Background to this inspection
Updated
20 August 2019
The Staunton Group Practice (the practice) is based at Morum House Medical Centre, 3-5 Bounds Green Road, Wood Green, London N22 8HE. It shares the premises with other healthcare services.
The practice’s CQC registration relates to the following regulated activities - Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures, and Treatment of disease, disorder or injury. The practice’s CQC registration is for a partnership of four GPs. Shortly before our inspection in May 2018, we received notice that two of the GPs would be leaving the partnership. One would remain working in the service as a salaried GP; the other would be leaving it entirely. However, due to the concerns we identified at the May 2018 inspection we put the processes to make changes to the registration on hold.
The practice is part of the NHS Haringey Clinical Commissioning Group (CCG) which is made up of 51 general practices. The practice provided NHS primary medical services through a General Medical Services (GMS) contract to approximately 14,700 patients. Following our inspection in May 2018, we suspended the practice’s CQC registration, having identified significant concerns, which put patients’ safety at risk. The period of suspension was from 9 May 2018 to 23 October 2018. Service commissioners put a caretaker practice in place for the duration of the suspension. The caretaker practice was responsible for the service at the date of our inspection. However, some of the practice partners and salaried GPs continued to work in the service as locums, to provide some continuity of care for patients.
The practice partnership is made up of four GPs. It employed three salaried GPs. One of the salaried GPs was on extended leave. The practice used a number of regular locum GPs. There was a locum nurse practitioner, three locum nurses and a healthcare assistant. The new practice manager had been appointed in July 2018. There were 16 other staff in the administrative / reception team. The practice employed three caretakers / cleaners.
The service operates between 8.00 am and 7.00 pm, Monday to Friday, which include a 30 minute “extended hours” period each evening. It closed at weekends. Phones are operated between 8.00 am and 6.30 pm. Routine appointments are 10 minutes long and may be booked up to four weeks in advance. Double-length appointments can be booked, if needed. GPs also provide daily telephone appointments and carry out home visits to patients who are housebound or are too ill to visit the practice.
The CCG provides an extended hours service at three “hubs” across the borough, which operate between 6.30 pm and 8.30 pm, Monday to Friday and between 8.00 am and 8.00 pm on Saturdays and Sundays. All patients registered with Haringey practices may book appointments with the extended hours service.
The practice opted out of providing an out of hours service. Patients calling the practice when it is closed are connected with the local out of hours service provider.
Updated
20 August 2019
This practice is rated as Inadequate. (Previous rating August 2017 and May 2018 – Inadequate)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Inadequate
Are services responsive? – Inadequate
Are services well-led? - Inadequate
We carried out an announced comprehensive inspection at the Staunton Group Practice on 2 October 2018. Following a previous comprehensive inspection in August 2017, the practice had been placed in special measures as we had noted significant safety concerns. We carried out a focussed inspection in November 2017 and a further comprehensive inspection in May 2018, at the end of the special measures period, when we found there had been insufficient improvement and identified more concerns which put patients’ safety at risk. Accordingly, we imposed an urgent suspension of the provider’s registration, with effect from 9 May 2018 to 23 October 2018. During that period, a caretaker practice was put in place by NHSE (London) commissioners to provide the service. The reports of the previous inspections can be found by selecting the ‘reports’ link for Staunton Group Practice on our website at www.cqc.org.uk/location/1-573879781.
At this inspection on 2 October 2018 we found:
- Although some action had been taken since our previous inspections, it was insufficient to address all the safety and governance concerns noted, or to improve the effectiveness of the service. Changes made had been implemented by the caretaker practice with minimal involvement by the Staunton partners. We were not assured the practice had effective systems in place to keep patients safe and to protect them from risk of abuse or harm.
- The practice could not provide evidence that health and safety risk assessments had been carried out.
- No protocol had been established to manage patients’ records transferred from other practices, to ensure complete medical histories were maintained.
- Clinical audits carried out by the caretaker practice had identified significant issues relating to prescribing practice.
- There was no evidence that clinical audit by the practice was driving improvement. For example, an audit carried out in August 2018 had identified the need for further staff training, but this was not programmed before February 2019.
- The system for identifying and managing significant events and for handling patients’ complaints remained ineffective. Staff could not access records for us to review.
- The practice could not provide evidence that all staff had received training or appraisals.
- The practice’s results from the national GP Patient survey relating to the service being caring and responsive were in some cases significantly below local and national averages. The practice had taken insufficient action to address the concerns.
We again found the practice had made insufficient improvements and that patients would remain at significant risk should the suspension lapse and the practice’s registration be reinstated. Accordingly, we re-imposed the urgent suspension of its registration, under s31 of the Health and Social Care Act 2008 (the Act), from 24 October 2018 until 24 April 2019, intending to escalate our enforcement action to cancel the practice’s CQC registration.
We subsequently established that the practice continued to provide regulated activities whilst the registration was suspended. We therefore took urgent action to cancel the registration, under s30 of the Act, with an order being made by Highbury Corner Magistrates on 6 November 2018. The provider appealed against that order at a hearing before the First Tier Tribunal (FTT) in January 2019. The FTT confirmed the decision to cancel the practice’s registration on an urgent basis and dismissed the appeal. The practice then applied for permission to appeal to the Upper Tribunal against the FTT’s decision. That application was refused by the Upper Tribunal on 18 July 2019. Accordingly, we have now proceeded to cancel the practice’s registration.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care