Archived: Eltham Palace Surgery

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. We looked at whether staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as Requires improvement. At this assessment, the rating remains the same.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment was effective because they did not consistently make and document a complete assessment of their needs, in line with legislation and current evidence-based good practice and standards. The service did not always check and discuss people’s health, care, wellbeing and communication needs with them

When we assessed the practice in May 2023 and April 2024, we found patients requiring high dose steroid treatment for severe asthma exacerbations were not always followed up in line with national guidance to ensure that treatment had been effective.We found this again at this assessment. We saw that some patients with this long-term condition were receiving medicines that should have stopped being prescribed when their treatment plan changed.

We reviewed 5 patient records who had been prescribed 12 or more short-acting beta agonist (SABA) inhalers. SABA inhalers are used to quickly relieve the symptoms of asthma. We found that they did not all receive the required review of their condition and treatment. In 2 of the 5 records we looked at, the reviews had not adequately considered the mismatch between the symptom control recorded and the amount of medicine that had been prescribed.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

Our remote clinical records searches identified 83 out of 525 patients whose last HbA1c reading was over 75mmol/L/. HbA1c is a measure of someone’s average blood sugar over the previous 2-3 months. We reviewed 5 of these patient records and found that treatment escalation plans were not consistently documented, nor was follow up initiated when blood pressure monitoring indicated potential hypertension.

We looked at the records of reviews of people’s medicines. These were generally of poor quality, with a lack of clinical justification for some prescribing and blood tests, and medicines remaining available to patients on repeat prescription despite no longer being required. Some of the reviews were for medicines that should not normally be used for long periods because of high risk of harm and dependency. These records reviews did not show that the safety and suitability of continued prescribing had been adequately assessed.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

At our previous assessments in May 2023, April 2024 and February 2025, we found there had been a breakdown in the partnership between the 2 GP partners which impacted staff and patients.

At this assessment, we found these concerns remained and the relationship between the GP partners remained challenging. It was unclear what steps had been taken to create a successful working partnership since the last assessment. One of the GP partners continued to work alongside the business manager and 1 of the salaried GPs in attempts to provide stability to the practice. We reviewed clinical meeting minutes and found 1 partner did not always attend these meetings. We saw evidence of 1 of the GP partners being assigned a task to complete in 1 meeting despite them not physically being present. The 2 GP partners reported following different processes in various scenarios (for example, 1 GP partner stated some of the processes referred to by the other GP partner either “did not work” or “did not exist” when asked, such as the process for managing test results). One of the GP partners also claimed that they were refused prescription paper and clinical equipment, as well as being removed from being able to see significant events or complaints on the practice electronic system.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.