We carried out a review of the data available to us about Green Cedars Medical Services on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Green Cedars Medical Services, you can give feedback on this service.
We carried out an announced comprehensive inspection at Green Cedars Medical Services on 16 August 2016. The overall rating for the practice was good, however the effective domain was rated as requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Green Cedars Medical Services on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 3 August, 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 16 August, 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice rating remains as good, the practice is now rated good for providing effective services.
Our key findings were as follows:
Exception reporting rates had decreased significantly since the inspection on 16 August 2016.Exception reporting is the removal of patients from quality and outcomes framework (QOF) calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.
Clinical audits were used to drive improvement in patient outcomes.
All staff at the practice completed fire safety training.
All screens used in clinical rooms were visibly clean and were included on the daily cleaning schedule.
Prescription pads were kept in a secure area and all serial numbers were recorded on a log maintained by the practice manager.
Comprehensive infection control audits were completed two to three times per year.
Carers were identified through new patient registration forms, posters in reception and clinical consultations. The number of carers identified was less than one percent of patients registered at the practice. The practice told us this was in relation to their young patient population. For example, the number of patients at the practice aged 60 years or older is significantly lower than the national average.
At our previous inspection on 16 August 2016, we rated the practice as requires improvement for providing effective services as exception reporting was much higher than local and national averages. At this inspection we found that the exception reporting rate had decreased significantly. The practice is now rated as good for providing effective services.
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Green Cedars Medical Centre on 16 August 2016. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
Exception reporting at the practice was much higher than the local and national averages.
There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
Risks to patients were assessed and well managed.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
The practice had good facilities and was well equipped to treat patients and meet their needs.
There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
The provider was aware of and complied with the requirements of the duty of candour.
The area where the provider MUST make improvements is:
Review clinical exceptions for all long term conditions to ensure they meet the clinical criteria for exception reporting.
The areas where the provider SHOULD make improvements are:
Ensure there are quality assurance systems for identifying improvements in clinical care including two cycle completed clinical audits.
Ensure all staff complete fire training on an annual basis.
Ensure screens in clinical rooms are added to the cleaning schedule.
Review audit systems in relation to prescription pads.
Ensure the action plan in the infection control audit has a clear timescale for completion of issues identified.
Review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to them.
Chief Inspector of General Practice
Green Cedars Medical Services, also known as Green Cedars Medical Centre, is situated in Edmonton in the south-east of the London Borough of Enfield. The area was one of very high social and economic deprivation compared with the west of the borough and with England as a whole. This impacted on the practice’s performance in relation to providing healthcare for patients with long term conditions, for example, because high numbers of its patients did not respond to reminders to come in for routine health checks and reviews. It was beyond the capacity of the practice to address the many misconceptions about, and misunderstanding of, disease management and the workings of the NHS that were prevalent in its practice population.
The practice is housed in premises that were originally two shops and had been adapted for primary medical services. The practice provided primary care medical services to around 5,600 patients. The practice did not provide GP services at any other sites.
During our inspection we spoke with GPs, the Practice Manager, the Practice Nurse and Health Care Assistant, and reception and administrative staff. We also spoke with patients and their families.
Patients and their families we spoke with were very satisfied with the practice and had confidence in the treatment and care the practice provided. They found the doctors and staff approachable and that they explained things well to them. They felt the practice cared about them and was responsive to their needs.
While we identified some areas for improvement, the practice was providing services that were safe, effective, caring, responsive and well-led. The day-to-day operation of the service was well managed and systems were in place to keep patients safe and protect them from avoidable harm. Patients’ needs were met by suitably qualified staff and the practice was demonstrably working to recognised best practice guidelines in some areas. Patients were treated with compassion and understanding. They found it easy to get in touch with the practice to make an appointment to see a GP and were seen within a clinically appropriate timeframe.
The practice had many fewer patients aged over 65 on its practice list than average and therefore relatively few patients with dementia. The practice had met the national requirement that all its patients aged 75 and over had a named GP responsible for their care.
The practice was developing ways of ensuring patients with long term conditions received ongoing monitoring to keep them as well as possible and to prevent hospital admissions.
The practice provided services to meet the needs of pregnant women attending their GP for the first time late in their pregnancy. It was working hard to meet the nationally expected childhood immunisation rate of 90%.
The practice provided access to GP appointments within a clinically appropriate time frame and within 48 hours at most. It provided services aimed at preventing disease.
The practice worked hard to make its services responsive to the needs of migrants to the UK arriving in the area.
The practice referred patients with depression to specialist services including psychological therapy, and promoted the physical health and wellbeing of patients with a serious mental illness.
The practice was registered with the Care Quality Commission (CQC) to carry on the following regulated activities:
The practice had not been inspected by CQC before.