Archived: Half Penny Steps Health Centre

Updated 20 September 2017

Half Penny Steps Health Centre provides primary care services to around 4,940 patients living in West London. The practice holds an Alternative Personal Medical Services (APMS) contract with North West London Clinical Commissioning Group to deliver accessible primary care services to the local community, including people who are not formally registered with the practice. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury, surgical procedures, family planning and maternity and midwifery services.

The practice is part of a group of surgeries operated by the provider, Malling Health. The practice is managed day to day by a deputy practice-based manager and a lead GP and employs locum GPs to cover when the lead GP is not available. The practice also employs advanced nurse

practitioners (who lead on the walk-in primary care service), two locum practice nurses who work part-time, a health care assistant as well as a team of receptionists and administrators.

The practice is open seven days a week, 365 days of the year including Christmas day and other public holidays. Patients registered at this practice can make bookable appointments with GPs, the nurses and the health care assistant Monday to Friday 8am to 6pm. The nurse-led walk-in primary care service sees both registered and non-registered patients Monday to Friday 12pm to 8pm and Saturdays and Sundays 10am to 4pm. The details of the ‘out of hours’ service were communicated in a recorded message accessed by calling the practice when closed and details can also be found on the practice website. Longer appointments were available for patients who needed them and those with long-term conditions. This also included appointments with a named GP or the nurse. Pre-bookable appointments could be booked up to two weeks in advance; urgent appointments were available for people that needed them.

Out of hours primary care is contracted to a local out of hours care provider. The practice provides patients with information about how to access urgent care when the practice is closed on its website, answerphone and on the practice door, primarily informing patients to telephone the 111 service.

The local population is very diverse in terms of levels of deprivation and household income with average life expectancy being a little better than the national average. The practice population is relatively young. 

Updated 20 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Half Penny Steps Health Centre on 29 July 2015. The overall rating for the practice was good. The full comprehensive report can be found by selecting the ‘all reports’ link for Half Penny Steps health Centre on our website at www.cqc.org.uk

We carried out an unannounced inspection at Half Penny Steps Health Centre on 22 May and 13 June 2017 in response to concerns received by the Care Quality Commission (CQC) that the practice was not providing safe care and treatment to its patients. The concerns specifically related to the practice having no lead GP and using locum GPs to run the service, without proper induction into practice procedures which included two week referrals and following up on hospital reports. There were also concerns in relation to there being no on site management support for staff and their lack of understanding of safeguarding vulnerable patients resulting in these patients being at risk. As a result a decision was made to take enforcement action against the provider where warning notices were issued for regulations 17; Good Governance and 18, Staffing.

We returned to the practice to assess if the provider had addressed our concerns in the warning notices and undertook an unannounced full comprehensive inspection, on 21 July 2017 to look in further detail into the areas of concern we had noted. As a result of our finding at this inspection we took further action and served the provider with a ‘letter of intent’ to take immediate enforcement action under section 31 of the Health and Social Care Act 2008 in relation to regulation 12: Safe Care and Treatment and regulation 17: Good Governance.

This report covers our findings from the inspection on 21 July 2017. The overall rating is inadequate.

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

• Patients requiring treatment for long term conditions (such as asthma) and high risk medicines were prescribed repeat medicine without adequate review.
• Effective systems were not in place to ensure handover of patient information is through an experienced clinician at all times.
• Effective clinical leadership, support and oversight to staff was not in place three days a week.
• The practice had systems in place for reporting and recording significant events and there was evidence of learning and communication with staff about significant events.
• There were formal systems and process in place to identify and assess risks to the health and safety of service users and staff.
• Staff had received appropriate mandatory training such as basic life support or safeguarding.
• Patient outcomes were hard to identify as no clinical audits had been carried out to improve the quality of care and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
• There were no processes in place for patients or staff to give feedback about the service.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular – review and put in place measures to improve areas where patient outcomes are below average, in particular in relation to the proportion of patients excepted from the Quality and Outcomes Framework.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

In addition the provider should:

• Provide appropriate support and information to patients who are carers so their needs can be identified and met.
• Review systems to ensure patients with long term conditions are offered annual reviews.

• Review and update the business continuity plan
• Provide accessible information about the complaints procedure for patients

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 September 2017

The provider was rated as inadequate for safe, effective and well led. The issues identified as inadequate overall affected all patients including this population group.

• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Performance for diabetes related indicators was 90%, which was 7% above the CCG and 0.2% comparable to national averages. However, there was extremely high  exception reporting at 38% for patients with diabetes, on the register, in whom the last IFCC-HbA1c result was recorded in the preceding 12 months

Updated 20 September 2017

The provider was rated as inadequate for safe, effective and well led. The issues identified as inadequate overall affected all patients including this population group.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 76%, which was above the CCG average of 75% and below the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Immunisation rates were comparable to CCG averages for all standard childhood immunisations

Updated 20 September 2017

The provider was rated as inadequate for safe, effective and well led. The issues identified as inadequate overall affected all patients including this population group.

• 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. The GPs carried out home visits when needed.
• Patients over 75 years had a named GP to co-ordinate their care.

Updated 20 September 2017

The provider was rated as inadequate for safe, effective and well led. The issues identified as inadequate overall affected all patients including this population group.

• The practice offered working age patients access to extended appointments.

• They offered on-line services for repeat prescriptions and registration.
• The practice offered the NHS health checks for patients aged 40–74

Updated 20 September 2017

The provider was rated as inadequate for safe, effective and well led. The issues identified as inadequate overall affected all patients including this population group.

• Patients experiencing poor mental health were invited to attend annual physical health checks however only 24 out of 41 had been reviewed in the last 12 months.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There were 16 patients on the dementia register and 10 had had their care reviewed in a face to face meeting in the last 12 months.

Updated 20 September 2017

The provider was rated as inadequate for safe, effective and well led. The issues identified as inadequate overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children as they had not received any training and were not aware of their responsibilities regarding information sharing, documentation of safeguarding concerns or how to contact relevant agencies in normal working hours and out of hours.