

• Not all staff had received training in safeguarding relevant to their role.

• Some staff did not know how to recognise signs of abuse in vulnerable adults and children, but they were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies out of normal working hours.