Inadequate Virgin practice understaffed and lacked clinical oversight, CQC found

A CQC check on an inadequate GP practice run by private provider Virgin Care found a 'sustained shortfall in appointments', a patient whose medication was stopped in error and tasks assigned to doctors not due to work at the practice for months.

CQC inspectors carrying out a surprise follow-up inspection at the Sutherland Lodge practice in Essex decided against 'significant enforcement action' after finding that care had improved since an earlier visit that led to an 'inadequate' overall rating for the practice.

GPonline reported earlier this year that the practice went from outstanding to inadequate in just 18 months after being taken over by Virgin Care - despite the private provider operating under an APMS contract worth 14% more than the PMS contract for the previous GP partnership at Sutherland Lodge.

Inspectors visiting unannounced for a 'focused inspection' in January - just over a month after the initial full check - found concerns remained around safety, leadership and access to appointments, a report published at the end of June reveals.

Inadequate rating

Virgin Care told GPonline that the report reflected the situation at Sutherland Lodge just a month after the initial inspection that triggered its inadequate rating - and that over the past five months a number of problems found at the practice had been tackled.

However, the focused inspection report highlights concerns that at that stage 'there remained no clinical oversight and letters were not being actioned in a timely manner'.

It says: 'A letter received in the practice on 17 November 2017 was scanned into the system on 6 December 2017, only allocated to be processed on 10 January 2018. That represented a delay of over seven weeks.

'A letter received on 12 December was scanned into the clinical system on 22 December. This letter was from a children’s consultant requesting the practice continue with a certain medicine. We reviewed their notes and saw the medicine had stopped being prescribed.'

The report highlights that inspectors 'saw from the outstanding task list that GPs who did not work frequently at the practice, had outstanding requests allocated to them'. One GP not due to work in the practice for the next two months had been allocated two 'outstanding tasks' on 27 December 2017. The report found 'no process to oversee outstanding tasks'.

Clinical need

Patients struggled to access appointments 'even where there was an urgent clinical need', the CQC found, highlighting 'a sustained shortfall in the delivery of GP appointment sessions'. Staffing levels 'did not compare with planned levels', the watchdog added.

Neighbouring practices have also warned that they are facing extra pressure from patients who are moving over from the Sutherland Lodge practice.

Improvements identified at the practice between the two CQC visits included a reduction in the number of clinical letters to be reviewed, measures to improve prescribing and medicines safety, a review of skill mix and staffing and some improvement with complaint handling.

A Virgin Care spokeswoman said: 'After inspectors visited in December, we immediately set about making the improvements and the report published on 29 June reflects the improvements we made in the three weeks after the original inspection in December.

'Over the last five months we’ve continued to make improvements. With a dedicated improvement team based at the practice, we’ve been working hard to recruit new doctors, adding additional appointments, calling patients back in for reviews and delivering training for the practice team.

'While there is still much more to do, we are confident patients are already seeing improvements and that they will continue to do so and we are looking forward to welcoming inspectors back soon to see the work we’ve done.'

Virgin Care says it has boosted admin support and back-office staff since the original inspection, and that available appointments have been increased to exceed the number contractually required. The provider says the majority of services it operates are rated 'good' by the CQC.

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