Archived: Somerset Medical centre

Updated 29 September 2016

Somerset Medical Centre is situated at 64 Somerset Road, Southall, Ealing, UB1 2TS. The practice provides primary medical services through a General Medical Services (GMS) to approximately 1733 patients in Southall (GMS is one of the three contracting routes that have been made available to enable commissioning of primary care services). The practice is part of the NHS Ealing Clinical Commissioning Group (CCG) which comprises 79 GP practices.

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

The ethnicity of the practice population is predominantly of Indian origin with a significantly higher than national average number of male patients 20-54 years old and female patients 30-34 years old. There is also a higher than average number of children 0-4 years old. Life expectancy is 78 years for males and 83 years for females which is similar to national averages. The practice serves a multi-lingual community including English, Panjabi, Tamil, Gujarati and Polish speakers. The local area is the fifth most deprived in the London Borough of Ealing (people living in more deprived areas tend to have greater need for health services).

The practice team consists of a male GP partner (five sessions), female GP partner (four sessions), female salaried GP (five sessions, currently on maternity leave), a nurse prescriber (16 hours), two healthcare assistants/phlebotomists (32 hours) and a practice manager supported by a small team of reception/administration staff. The male GP partner is also the registered manager and he took over leadership of the practice in January 2016, the female GP partner joined the practice shorty after.

The opening hours are 8:00am to 6:30pm Monday to Friday with extended hours on Monday and Friday from 6:30pm to 7:15pm. The practice does not close for lunch. Patients can access out of hours care through the NHS 111 service.

Services provided include phlebotomy, chronic disease management, vaccination and immunisation, cervical screening and family planning.

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

Following a comprehensive inspection of Somerset Medical Centre on 21 July 2015, the practice was given an overall inadequate rating. Due to serious concerns about patient safety a decision was made to suspend the registration of the provider for a period of three months from 27 July 2015 to 27 October 2015. The provider appealed to a first-tier tribunal and a hearing was held on 01 October 2015. The appeal was dismissed by the tribunal upon agreement that we would re-inspect the practice on 14 October 2015 to assess if sufficient improvements had been made to allow the practice to re-open.

Following the inspection in October 2015 we found some improvements had been made however we still had concerns about the leadership of the practice and a decision was made to cancel the registration of the registered manager. The practice was placed in special measures and was found to be in breach of five regulations. Requirement notices were set for regulations 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008.

We then carried out an announced comprehensive inspection on 16 August 2016 to consider if all regulatory breaches in the previous October 2015 inspections had been addressed and to consider whether sufficient improvements had been made to bring the practice out of special measures.

At this inspection we found the practice had a new leadership team in place who had worked with the Royal College of General Practitioners (RCGP) to make the necessary improvements to the service provided. We found significant improvements had been made.  Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had facilities and was equipped to treat patients and meet their needs although the premises were in need of a general upgrade.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Continue to improve the identification of disease and the coding of patients on the Quality and Framework Outcomes (QOF) registers.
• Improve multidisciplinary team working to meet the needs of patients with complex conditions.
• Record do not attempt cardiopulmonary resuscitation decisions on care plans where appropriate.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

​ Chief Inspector of General Practice

Updated 29 September 2016

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

• 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 74% which was 12% below the CCG average and 16% below the national average with a 13% exception rate. However, unpublished 2015/16 data provided by the practice showed their diabetes performance had improved to 93%.
• 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.

Updated 29 September 2016

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

• 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. Immunisation rates were comparable to others for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice’s uptake for the cervical screening programme was 76%, which was comparable to the CCG average of 78% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 29 September 2016

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

• 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 29 September 2016

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

• 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 29 September 2016

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

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 88% and the national average of 84%.
• 100% 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.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 29 September 2016

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

• 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. 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.