Archived: Sai Medical Centre

Updated 23 January 2017

The Sai Medical Centre is located in Tilbury, Essex. There is limited parking at the rear of the practice and it is situated close to local bus routes and a main line train station.

The practice has a general medical services (GMS) contract with the NHS. There are approximately 5600 patients registered at the practice. The practice took on the patients from another practice nearby which closed in May 2015 and this has doubled their patient population.

The practice is registered with the Care Quality Commission as a partnership and there are two GP partners. There is one male and one female GPs. There is one regular female locum GP used by the practice. The GPs are supported by a practice nurse.

There is a practice manager, a senior receptionist and two receptionists. They all have shared roles including administrative functions.

The practice is open from Monday to Friday between the hours of 8am and 6.30pm and 7.30pm on a Tuesday. The practice remains open at lunchtime throughout the week for the collection of prescriptions and for making appointments.

The GP surgeries are available on Monday to Friday mornings between 9am and 12 noon and each afternoon between 4pm and 5.50pm with some minor variations. There is a late evening surgery on a Tuesday until 7.30pm. Patients from the practice can access weekend appointments with a GP or nurse through a local arrangement that is shared between different practices covering a rota. These appointments are pre-bookable only. These are available both Saturday and Sundays during the hours of 9am to 12 noon.

When the practice is closed primary medical services can be obtained from the out of hour’s provider, Integrated Care 24 via the non-emergency 111 service.

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Sai Medical Centre on 14 January 2016. The practice was rated as inadequate overall. Specifically they were rated as requires improvement for safe and responsive, and inadequate for effective, caring and well-led. The practice was placed in special measures for a period of six months.

In particular, on 14 January 2016, we found the following areas of concern:

• Where complaints or significant incidents were raised, an investigation and analysis were undertaken but not shared with staff in a timely manner.
• Risks to staff and patients were not well assessed including the management of medicines and patient safety alerts.
• Recruitment documentation was being inconsistently sought prior to being employed at the practice and written induction programmes were not being undertaken.
• Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• The practice had not routinely sought feedback from patients.
• The partners at the practice were not aware of some of the issues affecting the practice and needed to provide more visible leadership.

As a result of our findings at this inspection we took enforcement action against the provider and issued them with a warning notice for improvement.

Following the inspection on 14 January 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations and the warning notices that we issued.

We carried out a further comprehensive inspection at Sai Medical Centre on 11 October 2016 to check whether the practice had made the required improvements. We found that all of the improvements had been made.

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

• Staff were aware of their responsibilities regarding safety, and the reporting and recording of significant events. There were policies and procedures in place to support this. Any learning identified was shared with staff.
• The practice assessed risks to patients and staff and there were systems in place to manage them.
• Where patients were prescribed medicines requiring monitoring we found that the system in place was effective. There was a system in place for clinical staff to receive, action and disseminate patient and medicine safety alerts.
• The practice had a defibrillator and oxygen. There was a system in place to check that equipment was in working order and medicines had not expired.
• There was no risk assessment to assess whether the practice held stock of appropriate medicines on the premises in the event of a medical emergency.
• A risk assessment for the Control of Substances Hazardous to Health (COSHH) had been completed and details of chemicals used were kept in a folder accessible to staff.
• We found although no new staff had been employed since our previous inspection, the provider had an effective recruitment procedure in place.
• The practice business continuity plan enabled staff to take action in the event of a loss of utilities or premises.
• Staff had received training in their computer system to be able to accurately code patients’ diagnoses and other relevant information.
• We saw evidence of audits that demonstrated improvements in patient outcomes, and there was a timetabled audit scheduled for the year.
• Views of patients from comments card and those we spoke with during the inspection were mostly positive. The majority of patients said they were treated with dignity and respect, and they were involved in their care and decisions about their treatment.
• The practice had discovered that the GP survey was using two sources of data for their practice and with the support of the local CCG was trying to resolve this as it affected their GP survey scores. The PPG had undertaken an independent survey using the questions from the GP survey to gain a more accurate picture and had seen positive results.
• Complaints were investigated appropriately and in a timely manner and learning was shared with all staff.
• The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from CQC, the local Clinical Commissioning group (CCG) and its own staff.
• The meeting structure had been reviewed so that all staff were aware of the performance of the practice and any issues affecting the patients. Minutes were available for staff to view.
• There was now a strong management and staff team structure. The practice manager and two partners worked as a team to ensure that the performance of the practice was maintained and improved.
• Staff told us they felt supported and involved in the development of the practice.
• The culture of the practice was friendly, open and honest. It was evident that the practice complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Complete a risk assessment of the emergency medicines that need to be kept onsite.
• Ensure that the fridge thermometer is reset according to manufacturer’s guidance.
• Ensure that issues identified from infection control audits are clearly documented and actioned in a timely manner.
• Improve the identification of patients who are carers.
• Review their exception reporting to ensure it is accurate.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 2017

The practice is rated as good for the care of people with long-term conditions.

• Both GPs and the practice nurse took the lead in reviews and management of patients with long term conditions. The practice nurse was encouraged to carry out checks on an opportunistic basis to avoid patients having to re-attend another day.
• The practice performance for diabetes indicators was in line with and for some indicators higher than the CCG and national averages. For example, the number of patients who had received a foot examination and risk classification was higher than the CCG and national average.
• If patients required a longer appointment due to complex needs or multiple medical conditions this was available. Housebound patients could also request a home visit.

Updated 23 January 2017

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were lower or in line with CCG and national averages for most standard childhood immunisations.
• Due to opening hours appointments were available outside of school hours.
• The premises were suitable for children and babies.
• Young people attended the patient participation group meetings to put their viewpoint across.
• There was a children’s’ sit and wait service if all appointments were booked.

Updated 23 January 2017

The practice is rated as good for the care of older people.

• All older patients had a named GP.
• Those patients unable to come to the practice, for example, due to being housebound, were able to access home visits from the GP.
• The practice proactively looked at their register of older people to assess which patients would always require a home visit.
• The practice saw patients opportunistically for checks and vaccinations to avoid the patient having to re-attend another day.
• Other professionals told us that the practice have positive working relationships with the care homes and community matrons.

Updated 23 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered extended hours on a Tuesday evening.
• Prescriptions were sent electronically to the patients preferred chemist.
• The practice offered a full range of health promotion and screening that reflects the needs for this age group.
• The percentage of women aged 25-64 who have had a cervical screening test in the past 5 years was lower than the CCG and national average.

Updated 23 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national average.
• The practice performance for mental health indicators was lower than the CCG and national average. This was due to the very low numbers of patients affecting the data.
• For some mental health indicators the practice exception reporting was high compared to the local and national averages (The QOF includes the concept of 'exception reporting' to ensure that practices are not penalised where, for example, patients do not attend for review).
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• There was information in the waiting area to sign post patients experiencing poor mental health to various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice supported patients through the transition from adolescent to adult services.

Updated 23 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice was aware of those patients on their register who lived in vulnerable circumstances.
• If patients required a longer appointment due to complex needs or multiple medical conditions this was available.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• There were established systems and processes in place to ensure patient safety and enable staff to identify and take appropriate action to safeguard patients from abuse. Staff knew how to recognise signs of abuse in vulnerable adults and children.
• The practice had identified 43 patients as carers (0.8% of the practice list).