Background to this inspection
Updated
4 May 2018
Dr Alec Yolomoni Kapenda (Abbey Surgery, 60 Abbey Street, Accrington, Lancashire, BB5 1EE) provides primary health care services to 1597 patients in the industrial town of Accrington, East Lancashire under a General Medical Services (GMS) contract with NHS England. The practice is part of the East Lancashire Clinical Commissioning Group (CCG). The practice has experienced a recent growth in its patient list size due to a neighbouring practice closing.
Dr Kapenda is a sole GP provider and works with a small team, this includes a practice nurse who is also the practice manager and a support team of four administration staff. The building is a converted residential property and comprises a reception and waiting area downstairs with a storage room and consulting room. There is a patient toilet and baby change facility on the ground floor. Upstairs is a nurse treatment room, an office and a meeting room.
The practice is open Monday to Friday 8am until 6.30pm. Appointments are available throughout the day, from 9.30am until 5.30pm, apart from Tuesday evenings when extended hours are available until 7.15pm, and Thursday afternoons, when pre-bookable appointments with the GP are not available.
The average life expectancy of the practice population is below the national average but in line with CCG averages for females and below both the local and national averages for males (81 years for females, compared to CCG average of 81 years and national average of 83 years. For males; 76 years compared to CCG average of 77 years and national average of 79 years). The practice patient population contains a higher proportion of younger people when compared to local and national averages. For example, 27% aged under 18 years (CCG average 23% and national average 21%). Conversely, only 10% of the practice’s patient population are aged over 65 years, compared to the CCG average of 18% and national average of 17%. The practice caters for a lower proportion of patients with a long standing health condition (46% compared to the CCG average of 56% and national average of 54%).
Information published by Public Health England rates the level of deprivation within the practice population as two on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). East Lancashire generally has a higher prevalence of Chronic Obstructive Pulmonary Disease (COPD, a disease of the lungs), smoking and smoking related ill-health, cancer, mental health and dementia than national averages.
Outside normal surgery hours, patients are advised to contact the out of hour’s service, offered locally by the provider East Lancashire Medical Services.
Updated
4 May 2018
This practice is rated as inadequate overall. (Previous inspection July 2016 – Good)
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 recently retired and students – Inadequate
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
We carried out an announced comprehensive inspection at Dr Alec Yolomoni Kapenda (Abbey Surgery) on 21 March 2018 as part of our inspection programme.
At this inspection we found:
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The practice had failed to implement clear systems to manage risk meaning safety incidents were more likely to happen. When incidents did happen, the practice was unable to demonstrate how it learned from them or improved processes.
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Care and treatment were not consistently delivered in line with evidence based best practice guidelines.
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Patient consultation records were not appropriately maintained.
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The practice lacked adequate leadership capacity.
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Governance structures were not sufficient to ensure safe and effective care was offered. There were gaps in practice policies and procedures to govern key activities.
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The practice had failed to review the effectiveness and appropriateness of the care it provided.
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Medicines were not managed in a safe way according to guidance. We saw evidence that some patients were prescribed medicine without appropriate medication reviews and health checks being completed.
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Staff treated patients with compassion, kindness, dignity and respect during face to face interactions.
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Patients were universally positive about access to the service and told us they found the appointment system easy to use. They were able to access care when they needed it.
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There were gaps in the practice’s approach to managing and responding to patient complaints.
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There was a lack of managerial oversight of staff training and we found some gaps in the mandatory and role specific training completed by clinicians.
The areas where the provider must make improvements as they are in breach of regulations are:
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Ensure care and treatment is provided in a safe way to patients.
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Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
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Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
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Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of 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 to 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 by adopting our proposal to remove this location or cancel the provider’s registration.
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