The Sutherland Lodge practice in Chelmsford, Essex, was taken over by the private provider in July 2016 after the previous partners handed back their contracts in the wake of £400,000 cuts to their PMS funding.

Ahead of the takeover, the practice was among the 4% rated outstanding across England. But an inspection report published on 14 May by the CQC reveals that Sutherland Lodge is now rated inadequate overall. The report is based on an inspection carried out in December 2017 - just 18 months after Virgin Care took over the practice.

Inspectors have placed the practice in special measures, warning that if improvements are not made within six months Virgin Care could be stripped of the 10-year APMS contract it was awarded to run Sutherland Lodge.

APMS funding

The sharp decline in performance at the practice comes despite evidence that the contract awarded to Virgin cost more than the previous PMS contract. A freedom of information response from NHS England seen by GPonline confirms that the 'contract value rate' of the APMS deal awarded to Virgin was 14% higher than the 'PMS arrangements previously in place'.

Further major investment has been approved for premises improvements - Chelmsford City Council was advised last year by a spending panel to provide £525,000 in funding for 'full refurbishment of the Sutherland Lodge doctors surgery'.

Former practice manager at Sutherland Lodge Carol Sams said it was 'devastating' to see the rapid decline of the practice. She said that when the previous partnership was forced out by the threat of losing a third of its income, 'we had just completed our 19th year underspent in prescribing, our fifth year underspent in planned care and the many extra services we provided under our PMS contract had saved the local economy £750,000'.

GPC member Dr Katie Bramall-Stainer, who highlighted extra funding under the APMS deal at an LMCs conference in 2017, told GPonline: 'What is clear is that this practice, having lost its longstanding GPs, has in the space of two years gone from providing outstanding care to inadequate care.

PMS review

'Those doctors felt forced to resign due to a compulsory contract review which would have stripped thousands of pounds from their baseline. It was replaced by an APMS contract worth 14% more than the original contract. This had to be uncovered via FOI due to "commercial sensitivities".'

Under Virgin Care Services Ltd, the CQC rated Sutherland Lodge inadequate on four of the five key measures looked at by the regulator - the safe, effective, responsive and well-led categories - and rated it 'requires improvement' in the 'caring' category.

A damning report by the CQC found that 'risks to patients were not being appropriately assessed or their safety monitored and managed so that they were supported to stay safe'. Medicines and equipment 'were not always in date or stored at the correct temperature' and staff did not take action when temperatures were above recommended levels, it warned.

There was 'no evidence of learning from incidents to improve care', medicine reviews were not always taking place and reviews of high-risk medicines were inconsistent, inspectors found.

A lack of continuity of care reported by patients 'had a detrimental impact on the quality of patient treatment and care', services were 'not always planned or delivered in a way that met patients' needs', appointment systems were 'not working well' and the practice had 'no clear leadership structure', the CQC warned.

CQC inspection

Inspectors have placed the practice in special measures, and ordered Virgin Care Services to ensure that there are systems to manage risks to patients' health and safety, ensure that 'persons providing care of treatment to service users have the qualifications, competence, skills and experience to do so', improve governance and ensure proper and safe management of prescribing.

CQC chief inspector of general practice Professor Steve Field wrote in the report: '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 vary the provider’s registration to remove this location or cancel the provider’s registration.'

A spokesman for Sutherland Lodge Surgery said: 'We were aware of and were addressing issues at the surgery before the CQC’s inspection on 7 December. We have continued to implement our comprehensive action plan since, taking on board the inspectors’ feedback and the vast majority of improvements have been implemented and inspectors have already acknowledged improvements.'

Virgin pointed out that a follow-up inspection in January found that risks had been reduced and that steps had been taken to make improvements. The surgery is carrying out a training review, a review of vulnerable patients and those with long-term conditions.

It advised any patients with concerns to 'speak to practice manager Susan Wray or contact Virgin Care’s customer experience team on 0300 303 9509'.