Archived: Dr Prosanta Kumar Sarkar

Updated 28 January 2016

Bath Street Medical Centre is a long established practice located in the Kingswinford area of Dudley. There are approximately 2700 patients of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

At the point of our inspection the clinical team was led by a single handed GP. The team included a salaried GP and a long term locum GP. The principle GP has since retired and the practice now has a new lead GP in place who transitioned from a salaried GP at Bath Street Medical Centre. The clinical team includes a long term locum GP and the practice nurse team consists of a nurse practitioner and a practice nurse. The lead GP and the practice manager form the practice management team and they are supported by a team of four receptionists and an administrator.

The practice is open between 8am and 8pm on Mondays when extended hours operate from 6:30pm to 8pm. On Tuesdays , Wednesdays and Fridays the practice is open from 8am to 6:30pm. The practice is open between 8am and 1pm on Thursdays.

Staff we spoke with on the day of our inspection confirmed that a GP is on call between 1pm and 6:30pm on Thursdays and patients are given a mobile number to call to access the GP on call. However, we found that patients were advised to attend the walk in centre or access the NHS 111 service when we discussed the process during our follow up inspection on the 26 November 2015.

There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bath Street Medical Centre on 24 November 2015 and an unannounced follow up inspection on 26 November 2015. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, our review of specific minor surgery procedures carried out by one of the GPs highlighted that patients were at risk of harm because the GP was not following the current referral guidelines.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, we found that some significant events had not been recorded and that the practice could not demonstrate a safe track record of incidents over time.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement.

• Arrangements were in place to safeguard children and vulnerable adults from abuse that reflected relevant legislation and local requirements.

• There were systems in place for repeat prescribing and a system in place for the prescribing of high risk medicines. However, some records we viewed highlighted that medication reviews had not taken place within the relevant 12 month period.

• Patients we spoke with on the day of our inspection were positive about their interactions with staff and said they were treated with compassion and dignity.

• Data showed that patients rated the practice lower than others for some aspects of care and appointment waiting times.

• The practice had a number of policies and procedures to govern activity. However, we found that governance arrangement were not always robust.

• Prescription pads used for home visits were stored securely however the practice did not have a system in place to track and monitor their use.

• We did not see evidence to support that staff were up to date with some of the immunisations recommended for staff who work in general practice.

The areas where the provider must make improvements are:

During our inspection on 24 November 2015 we identified a number of cases where a GP had not followed current guidelines in relation to referrals for suspected melanoma. The Care Quality Commission contacted the GP in question on 27 November 2015 to request that the GP stopped performing minor surgery as a matter of urgency. The GP in question confirmed in writing that they would stop providing minor surgery from 27 November 2015 and that another GP in the practice would perform this service when required.

• The provider must ensure that they continue to comply with this arrangement.

• The provider must ensure systems are in place so that all clinicians are kept up to date with national guidance and guidelines.

• The provider must carry out clinical audits including re-audits to ensure improvements have been identified and achieved and improve governance arrangements including systems for recording, assessing and mitigating risks across the practice.

• The provider must ensure processes are robust for reporting and managing significant events, incidents and near misses, ensure all events are recorded.

• The provider must improve recall and review systems to ensure patient care, treatment and medication are regularly reviewed.

• The provider must ensure the use of prescriptions used during home visits are clearly tracked and monitored.

The areas where the provider should make improvement are:

• Address areas for improvement highlighted through patient feedback such as national survey results.

• Improve minutes of meetings to clearly document discussions which take place and record and review actions required.

• Ensure staff are up to date with relevant routine immunisations.

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 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 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 by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. 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 28 January 2016

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

• The practice is rated as inadequate for providing safe and effective services and improvements must be made, this affects all six population groups.
• Performance for overall diabetes related indicators was 91% which was above the CCG average of 88% and national average of 87%.

• Nursing staff had lead roles in chronic disease management.

• Structured annual reviews were not regularly undertaken to check that patients’ health and care needs were being met.

Updated 28 January 2016

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

• The practice is rated as inadequate for providing safe and effective services and improvements must be made, this affects all six population groups.
• Patients told us that children and young people were treated in an age-appropriate way
• Immunisation rates were relatively high for all standard childhood immunisations. Childhood immunisation rates for under two year olds ranged from 88% to 100% compared to the CCG averages which ranged from 40% to 100%. Immunisation rates for five year olds were at 100% compared to the CCG averages which ranged from 93% to 98%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 28 January 2016

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

• The practice is rated as inadequate for providing safe and effective services and improvements must be made, this affects all six population groups.
• Data showed that care and treatment was not delivered in line with recognised professional standards and guidelines.
• Patient outcomes were hard to identify as little reference was made to quality improvement. For example, we saw that an incomplete audit identified a number of patients were at risk of fall however the practice had not followed this up and could not demonstrate that they had placed any focus on this area.

• Flu vaccination rates for the over 65s was 77%, compared to the national average of 73%. .

• The practice offered home visits and longer appointments for those with enhanced needs.

Updated 28 January 2016

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

• The practice is rated as inadequate for providing safe and effective services and improvements must be made, this affects all six population groups.

• Data showed that patients rated the practice lower than others for some aspects of care. The results from the national GP survey highlighted that appointment waiting times were long and that 67% of patients were satisfied with the practice’s opening hours compared to the CCG and national averages of 75%.

• The practice was proactive in offering online services.
• The practice’s uptake for the cervical screening programme was 67%, compared to the national average of 81%.

Updated 28 January 2016

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

• The practice is rated as inadequate for providing safe and effective services and improvements must be made, this affects all six population groups.
• Performance for mental health related indicators was 46% compared to the CCG average of 93% and national average of 92% and the dementia diagnosis rate was 76% compared to the CCG average of 95% and national average of 94%.
• Staff had a good understanding of how to support people with mental health needs and dementia.
• The practice worked with a mental health gateway worker from the local mental health trust who provided counselling services on a weekly basis in the practice. The practice also referred patients to the community psychiatric nurse (CPN) worker who attended the practice on a weekly basis.

Updated 28 January 2016

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

• The practice is rated as inadequate for providing safe and effective services and improvements must be made, this affects all six population groups.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. However, we found that the minutes to support these meetings were brief and did not contain sufficient information to show that vulnerable patients and patients with complex needs were regularly discussed.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities and how to contact relevant agencies in normal working hours and out of hours.
• It had told vulnerable patients about how to access various support groups such as and the Dudley Council for Voluntary Service (CVS) team to improve outcomes for patients in the area. However, staff could not provide examples of any written information available to direct carers to the various avenues of support available to them.