Background to this inspection
Updated
5 September 2018
Dr Anzeema Nathu, Pennygate Health Centre, is located in the South Lincolnshire town of Spalding.
The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.
Dr Nathu is registered with CQC to provide the regulated activities of: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures; treatment of disease, disorder or injury;
from a single location at 210 Pennygate, Spalding PE11 1LT
The practice has one principal GP (female), two locum GPs (male), one practice nurse, two members of staff who have dual roles as dispensers / administrators. There are two receptionists and a cleaner who is employed directly by the practice.
The practice list size is 3293.
The practice is situated amongst the 20% of the most deprived areas in England. There is clear evidence of deprivation, particularly associated with eastern European migrant workers and their families. 18% of the practice patients are from this group. The practice had a higher than average number of younger patients. Both male and female life expectancy are comparable to the national average.
The practice was able to provide dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy premises.
All patient accessible areas were located on the ground floor.
The practice lies within the NHS South Lincolnshire Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.
The practice has opted out of the requirement to provide GP consultations when the surgery is closed. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust.
Updated
5 September 2018
We carried out a short notice, announced comprehensive inspection at Dr Azmeena Nathu, Pennygate Health Centre on 18 June 2018. This inspection was to see if the practice had made sufficient improvement for it to come out of Special Measures. This practice is rated as inadequate overall.
We carried out an announced comprehensive inspection at Pennygate Health Centre on 19 October 2017.
Breaches of legal requirements were found in relation to the governance arrangements within the practice.
We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in the warning notices by 12 January 2018.
The practice was placed into Special Measures on 28 December 2017.
At that inspection we found:
- Some systems and process were not effective in keeping patients safe. These concerned patient safety alerts, safeguarding, medicines reviews, monitoring patients on high risk medicines, cold chain monitoring, recruitment and retention of staff and NICE guidance.
- The practice could not demonstrate role specific training for staff.
- There was no effective system in place to monitor training and therefore we could not be assured that staff had the skills, knowledge and experience to deliver effective care and treatment.
- There was no evidence to show that staff were aware of current, evidence based guidance.
- Data from the 2017 national GP patient survey showed that patients rated the practice lower than others for most aspects of care.
- There was limited evidence that learning from complaints was shared with staff
- Feedback from the 2017 national GP patient survey showed that in 21 of the 23 areas surveyed results were below CCG and national averages.
- There was a lack of leadership and governance relating to the overall management of the practice.
- The practice was unable to demonstrate strong leadership in respect of safety
- There was a limited governance framework to support the delivery of good quality care for example in respect of safeguarding, patient safety alerts, medicine reviews the monitoring of patient on high risk medicines, recruitment and retention of staff, NICE guidance, training, learning form significant events and minutes of meetings.
- The arrangements for managing risks were not effective
- The practice could not demonstrate that they proactively sought feedback from patients and staff.
- There was little innovation or service development and minimal evidence of learning and reflective practice.
We undertook an unannounced focussed inspection on 19 April 2018 and a further announced inspection on 25 April 2018 to check that they now met the legal requirements. At the inspection on 19 and 25 April we found that not all the requirements of the warning notice had been met.
At this inspection carried out on 18 June 2018 we found that some improvements had been made. The key questions are now rated as:
Are services safe? – Inadequate
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Inadequate
At this inspection we found:
- Generally, the practice had clear systems to manage risk so that safety incidents were less likely to happen. However, there was no log kept of dispensary ‘near misses’.Following the inspection were provided with evidence that a ‘near miss’ log had been commenced.
- When incidents did happen, the practice learned from them and improved their processes.
- Records of consultations with patients were not always updated in a timely manner which put patients at risk.
- Clinicians were not always following evidenced based guidelines in respect of the assessment of unwell children, and the prescribing of antibiotics to children.This was addressed during the course of the inspection.
- Dispensary standard operating procedures had not always been signed by staff following update.
- Although the appointment system was easy to use and patients could access care when they needed it, access to extended hours appointments was limited. Patients were not able to book appointments directly through the reception staff and had to be referred to the GP before an appointment could be made.
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On the day of the inspection we were not provided with evidence of clinical audit being used as an aid to measure and improve performance. Following the inspection, we were provided with details of several such audits.
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Staff involved and treated patients with compassion, kindness, dignity and respect.
- There was a focus on equality and diversity and a culture that supported potentially vulnerable groups such as migrant workers and their families.
- The process for dealing with and responding to complaints was not embedded.
The areas where the provider must make improvements as they are in breach of regulations are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
- Review and embed the complaints handling process.Following the inspection, we were informed that the complaints process had been reviewed.
- Review the process for updating and managing standard operating procedures to ensure they reflect current practice and to ensure staff have read and signed the most up-to-date version.
- Review monitoring and undertake an audit of prescribing, in particular antibiotic prescribing, to ensure high quality, safe, evidence-based practice.
- Review the process and provide clarity for booking extended hours appointments.
This service was placed in special measures on 28 December 2018. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe and well-led services. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by cancelling the provider’s registration.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice