Archived: Balham Hill Medical Practice

Updated 2 February 2017

The practice operates from 143-145, Balham Hill, London, SW12 9DL in the London Borough of Wandsworth. The practice is on the ground floor of a premises that has been converted from two commercial properties.

The practice has approximately 1,500 patients. The surgery is based in an area with a deprivation score of 7 out of 10 (10 being the least deprived). The practice population’s age demographic is not in line with the national average. The practice has a significantly higher than average number of patients between the ages of 25-39 (particularly in the number of male patients), and a far lower number of patients for all age groups over 45. This demographic means that disease prevalence within the practice population is also not in line with national averages. For example, the practice had fewer than expected patients with Chronic Obstructive Pulmonary Disease (COPD).

The GP team includes two partners (one male and one female, 1.00 whole time equivalent [WTE], 10 clinical sessions provided). The nursing team includes two female nurses. The clinical team is supported by a practice manager, a deputy practice manager and three other administrative or reception staff.

The practice is open from 8.00am to 7:00pm Monday to Friday. Further extended hours are available between 7:00pm and 8:00pm on Fridays. The practice offers appointments from 9:30am to 11:30pm and 1:45pm until 7:00pm on Mondays, to Thursdays and from 9:30am to 11:30pm and 1:45pm until 8:00pm on Fridays.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning services, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice had been inspected by the CQC in 2013 at a time when practices were not rated. At that time the practice was compliant in all areas.  

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Balham Hill Medical Centre on 26 October 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, infection control audit findings had not been actioned and clinical equipment had not been calibrated. The practice was also not equipped to deal with medical emergencies.

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• Patient outcomes were in line with national averages in all areas with the exception of the management of diabetes. There were only limited audits and quality improvement at the practice.

• Patients were positive about their interactions with non-clinical and nursing staff and said they were treated with compassion and dignity. However, they reported that GP’s did not treat them with dignity and respect.

• Patients were able to access appointments at short notice.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Implement formal governance arrangements including systems for assessing and monitoring risks (including significant event analysis, and a business continuity plan) and the quality of the service provision (including audit/quality review). The practice should ensure that staff are able to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice, including ensuring that all staff are aware of their safeguarding responsibilities. All staff must also have appraisal as necessary to enable them to carry out their duties

• Ensure that there is appropriate equipment in place to manage emergencies and that the all potential risks have been assessed in the practice.
• Ensure that all clinical equipment is calibrated.
• Ensure that systems are in place to effectively monitor patients with diabetes, and recall patients for cervical smears.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements and ensure that systems are in place to support good practices. Where patient care and changes to process are discussed, ensure that the practice is able to review these decisions.
• Develop systems to consult patients and review their feedback, including feedback provided about GP consultations in the national patient survey.
• Ensure that a business plan is developed for the practice and share this with staff.

The areas where the provider should make improvement are:

• Consider formally discussing and documenting any discussions about NICE guidelines and best practice.

• Ensure that all actions from the last infection control audit are taken forward and that a cleaning schedule is implemented.

• Ensure that proof of identification is retained in staff files.
• Consider formalising the induction process.
• Consider working with the CCG to review the needs of the local population.

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

Updated 2 February 2017

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

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was lower than the national average. The practice had scored 35% for diabetes related indicators in the last QOF which is significantly lower than the national average of 89%. The exception reporting rate for diabetes related indicators was 3%, lower than the national average of 11%.

• Longer appointments and home visits were available when needed.

Updated 2 February 2017

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

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• 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. However, not all staff had been trained in safeguarding, and they were not aware of their responsibilities.

• Immunisation rates were in line with national averages for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme was 70%, which was lower than the CCG average of 81% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• There was limited joint working with midwives, health visitors and school nurses.

Updated 2 February 2017

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

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 2 February 2017

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

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 2 February 2017

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

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• 100% of four patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• Performance for mental health related indicators was similar to the national average. The practice had scored 100% for mental health related indicators in the last QOF, which was similar to the national average of 93%. The exception reporting rate for mental health related indicators was 3%, lower than the national average of 12%.

• The practice did not share the case management of patients experiencing poor mental health with other healthcare professionals.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 2 February 2017

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

The provider was rated as inadequate for safety, effective and for well-led and requires improvement for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice did not share the case management of vulnerable patients with other health professionals.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Non-clinical staff did not demonstrate knowledge of how to recognise signs of abuse in vulnerable adults and children.