Archived: Acorns PCT Medical Services (PCTMS) Practice

Updated 19 January 2017

Acorns PCT Medical Services (PCTMS) Practice is located in Grays, Essex and provides GP services to 3050 patients living within the practice boundary. The practice is one of 33 practices located within the Thurrock Clinical Commissioning Group.

Within Thurrock CCG, income deprivation affecting children and older people is higher than average, and 20% of children living in the area live in low income families, which is greater than the national average. The practice population is ethnically diverse, speaking 17 languages other than English.

GP services at Acorns PCT Medical Services (PCTMS) Practice are provided by North Essex Partnership University NHS Foundation Trust. Further details about the rating of the trust provider can be found on the CQC website.

There are no permanent GPs employed at Acorns PCT Medical Services (PCTMS) Practice PCT Medical Services, and the practice engages GP locums as they become available. There is a permanent part-time nurse employed at the practice.

The practice manager works across all three of the provider’s practices in Grays, including Acorns PCT Medical Services (PCTMS) Practice PCT Medical Services, Dilip Sabnis on Linford Road and St Clements Health Centre on London Road. St Clements Health Centre is located 1.5 miles away, and Dilip Sabnis is located 2.2 miles away. When there are no appointments available at the practice, patients are advised to attend these practices.

The practice also employs six reception and administrative staff. There is a permanent GP employed at St Clements Health Centre who is used to provide remote assistance.

The practice is located within the Queensgate Centre. The practice is open from 9am until 6pm on a Monday to Friday, after which time the shopping centre and practice are closed. Weekend appointments with a GP or nurse can be booked through the practice at the Thurrock Hub, which is located in Thurrock Community Hospital.

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acorns PCT Medical Services (PCTMS) Practice on 11 October 2016. The provider of services at Acorns PCT Medical Services (PCTMS) Practice is North Essex Partnership University NHS Foundation Trust. Overall the service is rated as inadequate.

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

• The overarching Trust governance systems had not been effectively embedded into the practice.

• There were no permanent GPs employed by the practice to offer continuity of care.

• The reporting and learning from significant events was not safe.

• There were no systems to receive or respond to Medicine and Health products Regulatory Agency (MHRA) alerts.

• Not all reasonable steps had been taken to improve security, although CCTV had been installed in the reception area in the last year.

• Systems and processes to keep patients safeguarded from abuse were not effective.

• The infection control audit had not identified all risks.

• Medicines had not been reviewed in accordance with guidance.

• The system for recording correspondence into the practice was not safe.

• The business continuity plan did not meet the needs of the practice. Policies did not meet the needs of the practice.

• QOF reviews and health checks were not carried out with an emphasis on monitoring and improving patient outcomes.

• Medicines, diagnosis and alerts were not routinely coded to ensure a safe hand over of information. Information recorded in the patients’ electronic record was unclear.

• Results from the national GP patient survey published in July 2016 showed patients did not always feel that they were treated with compassion, dignity and respect by the GPs.

• Patients spoke 17 different languages but appropriate translation services were not utilised.

• The practice nurse involved communities in their care, educating and informing them about the importance of routine health checks.

• Practice opening times were restricted from 9am until 6pm. Weekend appointments with a GP or nurse could be booked at the local health hub.

• The system of reporting, recording and investigating complaints was not effective.

• There was a lack of GP oversight.

• Locum GPs did not attend practice meetings where safeguarding concerns, significant events, complaints and learning were discussed and it was unclear how the clinical team was being effectively led.

The areas where the provider must make improvement are:

• Assess the risks to the health and safety of patients and do all that is reasonable possible to mitigate any such risks as follows: receive and cascade MHRA alerts and identify patients who may be at risk of the alert; ensure chaperones are DBS checked or risk assessed as to whether this is required; review patient’s medicines in line with NICE guidelines and their own policy; ensure patients under the age of 18 who are able to give their consent are receiving appropriate care and treatment.

• Ensure all people providing care have the qualifications, competence, skills and experience to do so safely by putting in place stringent pre-engagement checks of GP locums and review these periodically to ensure these are still valid in the case of later re-engagement

• Put in place systems to mitigate the risks to patients by ensuring the following: a GP is present at the practice every day when a GP surgery is scheduled to take place; all clinicians raise and partake in significant event reporting and recording and discussions relating to on-going safeguarding concerns; policies are accessible and appropriate for the practice and that infection control audits are effective in identifying risk;

• Put in place systems to assess and monitor the risks to patients and others for example by reviewing and improving the system for receiving correspondence, the security of the reception area, storage areas and treatment rooms and the arrangements for GPs to oversee the work completed by locums;

• Maintain an accurate, complete and contemporaneous patients’ record by ensuring

• Ensure persons employed are of good character by carrying out appropriate pre-employment checks.

The areas where the provider should make improvements are:

• Identify patients who are carers and offer them appropriate support.

• Encourage uptake for breast and bowel screening programmes.

• Ensure GP locums are aware of where to find shared care protocols.

On the basis of the ratings given to this practice at this inspection, I am placing the practice into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 January 2017

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

• There were no systems to receive or respond to Medicine and Health products Regulatory Agency (MHRA) alerts to ensure that patients with long-term conditions taking certain medicines were safe.

• Medicines were not consistently reviewed in accordance with guidance.

• The percentage of patients with asthma who had an asthma review in the preceding 12 months was 85% which was 10% above the local and England average. However, not all patients taking medicines for their asthma had a regular review of their medicines.

• Performance for diabetes indicators was in line with local and national averages. The percentage of patients with diabetes whose cholesterol was within specified limits was 97%, which was 7% above CCG average and 6% above England average.

• Two patients with atrial fibrillation had not received relevant therapy. There had been no review to check that whether this inaction was appropriate.

Updated 19 January 2017

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

• A midwife held a clinic at the practice once a week.

• Not all systems, processes and practices kept patients safe and safeguarded from abuse. Not all locum GPs working at the practice were trained to safeguarding children level three.

• There were not appropriate procedures in place to ensure patients under the age of 18 who were able to give their consent were receiving appropriate care and treatment. The nurse would not prescribe contraceptives to patients under the age of 18 without a parent or guardian being present.

• Systems were not effectively updated to record and code the outcome of pregnancy.

Updated 19 January 2017

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

• Less than 2% of the practice population were aged over 65. There were no patients at the practice who lived in care homes.

• The percentage of patients aged 75 or over with a record of a fragility fracture on or after 1 April 2014 who had a diagnosis of osteoporosis, who were currently treated with an appropriate bone-sparing agent was 100% which was 7% above the CCG and England average.

• The practice offered flu vaccinations to patients over 65.

Updated 19 January 2017

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

• For the year 2015/2016, 84% of females aged 25-64 had attended for their cervical screening tests within the required period. This was 5% above CCG average and 3% above England average.

• There were no systems in place to encourage patients to attend national bowel screening programmes, as only 24 out of 135 relevant patients had attended for this screening in the recommended timeframe. Only 52 out of 150 relevant patients had attended for breast screening.

• Weekend appointments with a GP or nurse could be booked at the local health hub.

• There was no website to enable patients to request services online, translate information and provide useful information such as directions and health promotion advice, for example.

• The practice could give patients a log-in to access appointments online.

Updated 19 January 2017

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

• No patients diagnosed with dementia had been reviewed in a face-to-face review in the preceding 12 months. This was 78% below England average and 84% below the England average.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a care plan documented in the record in the 12 months was 100% which was higher than the local average by 12% and England average of 20%.

• Clinicians could refer patients to the dementia clinic for screening and for on-going support by the community geriatrician.

Updated 19 January 2017

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

• The practice nurse had worked with local communities to educate and inform them about the importance of routine health checks, and told us of improved uptake as a result.

• There was no hearing loop.

• Despite the identified diversity of the practice population, appropriate translation services were not utilised. Leaflets and information was not provided in any other language than English.

• Patients spoke 17 languages yet resources were not deployed to ensure that patients could be involved in their care, as appropriate translation serves were not provided.

• Carers were not routinely identified, nor were there any additional services offered by the practice to support them.

• The practice had carried out health checks for 10 of their 15 patients with learning difficulties.

• There were no systems to alert clinicians if patients had a weakened immune system.