Archived: Heston Practice

Updated 19 February 2019

Heston Practice is located in Hounslow, West London. The practice is located in a purpose-built medical centre which is shared with other GP practices and community services. The practice also runs a branch site in Hounslow known as The Great West Surgery. Patients are free to book appointments at either site. The practice is run by Living Care Medical Services Limited which also runs a number of primary care services across London.

The practice is registered with the CQC to carry out the following regulated activities: diagnostic and screening procedures; treatment of disease, disorder or injury; family planning; surgical procedures and maternity and midwifery services.

The provider provides NHS services through an Alternative Provider Medical Services (APMS) contract to around 8500 patients. It took over the contract from another GP provider in June 2017.

The practice’s clinical team is led by a locum lead GP (male, full-time) who has been recently appointed. The practice provides 31 GP sessions per week across the main and branch site through a team of regular sessional and locum GPs. Male and female GPs are available. The practice also employs two part-time practice nurses, a full-time advanced nurse practitioner and a phlebotomist who has recently qualified as a health care assistant. There is a team of five administrators/receptionists and a deputy manager who is based at Heston Practice. The provider also has a central and regional management team who provide governance and support.

The practice is open Monday to Friday from 8am to 6.30pm and on Saturday morning from 8am to 12pm. Patients who have previously registered to do so may book appointments online. The GPs carry out home visits for patients whose health condition prevents them attending the surgery.

The patient profile for the practice has an above-average working age population, between the ages of 20 and 49 years and fewer than average children, teenagers and older patients, aged over-50. The locality is similar to the English average in terms of deprivation levels. Over half of the practice area population is of black and minority ethnic background.

Updated 19 February 2019

We carried out an announced comprehensive inspection at Heston Practice on 6 December 2018 as part of our inspection programme. We had also received concerns from staff (anonymous) and patients who reported concerns about the service which we followed up. We were also made aware that the practice had been issued with a contractual breach notice by the commissioner for not providing sufficient GP appointments.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• Receptionists and staff had not been given guidance on identifying deteriorating or acutely unwell patients.
• Not all administrative staff had received appropriate safeguarding training.
• Recently recruited administrative staff had not received an effective induction.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not learn and make improvements when things went wrong.

We rated the practice as inadequate for providing effective services because:

• The practice could not show that care was provided in line with current guidelines and best practice.
• There was limited monitoring of the outcomes of care and treatment and unusual variation identified in exception reporting.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

We rated the practice as inadequate for providing responsive services because:

• Patients had difficulty accessing the service by telephone.
• Patients reported difficulty making a complaint.
• The practice could not show that it was learning and making timely improvements to the service following complaints.

We rated the practice as inadequate for providing well-led services because:

• While the practice had a clear vision, that vision was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective and confused at local level.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• The practice did not have embedded systems and processes for learning or for continuous improvement and innovation.

These issues affected all population groups in particular and we rated the population groups as inadequate.

We rated the practice as requires improvement for providing caring services because:

• The practice consistently scored lower than average on the national GP patient survey.
• The practice had identified patients who were carers including some young carers. It did not actively maintain a carers’ register and staff were not always clear about the support they could offer to carer.

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The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review staff understanding of the services the practice can offer to patients who are carers.

I am placing this service in 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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Updated 19 February 2019

Updated 19 February 2019

Updated 19 February 2019

Updated 19 February 2019

Updated 19 February 2019

Updated 19 February 2019