Archived: Two Steeples Medical Centre

Updated 25 May 2017

Long Street Surgery delivers primary medical services under a personal medical services (PMS) contract between themselves and NHS England. The practice serves a patient population of 2904. There are roughly equal numbers of patients aged over 65, under 18 and of working age.

There are two partner GPs one male, one female plus a locum GP, who provide 16 sessions a week between Monday and Friday. The practice is open from 8.30am – 7pm on Monday, Tuesday 8.30am – 6.30pm, Wednesday 7.30am - 6:30pm, Thursday 8.30 – 6.30pm and Friday 8.30am – 6.30pm.

The clinical sessions of individual doctors and nurses vary within these hours. The practice does not open at weekends.

The GPs do not provide an out-of-hours service to their own patients and patients are signposted to the NHS 111out-of-hours service when the surgery is closed at the weekends and in the evenings.

The doctors are registered to carry out minor surgical procedures. There is a nursing team consisting of one nurse, a health care assistant and a phlebotomist. The nursing team are all employed on a part time basis. At the time of our inspection, there was a practice management consultant in place.

Long Street Surgery was opened in September 2014 at Two Steeples Medical Centre a modern, purpose built Health Centre after a move from the old surgery at Long Street, Wigston. The surgery facilities are provided on the ground and first floor levels with a lift available to provide accessibility to both floors. A disabled toilet is provided adjacent to the waiting room area.

A team comprising of four reception/ administration staff were employed to support the day to day running of the practice. They are all employed on a part time basis.

Updated 25 May 2017

Letter from the Chief Inspector of General Practice

This practice was placed in to special measures on 22 October 2015 following an inspection on 22 April 2015, which was carried out as part of our new comprehensive inspection programme. At that inspection, we found the practice inadequate for providing safe, effective, caring, responsive services and being well led. It was also inadequate for providing services for the older people, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health.

We carried out a focused inspection of Long Street Surgery with an unannounced visit on 7 December 2015 and an announced visit on 15 December 2015. The inspection in December 2015 was carried out during a period in which the provider was already in special measures and ahead of a scheduled inspection because of concerns received in respect of providing safe care and treatment for patients.

The report from our last comprehensive inspection, can be accessed by selecting the 'all reports' link for Long Street Surgery on our website at www.cqc.org.uk

Our key findings across all the areas we inspected on 7 and 15 December 2015 were as follows:

• Patients were at risk of harm because there was a lack of monitoring of the care and treatment of patients. There was a failure of the GPs to treat patients in accordance with national clinical guidelines.

• There was a heavy reliance on secondary care provision and recommendations for treatment and an abrogation of responsibility taken for managing patient care.

• Some staff were carrying out tasks but they did not have the required skills and competencies and without appropriate indemnity.

• There were many examples of inappropriate prescribing.

• Children were not protected as there was not an effective system in place to highlight or identify safeguarding concerns.

• Staff did not always report incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The provider is no longer providing care or treatment from Long Street Surgery.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 October 2015

The provider was rated inadequate for the domains of safety, effectiveness, responsiveness and well led; and requires improvement for caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed, longer appointments and home visits were available. Patients had reviews to check their health and medication needs were being met. The practice maintained a list of those patients who needed home visits. Routine aspects of care undertaken by community staff & discussed with allocated GP.

The practice failed to ensure end of life or palliative care patients had appropriate care plans in place and that appropriate multi-disciplinary meetings took place at regular intervals.

Updated 22 October 2015

The provider was rated inadequate for the domains of safety, effectiveness, responsiveness and well led; and requires improvement for caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were at risk. Patients told us that children and young people were treated in an age appropriate way and recognised as individuals. Appointments were available outside of school hours on Monday, Tuesday, Wednesday and Friday until 6.30pm however the practice did not offer weekend opening. The premises were suitable for children and babies. We were not provided with examples of joint working with midwives and health visitors.

The lead children’s safeguarding GP was aware of vulnerable children within the practice and records demonstrated good liaison with partner agencies such as the police and social services.

The practice failed to hold regular internal as well as multidisciplinary meetings to discuss the care and support needs of patients and their families. This therefore led to a lack of communication with patients and they received little written information or support.

Updated 22 October 2015

The provider was rated inadequate for the domains of safety, effectiveness, responsiveness and well led; and requires improvement for caring services. 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. We were told that patients aged over 75 since September 2014 do not have a named GP. This was required to ensure that there is a named accountable GP assigned to each patient aged 75 and over. Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

Staff could not demonstrate knowledge of consent to care and treatment in line with legislation and guidance (including the Mental Capacity Act 2005).

Updated 22 October 2015

The provider was rated inadequate for the domains of safety, effectiveness, responsiveness and well led; and requires improvement for caring services. 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 Monday, Tuesday, Wednesday and Friday until 6.30pm however the practice did not offer weekend opening. This meant that it was difficult for patients of working age to access the service.

Patients could book appointments or order repeat prescriptions online. Health promotion advice was offered but there was limited accessible health promotion material available through the practice.

Updated 22 October 2015

The provider was rated inadequate for the domains of safety, effectiveness, responsiveness and well led; and requires improvement for caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). Only 87% of people experiencing poor mental health had received an annual physical health check who had a comprehensive care plan documented in the record, (in the preceding 12 months,) agreed between individuals, their family and carers as appropriate compared to the CCG average of 96%. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health but not always those with dementia. The practice were unable to evidence any advance care planning for patients with dementia.

Neither the practice website or the practice leaflet gave any advice on how to access support groups or voluntary organisations such as the mental health charities (MIND or SANE) in this regard.

Staff had not received training on the Mental Capacity Act 2005 or how to care for people with mental health needs and dementia. It is a requirement that GPs and their staff (and all providers of health and social care) should have a good understanding of the MCA 2005. The staff were unable therefore when questioned to show that they had an adequate understanding of the act.

Updated 22 October 2015

The provider was rated inadequate for the domains of safety, effectiveness, responsiveness and well led; and requires improvement for caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice offered longer appointments for people, if required. All patients were treated on equal basis without prejudice. The practice did not offer any form of interpreter service. All information was displayed in english only.

Staff knew how to recognise signs of abuse in vulnerable adults and children. However staff had not received training in the Mental Capacity Act 2005. It is a requirement that GPs and their staff (and all providers of health and social care) should have a good understanding of the MCA 2005.

Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.