Archived: SMA Medical Centre

Updated 4 April 2018

SMA Medical Centre is located in a purpose built building on a busy high road in East London, with good transport links, two disabled parking bays for patients in the staff car park and parking available on surrounding roads. The practice is a part of Waltham Forest Clinical Commissioning Group (CCG).

There are approximately 11,000 patients registered at the practice, 60% did not have English as a first language. The practice has a young population, only 6% of patients were aged over 65 years and 28% were aged under 18. Forty eight percent of patients have a long standing health condition, which is similar to the CCG average of 49% and the practice has a lower rate of unemployment 3% compared to the CCG’s 7%. The practice is rated as two on the deprivation scale, where a rating of one represents the most deprived and 10 represents the least deprived.

The practice has one male principal GP and a mix of nine male and female locum sessional GPs who carry out a total of 39 sessions per week. There is one female practice nurse who carries out nine sessions per week and a male and female health care assistant (HCA), the practice manager undertakes both practice management and healthcare assistant roles within the practice and 10 reception/administration staff members.

The practice is an undergraduate training practice and currently has a fifth and sixth year medical student working with them.

The practice operated under a Personal Medical Services (PMS) contract (a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract).

The practice is open Monday to Friday from 8am, phone lines are also answered at this time and appointment times are as follows:

• Monday 9:30am to 12:30pm and 1:30pm to 8pm

• Tuesday 9:30am to 12:50pm and 4:30pm to 8pm

• Wednesday 9:30am to 12:20pm and 4:30pm to 8pm

• Thursday 9:30am to 12:30pm no appointments in the afternoon

• Friday 9:30am to 12:20pm and 4:30pm to 6:50pm

The locally agreed out of hours provider covers calls made to the practice when it is closed and it is part of the local HUB which provides GP and nurse appointments on weekday evenings and weekends when the practice is closed.

SMA Medical Centre operates regulated activities from one location and is registered with the Care Quality Commission to provide treatment of disorder, disease or injury, diagnostic and screening procedures, surgical procedures, maternity and midwifery services and family planning.

Updated 4 April 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

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

This inspection was an announced comprehensive inspection at SMA Medical Centre on 9 and 11 January 2018 as part of our inspection programme.

At this inspection we found:

• Processes for sharing learning and outcomes from significant events, patient safety alerts and complaints was not effective.

• The practice did not always act on information received from external agencies such as medicine changes, safeguarding information, referral requests and diagnosis updates.

• Patients’ records were not always contemporaneous; we found evidence of missing consultations.

• Exception reporting was above local and national averages.

• Evidence that health care assistants and reception staff were carrying out medicine reviews and annual reviews for patients with long term conditions without being trained to do so.

• Health care assistants administered flu vaccinations without patient specific directions.

• There were ineffective infection control processes.

• Non-clinical staff added new medicines to the patient records without input form a clinician.

• There was no system to ensure that prescriptions were picked up by patients including vulnerable patients and patients experiencing poor mental health.

• The process for obtaining urgent medical attention for patients who did not have an appointment was not effective.

• Appropriate staff recruitment checks were not always carried out prior to employment or routinely check once employed.

• The practice did not have an effective system to manage and mitigate risks to the premises, staff and patients.

• The practice did not always comply with the duty of candour.

• Clinical equipment had not undergone portable appliance testing or calibration to ensure they were fit for purpose, safe and in good working order.

• Data from the national GP patient survey showed patients rated services and care below the Clinical Commissioning Group and national averages.

• There were no systems to identify and address poor performance.

• Over 1% of patients had been identified as a carer.

• The practice had an active patient participation group.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Ensure all premises and equipment used by the service provider is fit for use

The areas where the provider should make improvements are:

• Work to improve patient satisfaction with services provided.

Following the inspection on 9 and 11 January 2018 urgent action was taken to suspend Dr Syed Ali as a registered provider for six months and a caretaking practice was put in place at SMA Medical Centre. Dr Syed Ali subsequently applied to CQC to cancel his registration and this was granted.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice