Archived: Dr Thomas Barnwell Also known as Little Venice Medical Centre

Updated 2 March 2017

Little Venice Medical Centre provides GP primary medical services to approximately 4,796 patients living in the London Borough of Westminster. The borough of Westminster has a diverse population being home to some of the wealthiest people in Britain alongside a high proportion of people living in poverty. A large proportion of the local population speak English as a second language.

At the time of our inspection in December 2015 the practice team was made up of one male GP, three female locum GPs, two agency practice nurses, a practice manager, Health Care Assistant and seven administrative staff. The majority of staff working at the practice at this time had temporary contracts of employment. The provider informed us during our inspection of negotiations which were underway for an imminent take-over of the practice by another provider.

At the time of our inspection in September 2016 the practice team was made up of one male GP, two new female GP locums, two new agency nurses, a Health Care Assistant and seven administrative staff, two of which were new employees. We saw evidence of new administrative staff having permanent contracts in place. At this inspection the provider again informed us of negotiations which were underway for an imminent take-over of the practice by another provider.

The practice is open between 9:00am-1:00pm and 2:00pm-6:30pm on Monday; 9:00am-1:00pm and 2:00pm-7:00pm Tuesday to Friday and 10:00am-12:45pm on Saturdays. Appointments are from 9:00am-12:30pm and 2:20pm-5:40pm on Mondays; 9:00am-12:30pm and 2:00pm-7:00pm on Tuesdays; 10:30am-12:40pm and 4:30pm-7:00pm on Wednesdays; 9:00am-12:30pm and 2:30pm-7:00pm on Thursdays; 10:30am-12:40pm and 4:30pm-7:00pm on Fridays; and 10:00am-12:30pm on Saturdays. Home visits are provided for patients who are housebound or too ill to visit the practice.

The practice has a General Medical Services (GMS) contract (GMS is one of the three contracting routes that have been available to enable the commissioning of primary medical services).The practice refers patients to the London Central and West Out of Hours and the NHS ‘111’ service for healthcare advice during out of hours.

The practice is registered with the Care Quality Commission to provide the regulated activities of maternity and midwifery services; family planning; surgical procedures; diagnostic and screening procedures; treatment of disease, disorder or injury.

The practice provides a range of services including maternity care, childhood immunisations, chronic disease management and travel immunisations.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Little Venice Medical Centre on 19 September 2016. Overall the practice is rated as Inadequate.

The provider had been previously inspected on 1 December 2015 and was rated as ‘Requires Improvement’ for Safe and Effective; ‘Good’ for Caring and Responsive; and ‘Inadequate’ for Well Led. This inspection was planned to check the action taken in response to findings of the inspection undertaken on 1 December 2015 to consider whether sufficient improvements had been made. The lead GP had decided not to attend the inspection on 19 September 2016 and was therefore asked to provide comments and evidence to support the inspection via email following our visit.

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

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

• Staff understood and fulfilled their responsibilities to raise concerns, however not all staff were clear about reporting incidents and there was no evidence of learning shared with staff to improve safety within the practice.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement initiatives.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• The practice had a number of policies and procedures to govern activity, but the majority were overdue a review.

• The practice had not proactively sought feedback from patients and the patient participation group was not active.

The areas where the provider must make improvements are:

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

• Develop effective systems and processes to ensure safe care and treatment including reporting and learning from significant events; consistent monitoring of the temperature of the medicines fridge and implementation of infection control procedures including infection control audit, correct use and disposal of sharps boxes and cleaning of clinical curtains.

• Undertake a risk assessment for the omission of glucagon and rectal diazepam from the emergency medicines kit.

• Ensure all staff have access to essential information and training including safeguarding and basic life support to enable them to carry out the duties they are employed to perform. Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.

• Ensure Patient Group Directions are signed by the appropriate persons to allow practice nurses to administer medicines in line with legislation.

• Ensure appropriate recruitment checks are documented for all locum GPs and agency nurses working at the practice in line with regulations.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. Carry out clinical audits including re-audits to ensure improvements have been achieved.Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.

• Seek and act on feedback from patients.

In addition the provider should:

• Consider improving communication with patients who have a hearing impairment.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate 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 varying the terms of their registration within six months if they do not improve.

The service 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 service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 March 2017

The practice is rated as inadequate for people with long term conditions. The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• It was unclear which staff had lead roles in chronic disease management.

• We were not assured the system in place for the recall of patients with long term conditions was effective. Our previous inspection found not all of these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met. We were unable to assess care plans and reviews for patients at this inspection due to the lead GP not attending the inspection.

• Performance for diabetes related indicators were in line with the national averages. The percentage of patients with diabetes, on the register, who received an influenza immunisation, was 92% in comparison to the national average of 94%; and the percentage of patients with diabetes, on the register, who received a foot examination, was above the national average at 96% in comparison with 88%.

• Longer appointments and home visits were available when needed.

Updated 2 March 2017

The practice is rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients 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.

• Immunisation rates were comparable to the CCG and national averages for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme was 64%, which was above the CCG average of 57% but below the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 2 March 2017

The practice is rated as inadequate for the care of older people. The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

Updated 2 March 2017

The practice is rated as inadequate for the care of working age people. The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The issues identified as requiring improvement overall 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, flexible and offered continuity of care.

• The practice offered extended hours on Saturdays from 9:30am-12:45pm for working patients who could not attend during normal opening hours.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 2 March 2017

The practice is rated as inadequate for the care of people experiencing poor mental health. The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• Performance for mental health related indicators was above the national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan was 95% and the national average is 88%. The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 95% which was above the national average of 84%. We were unable to assess the provision of mental health care for patients in further detail due to the lead GP not attending this inspection.

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

• The practice carried out advance care planning for patients with dementia.

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

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 2 March 2017

The practice is rated as inadequate for the care of vulnerable people. The provider was rated as inadequate for safe and well-led and requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

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

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

• The practice regularly 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 however not all non-clinical staff had received formal training in safeguarding.