Upminster surgery put into special measures as GP partner blames Covid-19 pandemic
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Staff shortages due to isolation for suspected Covid-19 and “gross pressures” created by the pandemic are among the reasons an Upminster surgery has been put into special measures, a GP partner has claimed.
Dr Farah Baig, a senior executive partner at Upminster Medical Centre, admitted the practice’s “normal high standards” came under stress during the coronavirus crisis.
Inspectors from the Care Quality Commission (CQC) visited the St Mary’s Lane surgery on June 5 and 11, before publishing their findings last week.
They graded the centre “Inadequate” overall, the lowest rating, and placed it into special measures.
The surgery had been rated ‘Good’ by the care regulator at the previous inspection in March 2017.
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In the latest report, inspectors found that the practice did not have an effective system for updating patients’ medication when changed by other providers.
A hospital had asked for a patient it had treated to be prescribed specific medicine by the practice to minimise the risk of another deep vein thrombosis (DVT).
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This did not happen and inspectors said: “There was no rationale for not prescribing the medicine, the patient had a second life-threatening DVT which might have been avoided.”
They wrote that discussions with practice staff found there was “an inconsistent approach to managing significant events which resulted in a number of events not being reported, recorded or discussed to ensure the learning could be shared.”
They also discovered the practice did not always follow clinical best practice in patient treatment, and that it did not always take timely action.
They gave an example where the surgery did not make an urgent referral to specialist services for a suspected cancer patient.
Inspectors said they found evidence the practice had not diagnosed diabetes in some cases, despite blood tests showing patients had the condition.
They also found patients being given extra quantities of the medicine zopiclone, used to treat insomnia, “without rationale or justification”.
The report said: “There was extensive evidence indicating insufficient leadership capacity and skills across a range of fundamental areas that underpin essential standards of safe and effective patient care.
“For example, we found gaps and weaknesses in areas such as safety systems and processes to identify, investigate and learn from incidents.
“The inspection team found a significant number of clinical concerns which had not been identified by the practice due to a lack of clinical oversight.
“Therefore, leaders within the practice could not be assured the care being provided to patients was safe and effective.”
A routine audit of medical records would have identified “the significant lack of detail regarding patients’ medical histories,
observations and assessments undertaken by clinicians, and diagnoses,” inspectors added.
When approached by the Recorder for comment, Dr Baig said the “gross pressures” and different ways of working caused by the Covid-19 pandemic, as well as having locum cover for a GP partner on maternity leave, had contributed to putting strain on standards.
She said follow-up care for diabetic patients and those on high-risk medications was compromised due to the halting in hospital clinics and diagnostic services.
“Even blood tests and x-rays in the community which could have been utilised by us to monitor our patients became difficult to access,” Dr Baig added.
“Sometimes the patients were themselves reluctant to go to those places where there was a risk of picking up Covid-19.
“A lot of this was reflected in our practice system and appeared to give the impression that we were negligent in the follow-up of these patients.”
She also described some practice staff as feeling stressed at working during the pandemic.
“Whenever we realised that this was the case, we offered them full support to address their concerns and tried to provide maximum protection from exposure to Covid-19.
“However, due to some staff being off due to suspected Covid-19 isolation public health advice at the time, remaining staff were having to take on extra work and we have been appreciative of their special efforts.”
Dr Baig described the ‘Inadequate’ rating as “highly disappointing”.
She said: “We have obtained extra professional support and made several improvements which are under ongoing monitoring by CQC.
“We are endeavouring to continue to provide our patients with healthcare of the high standard that we would wish for ourselves.
“We are confident that we will be able to satisfy CQC as we did previously that we are an asset to our local community and to the local NHS.”
The surgery will be inspected again within the next six months.