Archived: St Clements PCT Medical Services (PCTMS) Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St. Clements PCT Medical Services (PCTMS) Practice on 25 January 2017. Overall the practice is rated as requires improvement.

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

• There were systems in place for reporting, recording, investigating, responding and learning from significant events. However, the practice did not evidence consideration of wider risks and that changes had been embedded to mitigate against a reoccurrence.
• There was an effective system in place to receive and respond to Medicine and Healthcare products Regulatory Agency (MHRA) alerts. However, historical alerts from prior to 2015 still required actioning.
• The practice achieved 96% of the total points available under Quality and Outcomes Framework (QOF).
• We found there was no defined system in place to disseminate and check adherence to NICE guidance.
• We found some patients were incorrectly coded for health conditions they did not have.
• Improvements were required to ensure timely reviews of medicines and discussions of associated risks.
• There was an absence of clinical audit to inform quality improvement.
• Care plans were not in place for all patients on their admission avoidance programme.
• Patients had been appropriately identified and included in multidisciplinary discussions.
• The practice did not monitor their patient’s attendance for national screening programmes or have specific strategies to improve uptake.
• Data from the national GP patient survey showed patients rated the practice lower than others for many aspects of care. This included satisfaction with the opening hours and ease of contacting the practice by phone.
• Patients we spoke with including members of the patient participation group spoke highly of the care, commitment and professionalism of the practice nurse.
• The practice had identified 0.4% of their patient list as carers and was improving their identification and services to such patients.
• The practice offered a range of services to their patients who could access the practice or North Essex Partnership University NHS Foundation Trust (NEPT) neighbouring practices (The Acorns and Dilip Sabnis).
• The practice followed up on patients who failed to attend their appointments.
• The practice had a complaints procedure. It was accessible and supported patients to make a complaint including their right to advocacy services.
• The Trust responsible for the oversight of the practice had commissioned an external specialist to assist them to develop an overarching strategy regarding how they were to deliver their services individually or across the three practices within Grays, Essex.
• The overarching governance systems had not been effectively embedded into the practice.
• There was a lack of permanent clinical oversight. This role was currently being fulfilled by the external specialist GP advisor in partnership with the pharmacist.
• There was often only remote managerial oversight available for most of the week.
• Regular team meetings had been introduced and rotated between days to ensure all staff had an opportunity to attend and contribute to discussions.
• Systems were in place to support patients to provide feedback. However these were in their infancy and the practice could not demonstrate changes made in response to patient feedback.

Since the date of the inspection, the provider of this service has de-registered this location with the Care Quality Commission and another provider has registered with us. Had this not been the case we would have issued the provider with an improvement action for the following areas.

The areas where the provider must make improvements are:

• Ensure the dissemination and adherence to NICE guidance.
• Conduct reviews of high risk medicines in line with guidance, explaining potential risks to patients.
• Embed accessible and sustainable governance systems and processes to identify and implement quality improvements, including clinical and managerial oversight.
• Ensure the accurate coding of patient records and ensure that care plans are completed for patients on the admission avoidance register.
• Respond to patient feedback and use it to inform changes to the service.

The area where the provider should make improvement is;

• Review and action medicine safety alerts from prior to January 2015.
• Improve the analysis of risks and evidencing of actions taken to mitigate a reoccurrence.
• Monitor patient’s attendance for national screening programmes and improve uptake.
• Improve the identification of patients who are carers.
• Maintain accessible clinical and administrative leadership.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice