Background to this inspection
Updated
20 April 2018
Dr Stephen Lawrence (also known as St Mary’s Island Surgery) is situated in Chatham, Kent and has a registered patient population of approximately 3,200. There are more patients registered between the ages of 0 and 14 years as well as 35 and 49 years than the national average. The practice is not in an area of particular deprivation. The practice staff consists of the principal GP (male), a salaried GP (female), and a locum nurse and a healthcare assistant. There was no practice manager, administration or reception staff. At the time of the inspection reception and administration staff were provided on a temporary basis from local practices.
There is a reception and waiting area. All the patient areas are accessible to patients with mobility issues, as well as parents with children and babies.
The practice is not a teaching or training practice.
The practice has a general medical services contract for delivering primary care services to the local community.
The practice’s opening hours are Monday to Thursday between the hours of 8.30am to 1pm and 2pm to 6pm and Friday 8.30am to 1pm. The practice’s telephone lines remain open between the hours of 1pm to 2pm. Extended hours surgeries are advertised as available on Friday 6.30am to 8am. Primary medical services are available to patients registered at the provider via an appointments system.
There are arrangements with another provider (Medway On Call Care) to deliver services to patients outside of the practice’s working hours.
Services are provided from St Mary’s Island Surgery, Edgeway, St Mary’s Island, Chatham, Kent, ME4 3EP, only.
Updated
20 April 2018
This practice is rated as Inadequate
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – inadequate
Are services responsive? – Inadequate
Are services well-led? - Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Inadequate
People with long-term conditions – Inadequate
Families, children and young people – Inadequate
Working age people (including those retired and students – Inadequate
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
On 1 Dec 2015 the Care Quality Commission (CQC) inspected St Mary’s Island Surgery. The practice was rated as ‘inadequate’ for providing ‘safe’ and ‘well led’ services and ‘requires improvement’ for providing ‘effective’, ‘caring’ and ‘responsive’ services. The practice was rated inadequate overall. As a result in March 2016 the practice was placed in special measures.
The practice worked with NHS Medway CCG and NHS England while in special measures to significantly improve the level of care and treatment.
The CQC inspected again on 23, 26 & 29 September 2016. The practice had made improvements and was rated as ‘good’ for each of CQC’s key questions. As a result, the surgery was removed from special measures.
We carried out an unannounced comprehensive inspection at Dr Stephen Lawrence on 23 and 25 January 2018. We carried out the inspection in response to concerns that had been raised with us.
At this inspection we found:
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Systems to safeguard children from abuse were not effective. The practice had not responded to requests for information concerning the health and welfare of looked after children.
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There were no administration/reception staff working at the practice. Temporary reception staff, who had come from other practices to help, had not had an induction.
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Correspondence was not dealt with in a timely manner, large quantities of correspondence were awaiting inputting onto patients’ records.
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Medicine management was unsafe. Emergency medicines were out of date. The oxygen cylinder was empty.
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Significant events had not been reported. The practice did not have an effective system for receiving and acting on safety alerts
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GPs did not have access to the proper information technology tools to help make the best decisions for their patients’ treatment and care.
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Patient care was not well co-ordinated, including end of life care.
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Patients’ records and the coding of patients’ records were not up to date so staff were not always able to identify patients’ conditions and meet their needs.
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Patients were not referred to secondary care, nor were referrals from secondary care, dealt with in a timely manner.
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The provider was unable to demonstrate they had implemented all actions detailed in their plan to improve patient satisfaction scores.
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The practice’s results from the 2017 annual national GP patient survey were below the national average for its satisfaction scores on caring and responsive issues
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Although there had been an increase in the number of patients on the practice’s list who had been identified as carers we were unable to speak with staff to identify how carers were currently being identified.
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There were failings in the practice’s compliance with the Data Protection Act 1998.
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Care and treatment for patients with multiple long-term conditions and patients approaching the end of life was not always coordinated with other services.
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The needs of children were not always addressed in a timely way and vulnerable adults were not always supported.
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Patients did not always receive care and treatment from the practice within an acceptable timescale for their needs.
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The annual national GP patient survey, relating to the practice’s responsiveness was below the national average.
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Some complaints from patients were not acknowledged.
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Governance arrangements were insufficient, ineffectively implemented and were compounded by the regular absence of the GP.
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Significant issues that threatened the delivery of safe care were not identified or adequately managed.
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Staff we spoke with said that they did not feel valued or supported by the practice.
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There had been no recent staff meetings.
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There was no patient participation group.
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There was no evidence of systems and processes for learning, continuous improvement and innovation within the practice.
Following our inspection our concerns were such that on the 29 January 2018 we imposed immediate conditions on The provider’s registration with the Care Quality Commission. The conditions were:
Condition 1: By 8 February 2018 the registered person must clear the existing backlogs of prescription requests, medication reviews, referrals to and responses from secondary care, patients’ discharge notes and any other correspondence, relating to the health and care of patients. The progress of this task must be reported to the Care Quality Commission (the Commission) weekly by midday each Thursday.
Condition 2: By 8 February 2018 the registered person must implement a sustainable system to ensure prescription requests, medication reviews, referrals to and responses from secondary care, patients’ discharge notes and any other correspondence, relating to the health and care of patients are reviewed and actioned without delay. By 8 February 2018 the registered person must report to the Commission how this system has been implemented.
Condition 3: The registered provider must ensure that a suitably qualified, competent, skilled and experienced person is present at the practice to manage day to day operations to ensure a safe delivery of the service.
The provider was in breach of those conditions in that on 30 and 31January a CQC inspector called at the practice and found that on nether day was there a person on the premises who accepted responsibility for managing it.
On 31 January 2018 we issued a Notice of Proposal to cancel The provider’s registration with the Care Quality Commission under Section 17(1) (c) of the Health and Social Care Act 2008. This gave The provider 28 days in which to make written representations to Her Majesty’s Courts & Tribunals Service as to why he did not agree with any of the reasons for the notice of proposal. No representations were received.
On 2 March 2018 we issued a Notice of Decision to cancel The provider’s registration with the Care Quality Commission. This Notice gave The provider 28 days in which to make written representations to the Care Quality Commission as to why he does not agree with the Notice of Decision.
We reported our findings to Medway Clinical Commissioning Group (CCG) and NHS England. As result of our concerns the CCG attended The provider’s practice and carried out a review of aspects of care. Some evidence from that review is contained within this report.
The areas where the provider must make improvements as they are in breach of regulations are:
Good governance
Systems or processes must be established and operated effectively to ensure compliance with the requirements of the Act.
On 20 February 2018 a new provider was registered with the Care Quality Commission to provide general practice services from the St Mary’s island surgery site.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice