Archived: Landywood Lane Surgery

Updated 16 January 2017

Landywood Lane Surgery (known as Dr K Desai’s surgery) is registered with the Care Quality Commission (CQC) as a GP partnership provider in Great Wryley, Cannock. The practice is part of the NHS Cannock Chase Clinical Commissioning Group. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The practice area is one of lower deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 19,45 patients.

The practice staffing comprises of:

• Two GP partners (one male and one female).
• Two part time practice nurses.
• A practice manager and reception staff.

The practice was open between 8am and 1pm, and 3.30pm and 6.30pm Monday to Thursday and from 8am to 1pm on Fridays. GP appointments were available Monday to Friday from the earliest time of 9.30am to the latest time of 6pm, depending on the day of the week. Extended appointments hours with a GP were offered between 5.30pm and 7pm on a Wednesday.

The practice has opted out of providing cover to patients in the out-of-hours period. During this time services are provided by Staffordshire Doctors Urgent Care via NHS 111.

Updated 16 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Landywood Lane Surgery on 22 September 2016. Overall the practice is rated as inadequate.

Following the inspection we sent a letter to the provider, which required them to provide the Care Quality Commission with information under Section 65 of the Health and Social Care Act 2008 and Regulation 10 Care Quality Commission (Registration) Regulations 2009. This related to the rationale behind prescribing subcutaneous fluids to patients in care homes without visiting them to carry out a clinical review or access to recent blood results. We also requested information on the action the provider was going to take to ensure that the clinical care of these patients was safe. We received a response from the practice to our Section 65 letter.

Our key findings were as follows:

• Patients told us during the inspection that they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment. However, the GP survey results did not reflect these findings.
• Patients told us that they were able to get appointments when they needed them.
• Patients were not protected from risks because the GPs prescribed fluids for a number of patients without a clinical assessment, including recent blood monitoring.
• There was an inconsistent approach to risk management. For example, Disclosure and Barring Service checks hadn’t been obtained, safety checks on electrical equipment hadn’t been completed and there was a lack of planning and monitoring of staff numbers to meet the needs of patients.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure that there is an effective process in place to guide staff on the reporting, recording and managing of significant events.
• Ensure that there is access to all the recruitment information required under Schedule 3 of the regulations when recruiting staff, including locum GPs.
• Access whether there is a risk to patients of being cared for or treated by members of staff without Disclosure and Barring Service checks.
• Ensure that all electrical equipment and clinical equipment is safe to use and/or calibrated.
• Assess the risks of not keeping a full range of emergency medicines at the practice and mitigate the risks to patients.
• Provide appropriate sharps bins for the disposal of sharps contaminated with s
• The practice must ensure there are adequate numbers of appropriately skilled staff to cover sickness and absence.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
• Develop a clear leadership structure, including designated roles and responsibilities for staff.

In addition the provider should:

• Introduce a system which demonstrates that medicines and equipment alerts issued by external agencies are acted upon.
• Implement a system to monitor the use of prescription stationery.
• Introduce effective systems for monitoring the collection of prescriptions.
• Provide written evidence to demonstrate that all new staff are provided with, and complete an induction programme.
• Evaluate the reasons for poor performance in the national GP patient survey regarding patient satisfaction with their interactions with GPs and nurses in respect of their involvement in planning and making decisions about their care and treatment.
• Make information about how to make a complaint more accessible to patients.
• Review and update all policies and procedures.

On the basis of the ratings given to this practice at this inspection I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 January 2017

The practice was rated as inadequate in safe and well, requires improvement in effective and responsive and good in caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• One of the practice nurses was involved in chronic disease management.
• The practice maintained registers of patients with long term conditions. Patients were offered a structured annual review to check their health and medicines needs were being met.
• Performance in two of the five diabetes related indicators were below the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom a specific blood test was recorded was 62%, compared with the CCG average of 76% and national average of 77%. However, the exception reporting for all five indictors was below the CCG and national averages.

Updated 16 January 2017

The practice was rated as inadequate in safe and well, requires improvement in effective and responsive and good in caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There were systems in place to identify children who were at risk, for example families with children in need or on children protection plans.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were screening and vaccination programmes in place and the practice’s immunisation rates
• Data from the Quality and Outcomes Framework (QOF) for 2014/15 showed that 82% of women aged 25-64 had received a cervical screening test in the preceding five years. This was comparable to the national average.
• The practice offered routine contraception services.

Updated 16 January 2017

The practice was rated as inadequate in safe and well, requires improvement in effective and responsive and good in caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Care and treatment of older people did not always reflect current evidence-based practice. For example, prescribing subcutaneous fluids to patients without a clinical review or recent blood monitoring.
• The practice participated in the hospital admission avoidance scheme. The care of these patients was managed using care plans. It was not clear if there was a follow up procedure in place following discharge from hospital.

Updated 16 January 2017

The practice was rated as inadequate in safe and well, requires improvement in effective and responsive and good in caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The age profile of patients at the practice is mainly those of working age and the recently retired but the services available did not fully reflect the needs of this group.
• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Extended consultation hours with the GP were offered one evening a week. However the earliest appointment time with a nurse was 9am and with a GP was 9.30am.

Updated 16 January 2017

The practice was rated as inadequate in safe and well, requires improvement in effective and responsive and good in caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice identified patients who were experiencing poor mental health or those living with dementia.
• Eight three percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% compared to the national average of 88%.

Updated 16 January 2017

The practice was rated as inadequate in safe and well, requires improvement in effective and responsive and good in caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice carried out annual health checks and offered longer appointments for patients with a learning disability.
• Staff knew how to recognise signs of abuse in vulnerable adults and children.