Archived: St Peter's Health Centre - Mansingh & Partner Also known as Dr S Mansingh & Partner - St Peter's Health Centre

Updated 8 May 2015

St Peter’s Medical Centre is situated within St Peter’s Health Centre. The health centre brings together a wide range of health care professionals. The building is a shared occupancy and comprised of two GP practices and a range of other health care services.

St Peter’s Medical Centre – Dr Mansingh and Mehra provide Primary Medical Services for 2,800 patients in Leicester City.

At the time of our inspection the practice employed two GP partners(male), one practice manager, one assistant practice manager, one Quality and Outcomes Framework (QOF) co-ordinator, one nurse, one health care assistant and two reception and administrative staff. (QOF) is a system used to monitor the quality of services in GP practices.

The practice manager had been promoted to the post in Summer 2014 and was still in a period of induction. He had peer support from the previous practice manager who was available on a day to day basis. The practice manager told us he felt well supported.

The practice has a Primary Medical Services Contract (PMS). A PMS contract is a local contract agreed between NHS England and the practice, together with its funding arrangements.

We inspected the following location where regulated activities are provided:-

St Peter’s Medical Centre, St Peter’s Health Centre, Sparkenhoe St, Leicester. LE2 0TA.

We did not visit Queens Road Surgery, 282 Queens Road, Leicester, LE2 3FU as it is registered as a separate location.

The CQC intelligent monitoring placed the practice in band four. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

The practice is located within the area covered by Leicester City Clinical Commissioning Group (CCG). The CCG is responsible for commissioning services from the practice. A CCG is an organisation that brings together local GP’s and experience health professionals to take on commissioning responsibilities for local health services.

Leicester City is one of the most diverse and disadvantaged urban areas in the country. Leicester has a young population. About 60% of people living in Leicester are under the age of 40 and there are fewer people aged 65 and over compared to the national average. Approximately 50% of patients are from

ethnic minorities, with nearly a third of the population being South Asian. The city has the largest Indian population of any local authority area in England, while it also has thriving communities of people originating from Somali, middle eastern, African and eastern European backgrounds.

Leicester City have some of the most deprived areas and patients have some of the worst health of anywhere in the country. Leicester has the 20th most deprived population in England and about half

of patients are considered to be highly disadvantaged.

St Peters Medical Centre – Dr Mansingh and Mehra have opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided to Leicester City, Leicestershire and Rutland by Central Nottinghamshire Clinical Services.

Updated 8 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Peter’s Medical Centre on 6 January 2015.

Overall the practice is rated as Requires Improvement.

Specifically, we found the practice inadequate for providing safe care. It was requires improvement for the responsive and well-led domains. Required Improvement for providing services for all the population groups, It was good for providing effective and caring services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Patients said service received was good. Receptionists were friendly and helpful
• Immunisation rates were 96% and above the Clinical Commissioning Group (CCG) average.
• Data showed patient outcomes were average for the locality within the CCG.
• Some clinical audits had been carried out but we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• In the July 2014 national GP patient survey 81% patients described the overall experience as good which was average for the CCG.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had not proactively sought feedback from staff or patients.

The areas where the provider must make improvements are:

• Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include the checking of medical equipment, fridge temperatures and disclosure and barring for staff recruitment.
• Identify, assess and manage risks relating to the health, welfare and safety of patients, staff and other people who may be at risk within the practice. For example, risk assessments for, legionella, oxygen, general office environment, control of substances hazardous to health (COSHH), use of a chaperone and infection control.

• Regard should be made to information available and patient views in delivering services and driving improvements.
• Ensure its recruitment arrangements and necessary employment checks are in place for all staff.
• Ensure that staff have appropriate support, identified through a formal appraisal system to have the necessary training to enable them to deliver the care and work they carry out in the practice.
• Put in place an effective system to regularly assess and monitor the quality of the service provided by St Peter’s Medical Centre. For example, ensure staff have clear guidance and the practice manage and learn from significant events and complaints.

In addition the provider should

• The practice should have a patient participation group (PPG) in order for patients and the practice to work together to improve the service and improve the quality of care patients receive.
• The practice should have policies in place in areas relating to whistleblowing and legionella. to provide guidance and support to staff.
• Policies and procedures should be reviewed to ensure that they are reviewed, updated and do not contain contradictory information, for example, the chaperone protocol.
• Have a clear audit programme to improve the quality of patient outcomes.
• Identify and deliver training and awareness to staff so they can deliver care safely and to an appropriate standard, for example, chaperone and Mental Capacity Act 2005.
• Offer patients the opportunity to have an annual physical health check.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If the provider is inadequate for more than one key question they will go straight into special measures.

If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for a key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 May 2015

The practice is rated as requires improvement for people with long-term conditions.

The provider was rated as good for effective and caring overall and this includes this population group.

The provider was rated as inadequate for safety, requires improvement responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Emergency processes were in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. However, not all these patients had a named GP or a personalised care plan or structured annual review to check that their health and care needs were being met.

Updated 8 May 2015

The practice is rated as requires improvement for the families, children and young people.

The provider was rated as good for effective and caring overall and this includes this population group.

The provider was rated as inadequate for safety, requires improvement responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were systems 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. Emergency processes were in place and referrals were made for children and pregnant women whose health deteriorated suddenly. The practice could refer any pregnancy complications to the Early Pregnancy Assessment Unit or for admission as appropriate. Cervical smear uptake was 69.9% which was below the CCG average.

Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this. Appointments were available outside of school hours. Young people were signposted to local sexual health clinics. Last year’s performance for all immunisations was 96% and above average for the CCG, and there was a clear policy for following up non-attenders by the named practice nurse.

Updated 8 May 2015

The practice is rated as requires improvement for the care of older people.

The provider was rated as good for effective and caring overall and this includes this population group.

The provider was rated as inadequate for safety, requires improvement for responsive and well-led. 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, and some older people did not have care plans where necessary. Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients. The leadership of the practice had started to engage with this patient group to look at further options to improve services for them. Personalised care plans were in place for patients at end of life. Patients at high risk had been identified to reduce admissions to secondary care. Where admissions to secondary care had occurred 100% of patients had been followed up. 100% of people receiving structured annual medication reviews for polypharmacy. Polypharmacy is the use of four or more medications by a patient, generally adults aged over 65 years. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs

Updated 8 May 2015

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students).

The provider was rated as good for effective and caring overall and this includes this population group.

The provider was rated as inadequate for safety, requires improvement responsive and well-led. 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, students and the recently retired but the services available did not fully reflect the needs of this group. Although the practice offered extended opening hours for appointments from Monday to Friday.

The practice did not have a website for patients to gain information about the practice. However if they were registered for on-line services they could book/cancel appointments and order repeat prescriptions. NHS Choices also provided information about the practice. They had a practice leaflet which did not make reference to NHS Choices, online services for the practice health promotion or practice policies,

Only 23.4% of patients aged 40-74 had received a NHS Health check.

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

Updated 8 May 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).

The provider was rated as good for effective and caring overall and this includes this population group.

The provider was rated as inadequate for safety, requires improvement responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

80% of people experiencing poor mental health had received an annual physical health check. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health but not always those with dementia. Cognition testing had just commenced in the practice at the time of the inspection. It carried out advance care planning for patients with dementia. Patients with mental health problems were referred to the Crisis Team. Access was available with St Peter’s Health Centre where patients could be referred by a GP to a psychiatric clinic. Repeat prescribing of medicines was done as a shared care protocol with the psychiatrist.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND. MIND is a mental health charity in England and Wales. It offers information and advice to people with mental health problems. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Most staff had received training on how to care for people with mental health needs.

Updated 8 May 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

The provider was rated as good for effective and caring overall and this includes this population group.

The provider was rated as inadequate for safety, requires improvement responsive and well-led. 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 vulnerable circumstances including homeless people, travellers and those with a learning disability. 87% of patients with a learning disability had received an annual health check.

The practice worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.