Archived: Aspen Centre

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of London Medical Practice on 24 May 2016. We found that the practice had breached a regulation relating to the safe delivery of services. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. Overall the practice was rated as good.

The practice required improvement for the provision of safe services to ensure that the risks associated with assessing, monitoring and improving the quality of services were in place. Specifically we found the registered person did not have thorough recruitment procedures, including undertaking appropriate pre-employment checks to ensure persons employed for the purposes of carrying out regulated activity were of good character. Curriculum vitae’s (CVs) and reference checks had not been completed for all staff.

Following the inspection the provider sent us an action plan detailing how they would improve their recruitment process to ensure that they reflected national guidelines.

We carried out a desktop inspection of London Medical Practice on 9 November 2016 to ensure these changes had been implemented and the service was meeting the regulations previously breached. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report from 24 May 2016. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for London Medical Practice on our website at www.cqc.org.uk.

We found the practice had made improvements since our last inspection on 24 May 2016 and they were meeting the regulations that had previously been breached.

Specifically the practice was operating safe systems in relation to recruitment processes. This included:

• The practice had reviewed their systems for ensuring that two references were always received. The practice had amended the staff induction checklist to include a tick box for references requested and references obtained.

• The induction programme and recruitment policy were available on all practice computers to ensure that they were easily available for all staff members.
• The induction programme and recruitment policy were discussed at a practice meeting and minuted for all team members’ awareness.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 August 2016

The practice is rated as good for the care of patients with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance in 2014/15 for overall diabetes related indicators was 74% which was below both the clinical commissioning group average of 95% and national average of 89%. This was due to a staffing shortfall during this period, the practice showed us data from 2015/16 which showed they had achieved 100%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 August 2016

The practice is rated as good for the care of families, children and young patients.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations in 2015/16.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 71% which was below the national average of 77%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. There were baby changing and feeding rooms available.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The GPs held regular sessions at the King School in Gloucester.

Updated 10 August 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in influenza, pneumococcal and shingles immunisations.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice visited five local care homes weekly to see patients and carry out annual reviews, medication reviews and end of life planning. Each partner was allocated to a particular care home to ensure continuity of care.

Updated 10 August 2016

The practice is rated as good for the care of working-age patients (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours appointments were available on Saturdays twice monthly.

Updated 10 August 2016

The practice is rated as good for the care of patients experiencing poor mental health (including patients living with dementia).

• 87% of patients diagnosed with dementia had their care reviewed in the last 12 months (2014/15), which was above both the clinical commissioning group (CCG) average of 79% and the national average of 77%.

• Overall performance for mental health related indicators in 2014/15 was 91% compared to the CCG average of 97% and national average of 82%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 August 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.