We carried out an announced comprehensive inspection at Shepherd’s Bush Medical Centre on 22 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

•What we found when we inspected

•Information from our ongoing monitoring of data about services and

•Information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

•The practice did not have clear systems and processes to keep patients safe.

•Receptionists had not been given guidance on identifying deteriorating or acutely unwell patients. They were not aware of actions to take in respect of such patients.

•The practice did not have appropriate systems in place for the safe management of medicines.

•The practice did not learn and make improvements when things went wrong.

We rated the practice as inadequate for providing effective services because:

•There was limited monitoring of the outcomes of care and treatment.

•The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

•The practice was unable to show that it always obtained consent to care and treatment.

•There was evidence that insufficient clinical hours and a lack of systematic risk assessments across patient population groups were having a direct impact on patient care and some performance data was significantly below local and national averages.

•We did not see evidence of how GP and nursing staff hours were effectively managed during annual leave and sickness and when the service was under pressure due to patient demand.

We rated the practice as inadequate for providing well-led services because:

•The practice was unable to demonstrate effective systems and processes to keep people safe.

•There are inadequate systems and processes in place to be assured of the quality and safety of the service being provided.

•Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.

•While the practice had a clear vision, that vision was not supported by a credible strategy.

•The practice culture did not effectively support high quality sustainable care.

•The practice did not have clear and effective processes for managing risks, issues and performance.

•The practice did not always act on appropriate and accurate information.

•We saw no evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as requires improvement for providing caring services because:

•The practice had limited systems in place to identify carers, including young carers’, and provide relevant support.

•Patients made positive comments about the care and treatment they received.

•Patients could generally access care and treatment in a timely way, although appointment times with GPs’ were limited.

•Staff mostly dealt with patients with kindness and respect and involved them in decisions about their care.

We rated the practice as requires improvement for providing responsive services because:

•The practice provided evidence of multi-disciplinary work to coordinate end of life care.

•All patients had a named GP who supported them in whatever setting they lived, and conducted home visits when required.

The areas where the provider must make improvements are:

•Ensure that care and treatment is provided in a safe way.

•Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

I am placing this service in special measures. Services 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 service 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 remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shepherds Bush Medical Centre on 1 October 2014. The overall rating for the practice was requires improvement. The full comprehensive report on the 1 October 2014inspection can be found by selecting the ‘all reports’ link for Shepherds Bush Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 20 December 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 1 October 2014. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Effective systems were in place to minimise most risks to patient safety.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they felt the practice offered an excellent service and staff were kind, attentive, caring and helpful and treated them with dignity and respect.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients found it easy make an appointment with a GP with urgent appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The areas where the provider should make improvement are;

• Ensure the security and tracking of all prescription stationery in line with national guidance.
• Consider the implementation of environment cleaning audits.
• Review the medicines stocked for use in a medical emergency to ensure inclusion of those recommended or risk assess why not required.
• Review the health and safety arrangements to ensure that signage alerts are displayed in areas of potential risk,and that cables and IT equipment are safely stored.
• Continue to make improvements in the performance for QOF, including patient outcomes in long-term conditions, childhood immunisations and cervical screening programme to align with local and national averages.
• Continue to identify and support more patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Shepherds Bush Medical Centre, a GP service located in the London Borough of Hammersmith and Fulham. This is the only location operated by this provider.

We undertook a planned, comprehensive inspection on 1 October 2014. During our inspection visit which took place over one day, we spoke with two GPs, the practice nurse, the practice manager, the medical secretary, the administrator and two receptionists. We also spoke with 9 patients and received 27 completed Care Quality Commission (CQC) comment cards.

We liaised with Hammersmith and Fulham Clinical Commissioning Group (CCG), NHS England and Healthwatch.

Shepherds Bush Medical Centre provided a caring service. Patients’ needs were suitably assessed and care and treatment was delivered in line with current legislation and best practice. However improvements were needed to ensure the practice was also safe, effective, responsive and well-led.

The practice is rated as requires improvement. Our key findings are as follows:

• Staff demonstrated a clear understanding of the issues relating to safeguarding vulnerable adults and children.
• The practice was clean and there were suitable infection control arrangements to reduce the risk of cross infection.
• The GPs attended monthly network meetings to share good practice and discuss local patient needs.
• The practice had numerous ways of identifying patients who need addition support, and were proactive in offering this.
• GPs showed a sensitive and caring approach towards supporting patients, their family and carers with bereavement.
• Vulnerable patients were offered double appointments.
• Patients praised the practice on its ability to provide appointments at short notice.

Areas of practice where the provider needs to make improvements are as follows: 

Importantly, the provider must:

• All staff must receive training relevant to their job role. Regulation 23 (1) (a)
• The practice must demonstrate that they can respond appropriately to medical emergencies. Regulation 9 (2)
• The practice must develop a formal procedure to respond to national patient safety alerts. Regulation 9 (1) (B) (i) (ii) (iii)
• The practice must ensure accurate stock control records are in place for the management of medicines. Regulation 13
• The practice must demonstrate how learning from significant events and clinical audits have influenced practice and improved patient outcomes. Regulation 10 (1) (a) (b) (2) (c)
• The practice must regularly seek the views of patients and those acting on their behalf to enable them to come to an informed view of the standard of care and treatment provided. Regulation 10 (2) (e)

In addition the provider should:

• The chaperone policy should provide more detail.
• The practice should introduce an on-line appointment booking system.
• The practice should ensure the clinical audit cycle is completed.
• The provider should introduce a back-up checking system to ensure that treatment recommendations and prescription changes made in hospital discharge letters have been responded to.
• The practice should establish a patient participation group (PPG) to support quality monitoring.
• The practice should include timescales for dealing with complaints in the complaints leaflet.
• The practice should improve access and information sharing through the introduction of a website.
• The practice should consider giving more time to staff personal development.
• The practice should formalise plans for the future of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice