Archived: Dr Nader Lewis Also known as St Marks Medical Centre

Updated 29 March 2018

Dr Nader Lewis provides services to approximately 1600 patients in the surrounding areas of Ealing through a general medical services contract. The practice is known locally as St Marks Medical Centre and is located in a converted residential property.

The service is provided through a recently established partnership led by two GPs each currently providing three clinical sessions per week. One of the partners owns three other practices in the West London area. These are registered with CQC separately and this inspection report focuses solely on the service provided at St Marks Medical Centre.

The practice also contracts with a regular locum GP who typically provides three sessions a week. The practice employs a practice nurse (one day a week), a health care assistant (one day a week) and a practice manager (full time) and receptionists. Patients have the choice of a male or female GP.

The practice is open Monday to Friday from 9am to 1pm and from 3pm to 6.30pm apart from Thursday afternoon when the practice is closed. Appointments are available morning and afternoon when the practice is open.

Out of hours primary care is contracted to a local out of hours care provider including the early morning and lunch periods and Thursday afternoons when the practice is closed. The practice provides patients with information in the practice leaflet, on an answerphone and on the practice door about how to access urgent care out of hours. The practice can also direct patients to the local primary care ‘hub’ service which offers appointments with GPs and nurses in the evenings and at weekends.

The local practice population is similar to the English average in terms of socio-economic indicators and life expectancy. The practice has a high proportion of young adult patients aged between 20-44 years, and fewer than 100 patients (5%) aged over 75 years. The population is mobile and culturally and ethnically diverse. Around a quarter of practice patients originate from Poland.

The practice is registered to provide the following regulatory activities: family planning; maternity and midwifery services; diagnostic and screening procedures; and treatment of disease, disorder or injury.

Updated 29 March 2018

This practice is rated as requires improvement overall.

The practice was previously inspected on 10 May 2017. At that inspection the rating for the practice was inadequate overall. Following the inspection the practice was placed into special measures for six months and warning notices were issued. The full comprehensive report can be found by selecting the Dr Nader Lewis ‘all reports’ link on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 6 February 2018. The practice is now rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) – Requires improvement

Since our previous inspection, the GP (who was a sole provider at that time) has entered into a partnership with another GP who has taken on a leadership role within the practice. At this inspection we found:

• Improvements had been made since our previous inspection. There was a clearer understanding of risk and the practice was systematically reviewing and updating its risk assessments, policies and procedures. The practice needed to strengthen its arrangements for identifying and assessing the signs of potential sepsis.

• When incidents or near misses occurred, the practice was learning from them and had taken action to prevent reoccurrence.
• The practice had improved its arrangements to safeguard children and vulnerable adults from abuse.
• The practice was able to provide evidence that it was now maintaining appropriate clinical records of patient care and treatment.
• The practice had improved its clinical performance since our previous inspection, particularly in relation to the management of diabetes.
• The practice reviewed the effectiveness and appropriateness of the care it provided . However, it had made little use of clinical audit to monitor and improve clinical quality.
• The practice encouraged healthier lifestyles and preventative care. However, its cancer screening rates remained lower than average.
• Staff told us they were committed to treating patients with compassion, kindness, dignity and respect. The national patient survey results remained lower than average however.
• Patient feedback was positive about the ease of obtaining an appointment. However patients scored the practice lower than average for satisfaction with its opening hours which were relatively restricted.
• The practice had a clear strategy for its longer term development and sustainability and was increasingly involving patients in its planning.

The area where the provider must make improvements 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 its approach to cancer screening with the aim of improving uptake and coverage.
• Review its emergency procedures and training to ensure that the practice responds to cases of potential sepsis in line with current guidelines.
• Continue to review patient experience of GP and nurse consultations and take action to improve this as appropriate.
• Review its opening hours to ensure patients have reasonable access to their GP and other practice based services.
• Review its use of clinical audit to ensure this is appropriately embedded in its approach to quality improvement.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 March 2018

Updated 29 March 2018

Updated 29 March 2018

Updated 29 March 2018

Updated 29 March 2018

Updated 29 March 2018