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Instant closure of surgeries

Two GP surgeries are closed by court order ‘with immediate effect’ for first time in East Anglia, The Eastern Daily Press reported.

Two doctors’ surgeries, with more than 5,000 registered patients in the Lowestoft area, have closed as urgent legal action was taken following “serious concerns about the service and the risks it presented to patients”.

The CQC has cancelled the registration of Oulton Medical Centre and its satellite branch of Marine Parade Surgery, a first “urgent cancellation of a GP’s registration” in Suffolk, Norfolk or Cambridgeshire, under a Section 30 order of the Health and Social Care Act 2008.

What does this mean for GPs?
This is not new to those operating care homes and dentists who are not given second chances in such cases. So far, GPs have been isulated from strict measures and treated with kid golves by the CQC, thanks largely to the influence of the BMA and GMA.

This was the result of an unannounced inspection in March 2015, when the services were rated inadequate and placed into special measures. In a follow up visit in October the CQC said: “Further concerns were identified in relation to a lack of clinical leadership and a failure to learn from errors, meaning patient wellbeing was placed at risk.”

 

Editor's note:-

Amazingly, the PPG co-ordinator said "the closure came as as a surprise and a shock to the patients",s o once again we see a practice deemed perfectly adequate by the patients as well as the PPG, and yet the CQC find things that demand immediate closure.
This is not a criticism of the CQC, far from that, it demonstrates that patients are often ill informed about what constitutes a safe practice.

This is a lesson for practices not to be lulled into a false sense of security by positive comments by patients as they might simply be impressed by great service rather than great care.

Suspension Case Study

Southfields - Granville Road Surgery

We have already covered how a south London practice got suspended earlier this year. Although "suspension" implies something temporary, the consequences could be catastrophic and end up in closing you down altogether.

Looking beyond the fate of that practice, we should all be worried, even if we are not "that" practice. So what are the potential consequences of a suspension?.

Patients

Your patients get transferred, probably to a nearby NHSE site, until you are ready to open your doors again. It is quite likely that many will not return once they have lost confidence in your ability to look after them.

Bad publicity

In this case the local Guardian focused purely on all the issues that would strike a chord with patients and something they can visualise easily, such as dirty rooms. The image of a filthy practice where you will catch something, is difficult to shake off. Put yourself in the patient's shoes, and visualise a restaurant that Health & Safety has suspended for FOUR MONTHS. How bad would it have been? Can you ever trust them again? Would you take little kids there, ever?

When you Google Dr Mujib ul Haq Khan, all the bad news comes up before details of his surgery, this is what prospective patients will see first. The reputational damage could be irreparable.

My Federation

Your Federation will have to think twice before giving you a slice of contracts. In fact, this could be suicidal for them in the short run at least. So your immediate avenues to new revenues is cut off immediately.

What will the CCG do?

Any CCG would rightly be cautious about any practice that has been suspended, and logically, even the Federation that your practice belongs to should be subject to more scrutiny. What sort of membership do they have? Do they check the quality performance of their members before bidding for contracts?

Lessons:

Look past the obvious failures highlighted by the CQC, the real risk of your practice being caught out could be a lot higher than you imagine, and could even be existential.

If you are currently part of a Federation, it is in your interests to make sure that a poor performing member does not risk and sink your Federation.

Why did a GP lose his case against the CQC?

Here is an interesting case of how Patient Safety interacts with compliance.

The CQC inspectors closed down the surgery of Dr Mujib ul Haq Khan of Granville Road Surgery in London. Dr Khan decided to take the CQC to a tribunal court, disputing several of the inspector's findings. His appeal was ‘unanimously dismissed’.

Dr Khan's viewpoint:
He is quoted as saying ‘I am disappointed by the decision of the tribunal, but I am grateful that it acknowledged my practice had run for 33 years, “without incident” and with very few complaints. I have been with the NHS for 45 years.'

He also contends that the CQC looked at hypothetical scenarios and "The decision to close my surgery did not relate to any actual treatment of my patients, for which no criticism has ever been made by either the GMC or the CQC"

 

So why does a practice with an "impeccable" record get closed down by the CQC?

The lesson to learn is that maybe nothing ever went wrong, BUT if you cannot demonstrate that you are taking prevention measures, YOU become the risk.

CQC’s arguments:

  1. Checks on staff had not being undertaken prior to their employment, and that the practice did not have systems in place for responding to risk.
  2. That, in the Tribunal’s view was indicative of Dr Khan’s careless, passive and reactive approach to the management of his practice.

Examples:-

  1. Lack of any adequate induction procedure for new locum doctors.
  2. Absence of any Disclosure and Barring Service check
  3. Hepatitis status check or references
  4. Lack of child protection or adult safeguarding policies
  5. Lack of adequate staff fire training.

GPs Point of view

  1. CQC acknowledged my practice had run for 33 years, “without incident” and with very few complaints.
  2. I have been with the NHS for 45 years.
  3. This is after all a decision by the CQC based largely on issues such as the keeping of records, fire risk assessments, extension cables and hypothetical scenarios.
  4. The decision to close my surgery did not relate to any actual treatment of my patients, for which no criticism has ever been made by either the GMC or the CQC

 

Editor's comments:

Dr Khan's performance was described as "careless, passive and reactive approach to the management of his practice".
The acid test for any independent audit is that you have to be able to demonstrate to a total stranger that you did what you said you did, when you said you did it.

Up to 95% of practices may not have read the CQC Guidelines yet

CQC Regulations came into force from 1st April 2013, and practices are already undergoing inspections. The registration process asked practices to certify that they meet the compliance standards set under the CQC regime, and practices are required to have made themselves familiar with the CQC Guidelines issued by the Care Quality Commission.

Although every practice has certified that they are compliant or that they have an action plan in place, alarmingly, anecdotal evidence suggests that up to 95% of Practice managers may not even have read the CQC guidance.

“We were the first independent organisation to hold CQC seminars for GP practices, and when we asked this question in 2011, hardly any hands went up” says Shabana Dehlavi, the editor of Everything CQC. “But what will be surprising to many is that the same applies, even today”.

If these straw polls were to be extrapolated to the general GP population, it would indicate that up to 95% of the practices have not read the Guidelines or gave up part of the way through, usually after reading just the first few pages. So if you too have not read the CQC Essential Guidance then it looks like you are in good company.

Most providers find the Guideline a difficult read because of the ‘bureaucratic’ language used.  Trying to ‘decipher’ the meaning of a single sentence can sometimes take quite some time, and most just give up mentally exhausted.

An example of this language is Prompt 3E about Fees, to be found on page 59 of the Guideline.

Contrast what the Guideline says:
“People who use services who pay the provider in full for their care, treatment and support and people who use services who enter into a separate arrangement with a service provider because they choose to pay for care, treatment and support that is not contracted on their behalf by a third party purchaser…”

What it means in plain English:
“If the patient pays for the entire treatment out of their own pocket, then …...”

The Guideline, is some 278 pages long, and it is not difficult to see why readers describe it as a cure for insomnia.

On a serious note, without a full understanding what the requirements are, practices are in danger of mis-declarations, and carrying on doing the wrong things for the rest of the year. This should be of great concern to GPs, especially Registered Managers, who may be held accountable.

 

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