Shepherds Bush Medical Centre

We carried out an announced comprehensive inspection at Shepherds Bush Medical Centre on 10 October 2019 as part of our inspection programme.

We previously inspected Shepherds Bush Medical Centre on 22 January 2019. At that inspection, we rated the service as inadequate for safe, effective and well-led care. We rated the service as requires improvement for being caring and responsive. The service was rated as inadequate for all population groups. The service was placed into special measures for six months from 21 February 2019.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We have rated it as good for the following population groups: Older people, people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

We rated the following population groups: people with long-term conditions; working age people and families, children and young people as requires improvement.

Overall, we have rated patient population groups as requires improvement.

We rated the practice as good in providing safe services because they had improved:

• The practice had clear systems and processes to keep patients safe.
• The practice had improved its systems for the management of emergency medicines.
• The practice had adequate systems in place to ensure that prescribing materials were kept securely.
• The practice had an effective system in place to safely manage patients who are prescribed high risk medicines.
• The practice had an effective system in place to manage safety alerts.
• The practice had made improvements to its systems when things went wrong

We rated the practice as requires improvement in providing effective services. We found the practice had improved in providing effective services. However, we found :

• The long term conditions, working age people; and families, children and young people population groups as requires improvement because patient data regarding long term conditions, cervical screening and childhood immunisation uptake rates were not yet in line with the relevant national targets.

We rated the practice as good in providing well-led as services because they had improved:

• The practice could demonstrate they had effective systems and processes in place to keep people safe.
• There are adequate systems and processes in place to be assured of the quality and safety of the service being provided.
• Leaders could show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice had a clear vision, that was supported by a credible strategy.
• The practice culture supported high quality sustainable care.
• The practice could demonstrate they had clear and effective processes in place for managing risks, issues and performance.

We rated the practice as good in providing caring and responsive services because:

Whilst we found no breaches of regulations, the provider should:

• Monitor the effectiveness of actions to increase uptake of cervical screening.
• Continue efforts to increase the uptake of childhood immunisations.
• Monitor the effectiveness of action plans regarding long term conditions management to increase patients’ attendance.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection at Shepherds Bush Medical Centre on 29 May 2019. The purpose of the inspection was to follow up on breaches of regulations identified at our previous inspection on 22 January 2019. Following the January 2019 inspection, the practice was rated Inadequate and placed in special measures. We issued warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The practice was required to address these concerns by 15 May 2019.

We did not review the ratings awarded to this practice at this inspection.

We based our judgement of the quality of care at this service on a combination of:

•what we found when we inspected

•information from our ongoing monitoring of data about services and

•information from the provider, patients, the public and other organisations.

At this inspection we found:

We found the provider had improved in providing safe services because:

•The practice had clear systems and processes to keep patients safe.

•The practice had improved its systems for the management of emergency medicines.

•The practice had adequate systems in place to ensure that prescribing materials were kept securely.

•The practice had an effective system in place to safely manage patients who are prescribed high risk medicines.

•The practice had an effective system in place to manage safety alerts.

•The practice had made improvements to its systems when things went wrong.

We found the provider had improved in providing effective services because:

•There was improved monitoring of the outcomes of care and treatment.

•The practice could demonstrate that it always obtained consent to care and treatment.

•The practice had increased clinical capacity and could demonstrate they effectively managed the service during annual leave and sickness and when the service was under pressure due to patient demand.

We found the provider had improved in providing well-led services because:

•The practice could demonstrate they had effective systems and processes in place to keep people safe.

•There are adequate systems and processes in place to be assured of the quality and safety of the service being provided.

•Leaders could show that they had the capacity and skills to deliver high quality, sustainable care.

•The practice had a clear vision, that was supported by a credible strategy.

•The practice culture supported high quality sustainable care.

•The practice could demonstrate they had clear and effective processes in place for managing risks, issues and performance.

The areas where the provider must make improvements are:

•The provider must ensure that all staff have undertaken immunisations or have certified immunity in line with national guidance.

•The provider must ensure that persons providing care or treatment to service users have the qualifications and experience to do so safely.

•The provider must ensure that all action points related to fire safety and electrical wiring have been completed.

(Please see the specific details on action required at the end of this report).

The service will remain in special measures until we have undertaken the next inspection and this will be reviewed at that time. This 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 remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Shepherd’s Bush Medical Centre on 22 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

•What we found when we inspected

•Information from our ongoing monitoring of data about services and

•Information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

•The practice did not have clear systems and processes to keep patients safe.

•Receptionists had not been given guidance on identifying deteriorating or acutely unwell patients. They were not aware of actions to take in respect of such patients.

•The practice did not have appropriate systems in place for the safe management of medicines.

•The practice did not learn and make improvements when things went wrong.

We rated the practice as inadequate for providing effective services because:

•There was limited monitoring of the outcomes of care and treatment.

•The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

•The practice was unable to show that it always obtained consent to care and treatment.

•There was evidence that insufficient clinical hours and a lack of systematic risk assessments across patient population groups were having a direct impact on patient care and some performance data was significantly below local and national averages.

•We did not see evidence of how GP and nursing staff hours were effectively managed during annual leave and sickness and when the service was under pressure due to patient demand.

We rated the practice as inadequate for providing well-led services because:

•The practice was unable to demonstrate effective systems and processes to keep people safe.

•There are inadequate systems and processes in place to be assured of the quality and safety of the service being provided.

•Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.

•While the practice had a clear vision, that vision was not supported by a credible strategy.

•The practice culture did not effectively support high quality sustainable care.

•The practice did not have clear and effective processes for managing risks, issues and performance.

•The practice did not always act on appropriate and accurate information.

•We saw no evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as requires improvement for providing caring services because:

•The practice had limited systems in place to identify carers, including young carers’, and provide relevant support.

•Patients made positive comments about the care and treatment they received.

•Patients could generally access care and treatment in a timely way, although appointment times with GPs’ were limited.

•Staff mostly dealt with patients with kindness and respect and involved them in decisions about their care.

We rated the practice as requires improvement for providing responsive services because:

•The practice provided evidence of multi-disciplinary work to coordinate end of life care.

•All patients had a named GP who supported them in whatever setting they lived, and conducted home visits when required.

The areas where the provider must make improvements are:

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

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

(Please see the specific details on action required at the end of this report).

I am placing this service in special measures. Services 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 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 by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care