Archived: Dr SS Sapre and Partners

Updated 11 February 2016

Dr S S Sapre and Partners is a practice located in Bootle, Liverpool and falls within the South Sefton Clinical Commissioning Group. The practice is located in an area measured as one of the most socially deprived in the country. Male life expectancy is 77 years, compared to the England average of 79 years. Female life expectancy is 82 years, compared with an England average of 83 years. Almost 60% of patients registered with the practice have a long-standing health condition. Just over 40% of patients are in paid work or full time education. Over 19% of patients are classed as unemployed.

The practice is located in a modern facility suited to delivery of GP services. The patient register is made up of approximately 2,400 patients. The practice has one treatment room and three consulting rooms, all located on the ground floor of the practice. The upper floor is given over to administrative offices, a meeting room and staff area. The practice is fully accessible but does not have automated entrance doors.

The practice team is made up of three partners, two male GP’s and one non-clinical manager. The practice retains the services of a female locum GP who delivers one clinical session each week. The combined hours of all the GPs gives the equivalent of just over one full time GP. A practice nurse supports the clinical team, working three days a week. There is an assistant practice manager who works part time at the practice, supported by the administrative team of six staff. The practice had recently appointed a business advisor who was helping to update policies, procedures and other support functions within the practice.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 9am to 11.30am every morning and 3.30pm to 6pm each afternoon. Extended hours surgeries are offered on Thursday each week between 6.30pm and 8.00pm. The practice is not open at weekends.

If patients require the services of a GP outside of the practice opening hours, they are directed by a phone message, to call NHS 111, who with triage their call and refer onwards to the appointed out of hours provider, Go to Doc.

The practice presented itself as a partnership. The Responsible Individual had failed to submit validated applications to register the practice as a partnership, and appoint a Registered Manager.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S S Sapre & Partners on 26 November 2015. Overall the practice is rated as requires improvement. Specifically, we found the practice to require improvement for providing safe, effective and well led services. The practice is rated as good for providing caring and responsive services.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There were systems in place to mitigate safety risks including analysing significant events and safeguarding however they were not consistently applied.

• The premises were clean and tidy. Systems were in place to ensure medication including vaccines were appropriately stored and in date. Emergency medicines were readily available as was a defibrillator but the practice did not have oxygen available for use in an emergency.

• The recruitment procedure was not consistently followed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. However the screening of patients at risk of dementia fell below the levels expected in a practice signed up to provide the enhanced service for dementia. The practice could not evidence care plans for these patients and could not produce minutes of multi-disciplinary team meetings for the care of palliative patients.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Although there was a clear leadership structure and staff felt supported by management, not all of the areas highlighted as requiring improvement had been focused on. The practice did not have a registered manager in place and could not demonstrate that this was being effectively dealt with. The lead GP could not demonstrate that the one day he spent at the practice was sufficient to allow full direction and control of the regulated activities.

There were areas were the provider must make improvements. The provider must:

• Ensure all recruitment checks as required by Schedule 3 are completed and copies of these checks are held in recruitment records.

• Ensure all significant events are reported, recorded and follow the written procedure for handling significant events.

• Apply the same level of scrutiny to complaints about clinical care, as would be applied to significant events ensuring lessons learnt are discussed and shared.

• Have oxygen in place for use in an emergency.

• Ensure a hearing loop is available for any patients who may need this.

• Carry out regular fire drills and keep records of these.

• Conduct a risk assessment on the need for Legionella checks and if required organise annual Legionella testing.

• Provide appropriate levels of screening for conditions, using appropriate tools.

• Ensure MDT meetings are held; where these are by telephone, keep appropriate records of these and minutes of all meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

The practice is rated as requires improvement of the care of patients with long term conditions. There were aspects of the safe, effective and well-led domains that impacted on all population groups. In three of the five indicators of performance for care of patient with diabetes, the practice was performing below the national average. The practice had improved in two areas. The practice had a higher rate of unplanned hospital admissions than the national average, but there was no plan in place to help reduce this. The practice told us they held palliative care meetings with the multi-disciplinary team but were unable to evidence this.

Updated 11 February 2016

The practice is rated as requires improvement for the care and treatment of families, children and young people. There were aspects of the safe, effective and well-led domains that impacted on all population groups.The uptake of cervical screening at the practice had improved slightly but was still below the national average. Childhood immunisation for children under 12 months of age was below the national average, although there were better rates of child immunisation in two year olds and pre-school children.  Appointments were available outside of school hours and the premises were suitable for children and babies. GPs responded to requests for submission of safeguarding reports for safeguarding review boards.

Updated 11 February 2016

The practice is rated as requires improvement for the care and treatment of older people. There were aspects of the safe, effective and well-led domains that impacted on all population groups.

The practice had not carried out the work required to identify those patients at risk of dementia. Where patients had been identified, only two had received an annual health check. The practice were unable to show us care plans for these patients. The rate of flu immunisation take-up by this patient group was 65.5%, compared to the national average of 73.24%. The provider could not show plans in place to increase this, which would help older patients to maintain good health and well-being.

Updated 11 February 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). There were aspects of the safe, effective and well-led domains that impacted on all population groups. 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 try to improve accessibility. The practice leaders explained that patients could access a sister practice approximately five miles away. Travel to that practice by public transport would be difficult for patients without a car and staff were unable to say how many times patients had accessed appointments this way.

The practice had started to offer online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 11 February 2016

The practice is rated as requires improvement for the care of patients experiencing poor mental health, including those with dementia. There were aspects of the safe, effective and well-led domains that impacted on all population groups.

The practice had care plans in place for those patients diagnosed with a mental health condition, but did not have care plans in place for all patients diagnosed with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Those patients diagnosed with a mental health problem were offered longer appointments to ensure their needs were met.

Updated 11 February 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. There were aspects of the safe, effective and well-led domains that impacted on all population groups.

The practice did not have a hearing loop available to assist communication with patients who were deaf or had impaired hearing.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It offered longer appointments for people with a learning disability. It had told 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.