Archived: Deanhill Surgery

Updated 5 March 2015

Deanhill Surgery is a small sized GP practice based in Richmond. The practice provides primary care services to around 2050 patients. The ethnicity of patients is mainly white British with small numbers of Asian and Black patients.

In the Borough of Richmond male life expectancy is 81.5 years and female life expectancy is 85 years. Both are above the England average for both males and females. An estimated 20,000 people in Richmond have a common mental disorder. Common mental disorders (such as depression and anxiety) are the most prevalent mental health conditions. About 50% of those with common mental health problems may require some form of treatment.

The practice is located in a purpose built building. The practice has two full time female locum GPs and one male locum GP working one day a week. The practice has no permanent salaried GPs. The principal GP is based at the main branch surgery and does not work from Deanhill Surgery. The practice has two reception staff and a practice manager based at another site. There was one practice nurse who provided 15 hours of care per week.

The practice holds a Personal Medical Services (PMS) contract for the delivery of general medical services. Personal Medical Services (PMS) agreements are locally agreed contracts between NHS England and a GP practice. PMS contracts offer local flexibility compared to the nationally negotiated General Medical Services (GMS) contracts by offering variation in the range of services which may be provided by the practice, the financial arrangements for those services and the provider structure (who can hold a contract).

The practice have opted out of providing out-of-hours services to their own patients. A local out of hours service, 111, is used to cover emergencies.

Updated 5 March 2015

Letter from the Chief Inspector of General Practice

Deanhill Surgery is a small sized GP practice based in Richmond. The practice provides primary care services to around 2050 patients.

We carried out an announced comprehensive inspection on 20 October 2014.

Overall the practice is rated as inadequate.

We found numerous issues in relation to the safety and there were inadequate systems in place to monitor and respond to risks. The extent of the issues identified indicated that there was a lack of managerial oversight. As a result, safe, effective and well-led were rated as inadequate. We rated effective and responsive as requires improvement and caring as good.

Due to inadequate ratings in safe,effective and well led .The concerns which led to these ratings apply to all population groups using the practice.

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

The leadership of the practice was inadequate. There was no clear leadership structure and staff did not feel supported by management. The provider had two practices, which were registered separately with the Care Quality Commission. We were told that the same management team were responsible for the running of both practices, but they rarely attended Deanhill Surgery and policies and procedures had not been adapted to ensure they were relevant and fit for purpose.

The practice did not hold regular governance meetings and issues were discussed at ad-hoc meetings. Staff did not feel involved or engaged and learning from incidents or complaints was not disseminated to support improvement.

Safety was not sufficiently prioritised and there were inadequate systems in place to monitor and manage risks. Staff understood their responsibilities to raise concerns, and report incidents and near misses. However, when things went wrong, reviews and investigations were not sufficiently thorough. Not all staff demonstrated the necessary competencies in relation to safeguarding and the nurse had not undergone a criminal records check prior to commencing work. The practice was visibly unclean on the day of our inspection and there were insufficient systems in place to protect patients from the risk of infection.

Staff had knowledge of and reference to National Guidelines but there were no systems to ensure this was consistent. There were no completed audit cycles for patient outcomes. Multidisciplinary working was not taking place.

Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions.

Importantly, the provider must:

Ensure there are appropriate systems, governance arrangements and effective leadership in place to monitor the quality of the service being provided.

Ensure that all clinical staff have full Disclosure and Barring Checks and there is a clearly documented rationale for not undertaking a DBS check on other staff to demonstrate that any risks have been assessed.

The practice must ensure all staff are sufficiently competent in child protection and safeguarding vulnerable adults so they are able to identify and respond appropriately to potential concerns.

The practice must ensure they maintain appropriate standards of cleanliness and hygiene in relation to premises occupied for the purpose of carrying on the regulated activity.

The practice must ensure that all clinical and administrative staff are properly trained, supervised and appraised.

In addition the provider should:

Ensure that clinical audit cycles are completed to demonstrate improved outcomes for patients. The practice should also work with other professionals and organisations involved in patients’ care to ensure they receive care that is well co-ordinated and effective.

Actively seek to involve patients in developing and improving the service.

Ensure staff are engaged and involved in developing and improving the service and ensure that learning from incidents and complaints are disseminated.

Provide a practice website, and offer online repeat prescription and appointments booking to enable patients to have flexibility.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 March 2015

The provider was rated as Inadequate for safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Very few of these patients had a named GP and personalised care plan. Structured annual reviews were not undertaken to check that patients’ health and care needs were being met. Multi-disciplinary team meetings were not held to support and review care of patients.

Updated 5 March 2015

The provider was rated as Inadequate for safe, effective  and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were no systems to identify and follow up patients in this group who were living in disadvantaged circumstances and who were at risk. There was no evidence of joint working with other health and social care services to ensure families, children and young people received multidisciplinary care.

Immunisation rates were also relatively low for a number of the standard childhood immunisations.

Updated 5 March 2015

The provider was rated as Inadequate for safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The care of older people was not managed in a holistic way. The leadership of the practice have little understanding of the needs of older people and were not attempting to improve the service for them. Services for older people were therefore reactive, and there was a limited attempt to engage this patient group to improve the service.

Updated 5 March 2015

The provider was rated as Inadequate for safe, effective 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 was mainly those of working age, students and the recently retired but the services available did not reflect the needs of this group. Appointments could only be booked by telephone and there were no early or extended opening hours for working people. There was a low uptake for both health checks and health screening.

Updated 5 March 2015

The provider was rated as Inadequate for safe,effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice was unable to identify patients experiencing poor mental health or those with dementia. It had not worked with multi-disciplinary teams in the case management of people experiencing poor mental health.

Updated 5 March 2015

The provider was rated as Inadequate for safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice did not hold a register of patients living in vulnerable circumstances. It was unable to identify the percentage of patients who had received an annual health check. The practice had not worked with multi-disciplinary teams in the case management of vulnerable people. Reception staff did not how to recognise signs of abuse in vulnerable adults and children. They were not aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies out of normal working hours or who the safeguarding lead at the practice was.