Archived: Dr SS Sapre and Partners

Updated 31 March 2016

Dr S S Sapre and Partners (the practice) is located in Maghull, Merseyside and falls within South Sefton Clinical Commissioning Group. All services for this practice are delivered under a General Medical Services (GMS) contract. The practice serves approximately 1,300 patients and is located in a building with a second practice, also owned by Dr Sapre. We did not inspect this second practice as it is registered as a separate location.

The practice clinical team consists of two GP partners (male) and one none clinical partner, supported by two long term locum GPs, (one male and one female). A further (male) locum GP is available on an ad hoc basis for additional cover as and when required. These GPs provide services to both practices in the building. The service has a practice nurse who works four days a week at the practice, although this time is split between the two surgeries on this site. The clinical team is supported by a practice manager, a practice administrator and seven administrative and reception staff. All staff support the second practice located in the same building which is also owned by Dr Sapre.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 9am to 11.30am every morning and from 3.30pm to 6pm daily. Extended surgery hours are offered at the practice on Tuesday of each week, from 6.30pm to 8pm.

The practice is in a facility shared with Maghull Community Health Centre. Community midwives, health visitors and nurses are based in this building. The practice has a slightly higher than average population of older patients, with 9.7% of the practice register being made up of patients over 75 years of age, compared to the England average of 7.6%. Patients over 65 years of age make up 19.9% of the patient register, compared to the England average of 16.7%.

Throughout our inspection the practice leaders presented the practice as a partnership. This does not reflect the registration of the practice with CQC. Dr Sapre has stated that he will apply to update his registration with CQC and ensure that all partners are accurately registered.

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S S Sapre & Partners on 13 January 2016. Overall the practice is rated as requires improvement.

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

• The practice had a system in place for the management of Medicines and Healthcare Products Regulatory Agency (MHRA) alerts. However, there was a delay of up to one week before these were shared with clinicians. These alerts were not held for future reference.

• Arrangements for managing medicines kept patients safe.

• The practice had completed a number of clinical audits which evidenced safe prescribing.

• Assurances given by the provider in response to the findings of an infection control audit at the practice had not been acted upon.

• At the time of inspection, the practice was carrying vacancies for a health care assistant and a permanent GP.

• Staff recruitment checks were incomplete; a number of staff had not received an induction and some staff had not received the appropriate employment contracts.

• There was no oxygen available for use on site. The practice manager pointed to the availability of oxygen at neighbouring facilities but could not confirm or show there was an agreement in place for shared use of oxygen.

• No care plans were in place for patients aged over 75 who may be more vulnerable to ill health .

• Dementia screening was being done opportunistically. There was no plan in place to show how all patients identified as being at risk of dementia, would be effectively screened in a timely manner.

• The practice did not have an efficient system in place to manage the health checks for patients aged 40-74 years.

• Complaints submitted to the NHS Choices website were not followed up and acted upon. All complaints were not recorded.

• The registration of the practice with the Care Quality Commission did not reflect the way in which the practice was run; the lead GP was present at the practice for two clinical sessions each week. Evidence from our inspection showed that this was insufficient to maintain overall direction and control of the practice.

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

• Ensure care plans are in place for patients aged 75 and over.

• Ensure there is access to oxygen for use in medical emergencies.

• Improve systems in place for the management and sharing of MHRA alerts.

• Effectively address points raised in the infection control audit by Liverpool Community Health.

• Record, investigate and respond to all complaints made about the practice, whether they are verbal or written, or registered on the NHS Choices website.

• Keep sufficient records in relation to staff recruitment.

• Keep sufficient records in relation to the management of regulated activities.

• Address issues around the registration of the practice.

There were areas were the provider SHOULD make improvements. The provider should:

• Provide a hearing loop facility for those patients with impaired or reduced hearing.

• Review all patient deaths (death audit) to ensure patients wishes around final place of care are observed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 31 March 2016

The practice is rated as requires improvement for the care of people with long term conditions. The ratings of requires improvement in the domains of safe, effective and well-led impacted on all population groups.

The nurse had a lead role in chronic disease management. Longer appointments were available to those that needed them and home visits were available for housebound patients. The practice recognised that they needed a health care assistant to support the work of the nurse.

Updated 31 March 2016

The practice is rated as requires improvement for the care and treatment of families, children and young people. The ratings of requires improvement in the domains of safe, effective and well-led impacted on all population groups.

The practice had a policy to see any child under five on the day, when this was required. The practice has access to Food Vouchers for use at a local foodbank, for those patients deemed to be classed as in urgent need.

Updated 31 March 2016

The practice is rated as requires improvement for the care of older people. The ratings of requires improvement in the domains of safe, effective and well-led impacted on all population groups.

The older patient population was slightly higher at the practice, than that of other practices in England. The practice offered pre-bookable appointments up to seven days in advance and appointments could be booked on-line. We were told that the ordering of repeat prescriptions on-line had been problematic, and the practice had not effectively addressed this issue. There were no care plans in place for patients aged over 75 who may have required more support.

Updated 31 March 2016

The practice is rated as requires improvement for the care and treatment of working age people, including those recently retired and students. The ratings of requires improvement in the domains of safe, effective and well-led impacted on all population groups.

The practice did not have an efficient system in place to manage the health checks for patients aged 40-74 years. At the time of inspection, the practice had completed 273 health checks on patients aged 40-74 years but could not say whether these were patients of the practice we were inspecting, or of a practice based in the same building which is also owned by Dr Sapre & Partners. The practice gave the figure of 273 health checks completed on patients between 40-74 years, out of a total patient list for the two practices of approximately 4,800 patients.

Immunisation rates were high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice took part in a number of screening programmes; we saw that the rate of screening for bowel cancer at the practice was slightly higher than the local CCG and England average. The numbers of women between the ages of 50 and 70 who had been screened for breast cancer in the last three years was in line with rates for the local CCG and England average.

Updated 31 March 2016

The practice is rated as requires improvement for the care and treatment of people experiencing poor mental health (including people with dementia). The ratings of requires improvement in the domains of safe, effective and well-led impacted on all population groups.

The practice was screening patients at risk of dementia on an opportunistic basis. There was no plan in place that showed how all patients would have access to this screening in a timely manner. The practice had a mental health register and care plans were in place for these patients.

Updated 31 March 2016

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

The locum GP at the practice (who had been working for the practice for a considerable time) said registers were in place for vulnerable patients. The practice had a lead for safeguarding of children and vulnerable adults and all staff knew who this was. Safeguarding registers were kept by the practice.