On 1 December 2015 the Care Quality Commission (‘CQC’) inspected St Mary’s Island Surgery, Edgeway, St Mary’s Island, Chatham, Kent, ME4 3EP. The registered provider of St Mary’s was Dr Stephen Lawrence. The practice was rated as ‘inadequate’ as the CQC considered that the practice was not providing effective, caring or responsive services.
In March 2016, as a result of the CQC report, the practice was placed into special measures. This meant that the practice began to work with NHS Medway Clinical Commissioning Group (‘CCG’) and NHS England to improve the level of care and treatment.
The CQC inspected again on 23, 26 & 29 September 2016 and the practice was rated as ‘good’ for each of the CQC’s key questions (i.e. is the service safe, effective, caring, responsive and well-led). The surgery was removed from special measures.
Then following an unannounced and comprehensive inspection on 23 and 25 January 2018 the CQC found that the practice was once again inadequate. Their findings included, but certainly were not limited to the following:
- The Systems to safeguard children from abuse were not effective.
- The practice had not responded to requests for information concerning the health and welfare of looked after children.
- Correspondence was not dealt with in a timely manner.
- Medicine management was unsafe.
- Emergency medicines were out of date.
- The oxygen cylinder was empty.
- Significant events had not been reported.
- The practice did not have an effective system for receiving and acting on safety alerts.
- GPs did not have access to the proper information technology tools to help make the best decisions for their patients’ treatment and care.
- Patient care was not well coordinated, including end of life care.
- Patients’ records and the coding of patients’ records were not up to date so staff was not always able to identify patients’ conditions and meet their needs.
- Patients were not referred to secondary care, nor were referrals from secondary care, dealt with in a timely manner.
- There were failures in compliance with the Data Protection Act 1998.
- Care and treatment for patients with multiple long-term conditions and patients approaching the end of life was not always coordinated with other services.
- The needs of children were not always addressed in a timely way and vulnerable adults were not always supported.
- Care and treatment wasn’t always provided within an acceptable timescale.
The full list can be found within the CQC’s full report at: http://www.cqc.org.uk/sites/default/files/new_reports/AAAH1029.pdf.
As a result of this unannounced and comprehensive inspection 3 conditions were imposed. They were:
Condition 1 – To clear the backlog of prescription requests, medication reviews, referrals to and from secondary care, patients’ discharge notes and any other correspondence, relating to the health and care of patients by 8 February 2018. The progress of this task to be reported to the CQC weekly by midday each Thursday.
Condition 2 – Implement a sustainable system to ensure prescription requests, medication reviews, referrals to and responses from secondary care, patients’ discharge notes and any other correspondence, relating to the health and care of patients were reviewed and actioned without delay and to report to the CQC how this was implemented by 8 February 2018.
Condition 3 – Ensure that a suitably qualified, competent, skilled and experienced person is present at the practice to manage day to day operations to ensure a safe delivery of the service.
A CQC Inspector then attended the surgery on 30 and 31 January 2018 and found that they had failed to comply with Condition 3 and so issued a Notice of Proposal to cancel ‘The provider’s’ registration with the CQC under Section 17(1)(c) of the Health and Social Care Act 2008.
This gave The provider 28 days in which to make representations to the HMCTS as to why he did not agree with the reasons for the notice of proposal.
No such representations were received by the CQC.
On 20 February 2018 a new provider was registered with the CQC to provide general practice services from the St Mary’s island surgery site.
Ruth Rankie, CQC’s deputy chief inspector of general practice, said:
“The way in which St Mary’s Island Surgery was operating under Dr Lawrence failed to meet the fundamental aspects of good care and treatment that people have the right to expect – high quality, compassionate and safe.
Enforcement action to close a service is not something that the CQC takes lightly.
Where we find that patients are at significant risk, as we did in this case, we have no choice but to work with our partner agencies in order to take action to protect the safety and welfare of the public.
In this instance, given the seriousness of what we found on inspection, we are confident we took the right decision to protect people.
When necessary, we will use our powers to do what it takes to make sure patients and the public are protected.”
Sarah Vaux, chief nurse at Medway CCG, added:
“As soon as we were alerted to potential issues we contacted the CQC and worked with them during their inspections.
We wish to reassure patients that Dr Lawrence is no longer at the surgery and a dedicated team of medical professionals has reviewed the notes of all the patients registered at the practice. Where necessary all patients have now been contacted.
If patients have any concerns about their own treatment they are asked to call the helpline on 01634 335281 or email firstname.lastname@example.org“
Steevi Henderson, Solicitor for Fairweathers Solicitors LLP, commented:
“It is a real concern that patient’s basic needs were not being met at this practice. The failure to deal with basic administrative tasks in a timely manner, such as sending secondary referrals, really can mean the difference between life and death. We can only hope that those who have been affected have not been left with any long term consequences and that the new provider is able to significantly improve the performance levels at the surgery.”