Agenda item

The Director of Primary Care Transformation (DPCT) and the Clinical and Care Director (CCD) Barking and Dagenham at NHS North East London (NEL) delivered an update on the Tulasi Medical Centre and the Faircross Health Centre, following their inadequate Care Quality Commission (CQC) ratings, to assure the Committee of the action that was being taken to improve these. The presentation detailed that:

• Tulasi Medical Centre had been rated inadequate against all key questions asked by the CQC (about whether services were safe, effective, caring, responsive to people’s needs, and well-led). It had also had its registration with the CQC suspended; it could still hold its GP contracts under the regulations, but whilst it was rated inadequate and addressing CQC issues, it had had to subcontract its services to the GP Federation.
• There would be a six-month period in which Tulasi Medical Centre would have an action plan in place, approved by the CQC and NHS NEL, to address the issues found by the CQC. An NHS NEL team would monitor progress with the Centre on a weekly basis, as well as to support around aspects such as medicine management, safeguarding and infection and disease control.
• As a commissioner, NHS NEL had also issued a breach notice to Tulasi Medical Centre, which the Centre had six months to address. The Centre would be monitored by the regulator, CQC, and NHS NEL as it provided its services under the GP contract. NHS NEL would also work with NHSE to look at the competencies of the clinicians working at the site.
• Faircross Medical Centre had been rated inadequate by the CQC, but could still hold their registration with the CQC. Whilst NHS NEL was working with Faircross on its action plan, it had been inspected earlier in the year, and so was further ahead in addressing its remedial actions.

In response to questions from Members, the DPCT and the CCD stated that:

• At the end of the six-month remedial period, a CQC reinspection would take place. These often took between four-five days, with the CQC bringing in a new team to thoroughly check actions across all key domains, to ensure that auditing was being undertaken correctly and that policies were in place.
• GP practices did change over time. The Tulasi Medical Centre lead held a lot of responsibility on their own; one of their actions was to look into recruiting partners to share the workload. The lead had held various roles in the system and had since stepped back from these, to concentrate on their GP practice.
• The CQC worked independently from NHS NEL, but other practices were undergoing inspections as part of the CQC’s inspection cycle. Through the Borough Partnership, NHS NEL was looking at holding a quality roundtable to look into general practice, focusing on workforce, funding and workload issues, as well as what the system could do to best support practices and help them to prepare for CQC inspections. It was also holding educational training events looking at inspections, data and correct auditing practices.

The CM noted that one positive to the new NEL ICS arrangements was that extended knowledge sharing could take place, as well as the increased capacity for different parts of the NEL system to support each other. It was also important to acknowledge that the role of GPs had changed, with their responsibilities now much more widespread than previously, as well as the pressures associated with this. This also meant that more frank discussions around quality needed to be had, as well as which other professionals needed to support GPs in their practices. The Director of Public Health noted that whilst hospital clinicians were very restricted in terms of what work they could undertake, this was not the case with GPs. As such, there needed to be more discussions about the long lengths of time that GPs were now working for, as well as around all of the responsibilities that they had.

In response to further questions, the DPCT and CCD stated that:

• It was a very tough time for GPs, with multiple demands arising from the pandemic. The system had to support GPs, as well as give them space. It was also important to have conversations about the number of roles that GPs could hold, to prevent burnout, as well as how other professionals could be developed to take on some of these roles.
• The Tulasi Medical Centre was also a Covid-19 vaccination site, with multiple asks of it. GP practices were like standalone hospitals, with many areas of practice, and were expected to meet the demands of each of these. Whilst improvements would continue, the support of patients and Councillors was needed; if for example, a person had not had their annual diabetes review, a phone call to the practice would ensure that this was picked up.
• There was a monthly GP education and training event in Barking and Dagenham, as well as for nurses and management. NHS NEL could look through common themes and issues, and look to address these.
• Whilst the Tulasi Medical Centre action plan was not in the public domain, the CQC report was, with a decision tree of the findings available. As well as with NHS NEL, the Centre was in regular contact with CQC, submitting regular updates to them as well as to NHSE.
• Patient safety was paramount and the CQC could urgently shut down a GP practice if it felt that this was needed; however, this had not happened with either Tulasi or Faircross Medical Centre.
• Tulasi Medical Centre had brought in additional resources to assist with remedial work. The GP Federation had also brought in resources and NHS NEL had provided the Centre with resilience money to support them.

The CM stated that she would consider which briefings she could deliver for Councillors, as to how they could better engage with the work of GP practices.