Archived: Dr KE Wilcox & Partners Also known as The Medical Centre

Updated 14 July 2017

Dr KE Wilcox & Partners, also known as The London Road Medical Centre, is situated in Sittingbourne, Kent. The practice has a general medical services contract with NHS England for delivering primary care services to the local community.

The practice has a patient population of 8,005. The proportion of patients who are aged 20 to 44 is lower than the national average and the proportion of patients aged over 65 is higher than the national average. The practice is in an area with a marginally lower than average deprivation score and lower than average levels of unemployment.

There is a reception and waiting area on the ground floor. Consultation and treatment rooms are also located on the ground floor. Patient areas are accessible to patients with mobility issues, as well as parents with children and babies. There is a small car park for use by staff and disabled patients.

There are two GP partners (one male and one female). Both of the partners are part time (1.78 Whole Time Equivalents (WTE) in total). There are two part time salaried GPs (one male and one female) (1.11 WTE in total). Regular locum GPs work in the practice on regular days each week and cover when the GPs are off sick or on holiday. There is one part time practice nurse and a phlebotomist, both of whom are female. In addition, there is a practice manager as well as a team of reception and administrative staff.

The practice does not teach medical students or train GP trainees and FY2 doctors.

The practice is open between 8am and 6.30pm Monday to Friday. The practice does not offer regular extended hours appointments.

There are arrangements with other providers (Medway on Call Care (MedOCC)) to deliver services to patients outside of the practice’s working hours.

Services are provided from The Medical Centre, 32 London Road, Sittingbourne, Kent, ME10 1ND.

Updated 14 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr KE Wilcox & Partners on 2 June 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Dr KE Wilcox & Partners on our website at www.cqc.org.uk.

The inspection carried out on 2 March 2017 found that the practice had responded to some of the concerns raised at the June 2015 inspection. However, we found other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the practice is inadequate.

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

• There was a system for reporting and recording significant events. However, not all staff understood what constituted an incident or near miss.
• Risks to patients were not always assessed and well managed. For example, those relating to recruitment checks.
• The practice was unable to demonstrate that there was an effective system for receiving and acting on medicines alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• The practice did not have an adequate supply of medicines and equipment to respond to medical emergencies in line with national guidance.
• The practice was unable to demonstrate that it had a system to track the use of blank prescription forms throughout the practice.
• Data showed patient outcomes were low compared to the national average. Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• The practice was unable to demonstrate that all staff had received sufficient training to enable them to carry out their roles effectively, and staff did not have regular appraisals.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it difficult to get through to the practice by telephone and to make an appointment that suited their needs, but that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure staff receive annual appraisals and are provided with appropriate training to carry out their roles in a safe and effective manner. For example, induction training for new staff, safeguarding, fire safety awareness, basic life support and information governance training.
• Ensure the practice has equipment and medicines suitable for use in a medical emergency.

• Ensure there is a system to ensure that medicines alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) are received and acted upon.

• Ensure the practice has a system for monitoring blank prescription pads and forms throughout the practice.
• Ensure the practice has a business continuity plan that ensures adequate staffing and the long term sustainability of the practice.
• Ensure patients with complex medical needs are discussed at multidisciplinary team meetings, and patients with long term conditions are regularly reviewed and have written care plans.
• Introduce a system to ensure a programme of clinical audit is carried out to drive improvements to patient care by the completion of clinical audit cycles.
• Ensure formal governance arrangements are implemented including systems for assessing and monitoring risks and the quality of the service provision. For example, risks relating to medicines and equipment at the practice for use in an emergency, pre-employment checks and staff training and appraisals.

In addition the provider should:

• Improve staff understanding of what constitutes a significant event, incident or near miss and ensure all significant events are reported.
• Minimise the risk of the refrigerator used to store vaccines being turned off by plugging it directly into a switchless wall socket.
• Proactively identify patients who are carers and support them to access additional support.
• Improve telephone access to the practice and the availability of non-urgent appointments.
• Establish and engage with a patient participation group to provide feedback and support to the practice.

I am placing this service into 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 14 July 2017

The provider was rated as inadequate for providing safe and well-led services; requires improvement for effective; and good for caring and responsive. The issues identified overall affected all patients including this population group. However, the practice is rated as inadequate for the care of people with long-term conditions.

• Performance for diabetes related indicators was similar to the CCG and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 72% compared to the CCG and national average of 78%.

• However, performance indicators for other long-term conditions was less favourable:
  • The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 Royal College of Physicians (RCP) questions was only 38% compared to the CCG average of 73% and the national average of 76%.
  • The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 66% compared to the CCG average of 86% and the national average of 90%.
• Longer appointments and home visits were available when patients needed them.
• Structured annual reviews were not undertaken to check that patients’ health and care needs were being met and patients did not have a personalised care plan. 

Updated 14 July 2017

The provider was rated as inadequate for providing safe and well-led services; requires improvement for effective; and good for caring and responsive. The issues identified overall affected all patients including this population group.

• There were systems 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 accident and emergency attendances.
• Childhood immunisation rates for the vaccinations given were comparable to the local CCG and national averages. The practice achieved the 90% target in three out of four areas; in the remaining areathey scored 59%.
• 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 80%, which was comparable with the clinical commissioning group (CCG) and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 14 July 2017

The provider was rated as inadequate for providing safe and well-led services; requires improvement for effective; and good for caring and responsive. The issues identified 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, longer appointments and urgent appointments for those with enhanced needs.
• Patients over the age of 75 years had been allocated to a designated GP to oversee their care and treatment requirements.

Updated 14 July 2017

The provider was rated as inadequate for providing safe and well-led services; requires improvement for effective; and good for caring and responsive. The issues identified overall affected all patients including this population group.

• 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 help ensure these were accessible, flexible and offered continuity of care.
• Extended hours appointments were not offered. The practice reserved a number of commuter appointments on Tuesday, Wednesday and Thursday between 5.30pm and 6pm for patients who were unable to attend the practice during normal working hours.
• The practice was proactive in offering some online services, as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 14 July 2017

The provider was rated as inadequate for providing safe and well-led services; requires improvement for effective; and good for caring and responsive. The issues identified overall affected all patients including this population group.

• The percentage of patients diagnosed with dementia whose care plan had been reviewed in a face-to-face review in the preceding 12 months was only 31% compared to the CCG average of 83% and the national average of 84%.
• Performance for other mental health related indicators was higher than the CCG and national averages. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% compared to the CCG average of 93% and the national average of 89%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 July 2017

The provider was rated as inadequate for providing safe and well-led services; requires improvement for effective; and good for caring and responsive. The issues identified 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 had identified 52 patients as carers (0.6% of the practice list).
• 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 we spoke with knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. However, the practice was unable to demonstrate that all staff had received safeguarding training to an appropriate level.