Archived: Barking Road Medical Centre

Updated 18 August 2016

At the time of our comprehensive inspection on 1 December 2015, Barking Road Medical Centre provided services to approximately 2900 patients in the East Ham area of Newham. In December 2015, the practice closed its nearby branch surgery at 154 High Street South, E6 3RW as planned.

The practice was owned and led by an individual GP principal through a General Medical Services contract. At the time of our focused inspection on 1 March 2016, the practice was not providing a service. The GP had plans in place to reopen five days a week with three locum GPs (two male and one female) and a part-time practice nurse. The practice also employed a practice manager, business manager and a team of administrators and receptionists.

The practice premises were accessible to people with disabilities with all facilities, including a disabled toilet, being available on the ground floor. There were good public transport links but no patient parking on site. The practice had an active patient participation group.

The practice population was younger than the English average with higher proportions of children and adults aged under 35 years. Income deprivation levels and unemployment rates were also higher than average. Around half of the practice population was estimated to have a health condition limiting daily life, and the prevalence of diabetes and conditions associated with heart disease were also relatively high. The local population is culturally and ethnically diverse.

The practice was registered to provide the following regulatory activities: family planning; maternity and midwifery services; diagnostic and screening procedures;and treatment of disease, disorder or injury. 

Updated 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barking Road Medical Centre on 1 December 2015. Overall the practice is rated as inadequate.

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

• Patients were at significant risk of harm because systems and processes were not in place to keep them safe. Clinical letters received by post were left in boxes and had not been acted on, in some cases for over six months. These included abnormal test results and requests for information in relation to safeguarding cases.

• Incidents were systematically under-reported and the practice was not always learning and improving when things went wrong.

• Patient records we reviewed were not always accurate or complete. This made it difficult to assess whether the practice was providing safe and effective treatment in line with recommended local and national guidelines in the cases we reviewed.

• The practice’s reported performance was in line with national and local averages for example, in relation to child immunisations and the Quality and Outcomes Framework.

• Patient feedback was variable. We received positive comments about the service but also critical comments about problems with prescriptions. The 2016 National GP Patient Survey indicated patient satisfaction was poor with GP consultations and the service overall.

• The service was open for extended hours and patients reported being able to book appointments when needed. The GP principal was routinely arriving late for clinical sessions and had been doing so for months. Patients and staff were not alerted to the likely length of delays. Staff told us they had been subject to verbal abuse as a result.

• The practice had no system for documenting, analysing and learning from verbal complaints.

• The practice did not foster a supportive, learning culture. Staff were discouraged from raising concerns about the service and fearful of the consequences. Many of the staff we spoke with were concerned that patients were not getting a high quality service from the practice.

The areas where the provider must make improvements are:

• Introduce robust processes for reporting, recording, acting on and monitoring all significant events, incidents and near misses.

• Ensure that patient records include all relevant information about patients’ treatment and care in line with professional requirements.

• Ensure that governance arrangements include systems for dealing with all incoming clinical correspondence in a timely way.

• Ensure that prescription requests are acted on in a timely way and can be tracked.

• Ensure that staff understand the practice ‘whistleblowing’ procedure and their duty to escalate safety concerns if necessary.

• Implement a review of clinical sessions provided to ensure that they routinely start at the advertised time.

• Document verbal complaints and investigate and act on these as appropriate.

• Ensure the accountable person understands the legal requirements relating to running a practice, (including CQC registration requirements and notifications) and when to seek additional support.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

The areas where the provider should make improvements are:

• Provide the clinical team with more opportunities to review incidents, unusual cases and complaints and share learning.

• Ensure that reception staff are informed of any delays or absence of clinical staff.

• Improve patient survey findings by involving patients in decisions about their treatment and care.

• Demonstrate to staff that their concerns and ideas are discussed, taken seriously and addressed.

On 2 December 2015 we took urgent enforcement action to suspend Dr Samuel Olatigbe from providing general medical services at Barking Road Medical Centre under Section 31 of the Health and Social Care Act 2008 ("the Act) for a period of three months as a minimum to protect patients. We will inspect the practice again prior to the end of the three month suspension.

I am also placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 March 2016

The practice is rated as inadequate for the care of people with long-term conditions.

The practice was rated as inadequate for being safe, effective, caring and well-led. The practice was rated as requires improvement for responsive care. The issues identified affected all patients including this population group.

• The practice nurse had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice was able to initiate insulin therapy for appropriate patients presenting with diabetes. The practice referred patients to education programmes to encourage effective self-management of the condition.

• Longer appointments and home visits were available when needed.

• Patients with long term conditions had an annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 March 2016

The practice is rated as inadequate for the care of families, children and young people.

• There were systems to identify and follow up patients in this group who were living in disadvantaged circumstances and who were at risk. However information about children at risk was not always shared with relevant statutory agencies or updated in the electronic records in a timely way.

• Immunisation rates were good for standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way.

• Cervical screening uptake was in line with the national average at 70%.

• Appointments were available outside of school hours.

Updated 24 March 2016

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

The practice was rated as inadequate for being safe, effective, caring and well-led. The practice was rated as requires improvement for responsive care. The issues identified affected all patients including this population group.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice participated in multidisciplinary meetings for older patients with complex needs.

• The practice identified carers on the electronic records system and signposted carers to local support groups and other relevant agencies.

• Flu vaccination uptake rates for the over 65s and patients in ‘at risk’ groups was better than the local CCG average. The practice also offered pneumococcal vaccination to eligible patients.

• The patient participation group included a number of older patients and carers.

Updated 24 March 2016

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

The practice was rated as inadequate for being safe, effective, caring and well-led. The practice was rated as requires improvement for responsive care. The issues identified affected all patients including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible
• The practice was open outside of normal working hours and until 8pm every Wednesday.
• The practice offered online services as well as a range of health promotion and screening that reflects the needs for this age group.
• The practice had a younger than average practice population and provided a range of services suitable for this group such as, family planning services including long acting contraceptive implants.

Updated 24 March 2016

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

The practice was rated as inadequate for being safe, effective, caring and well-led. The practice was rated as requires improvement for responsive care. The issues identified affected all patients including this population group.

• Performance for mental health related indicators was similar to the national average. For example, 79% of practice patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan.

• All practice patients diagnosed with dementia had a face-to-face review in the preceding 12 months.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 24 March 2016

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

The practice was rated as inadequate for being safe, effective, caring and well-led. The practice was rated as requires improvement for responsive care. The issues identified affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. 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.