Archived: Acorns PCT Medical Services (PCTMS) Practice

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