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 Personal Medical Services (PMS) contract. The practice serves approximately 3,500 patients and is located in a building with a second practice, also owned by Dr Sapre.

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 other practice located in the same building which is also owned by Dr Sapre. The practice clinicians provide approximately 60 GP appointments per day, but this is between the two practices on the site. It was not possible to say how many appointments each week were used by each practice, or to gauge whether access to appointments for patients was fair and equitable.

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 22.6% of patients being aged 65 and over, compared to the England average of 16.7%, and the practice had 10.6% of patients over age 75 years, compared to the England average of 7.6%. There is a small amount of car parking available outside the practice.

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 (Maghull Health Centre) on 2 February 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.

• 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 a vacancy for a permanent GP.

• Some references for staff had not been followed up. Some staff had not received an induction, appraisal or the appropriate employment contracts.

• There was no oxygen available for use on site.

• The practice performed well in terms of QOF (Quality and Outcomes Framework) performance, achieving 97% of points available for 2014-15.

• The practice had introduced a simple system to mark records of those patients who had declined the offer of cytology screening, which made exception reporting for this intervention transparent.

• The practice did not have an efficient system in place to manage the health checks for patients aged 40-74 years. 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 within the same building owned by Dr Sapre, of approximately 4,800 patients.

• Comment cards completed by patients before our inspection indicated that the practice and staff were caring, and treated patients with dignity and respect.

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

• The provider had failed to deal effectively with an IT issue which had been ongoing for six months.

• The division of responsibilities between leaders was unclear. Staff were unsure of how patient registers were produced. The carers register was inaccurate.

• The registration of the practice with the Care Quality Commission (CQC) did not reflect the way in which the practice was being run. This had not been addressed.

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

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

• 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, written, or registered anonymously.

• Keep sufficient records in relation to staff recruitment.

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

• Ensure the registration of the practice with the Care Quality Commission (CQC) accurately reflects the way in which the practice is being run.

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 patient deaths (death audit) to ensure patient’s wishes around final place of care are are observed.

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

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.

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. However, feedback on this was mixed; some patients we spoke with told us when they had requested this, they had been directed to the walk in centre at Litherland. Other patients told us that the nurse had given appointments as and when requested to ensure children received all vaccinations and immunisations. The policy to see any unwell child on the day was not displayed in the reception and waiting area of the practice. The practice has access to Food Vouchers for use at a local food bank, 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 practice had a slightly higher than average population of people who were older; for example 22.6% of patients aged over 65 compared to the England average of 16.7%, and 10.6% of patients aged over 75, compared to the England average of 7.6%. However, we found there were no care plans in place for patients aged 75 and over. Only those patients receiving shared care in the community had a care plan in place, for example those patients on the virtual ward run by the district matron and nursing team.

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.

At the time of inspection, the practice had completed 273 health checks on patients aged 40-74 years. However it was not clear 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. Work to forecast how many patients from the practice should receive health checks in each month was not available so it was difficult to say when all patients from the practice would have received this health check. The practice could not show us an accurate carers register. The one produced had three patients names on which indicated that markers on patient records were missing or incorrect.

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. We could see from work recently completed that the majority of patients with a diagnosis of dementia had received a face to face health review recently. The practice had a mental health register and care plans were in place for these patients. Although clinicians had all received recent training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, one GP had difficulty explaining the provisions of this legislation and on how it could impact on their daily work.

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.

A locum GP who had been working for the practice for a considerable time said registers were in place for vulnerable patients. However, there was no appointed lead for the care of patients with learning difficulties and clinicians could not say how many of health checks for these patients had been completed.  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. However this lead did not review frequent child attenders at A&E departments to identify any potential concerns.