Dr Plana & Partners Also known as Sherard Road Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Plana & Partners on 28 June 2016. We inspected the practice’s main site at 71 Sherard Road SE9 6ER, and its branch sites at 444-446 Rochester Way SE9 6LJ and 115 Tudway Road SE3 9YX. Overall the practice is rated as inadequate.

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

• Risks to patients were not assessed or managed enough to keep patients safe. This was in relation to the absence of evidence of training for several staff that was relevant to their roles, ineffective fire safety and infection control processes, the absence of risk assessments at the practice’s branch sites, and ineffective medicines management systems. The practice had not assessed the risks associated with the absence of defibrillators and oxygen for use in medical emergencies.

• Data for 2014/2015 showed several patient outcomes were significantly below local and national averages in relation to the Quality and Outcomes Framework clinical targets; the practice had not adequately addressed some of these areas in order to make improvements to patient outcomes.The practice provided evidence, after the inspection, that in 2015/2016 clinical performance had improved but this data had not been independently verified or published at the time of our inspection. 

• Audits had been conducted and we saw evidence that some audits had driven improvements to patient outcomes; however, the practice did not have any formal processes in place to continuously monitor and improve clinical and overall performance.

• The majority of patients said they were treated with compassion, dignity and respect, but there were no policies or arrangements to allow people with no fixed address to register as patients to receive on-going care at the practice.

• Patients found it difficult to get appointments and they had faced long waiting times after arriving for appointments. The practice had not adequately addressed this or implemented any action plans to make improvements.

• There was limited health and support information, and information about services at the Rochester Way branch site.

• The practice had a number of policies and procedures to govern activity, and all staff we spoke with felt supported and valued by the practice’s leaders; however record keeping, such as for governance meetings and training received, was limited.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations of incidents were thorough, and patients received apologies where appropriate.

The areas where the provider must make improvements are:

• Ensure emergency medicines and equipment are available in sufficient quantities across all sites with effective systems in place for monitoring them, ensure nurses are authorised to administer medicines, and ensure there are adequate systems in place to allow staff to raise an alarm in emergencies.

• Ensure there are effective systems in place for infection control and prevention, and for monitoring risks across all sites.

• Ensure all staff complete training (including basic life support), training is updated at appropriate intervals with records kept of training received, and include safeguarding, fire safety, infection control, health and safety and confidentiality in staff inductions.

• Ensure all staff have a good understanding of the practice’s procedures, implement an effective system for documenting practice processes, and ensure there are systems and processes to identify and improve where quality is being compromised.

In addition the provider should:

• Review the process for recording consent.

• Provide information for patients, including translation services available, in appropriate languages and formats.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them, and ensure homeless patients are able to register to receive on-going continuity of care.

• Review the need to install panic alarms in the disabled toilets.

• Ensure the business continuity plan includes emergency contact numbers for all staff.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of 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 to varying the terms of their registration within six months if they do not improve. The practice 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 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 FRCGPChief Inspector of General Practice