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Inspection carried out on 7 February 2020

During an inspection looking at part of the service

We carried out an announced focussed inspection of Streatham High Surgery on 7 February 2020 following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the key questions effective, responsive and well-led.

Because of the assurance received from our review of information we carried forward the ratings for the key questions safe and caring.

We rated the practice as good overall with the following key question ratings:

Effective – good

Responsive– good

Well-led – outstanding

The practice had previously been inspected on 12 November 2014 and had been rated as outstanding overall: safe, effective and caring were rated good and responsive and well led were rated outstanding.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall.

We rated the practice as good for providing effective services because:

  • Patients received effective care and treatment that met their needs.

We rated the practice as good for providing responsive services because:

  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care, particularly for working age people.
  • There were innovative approaches to providing integrated person-centred care.
  • Appointments were available at Streatham High Surgery from 8am to 8.30pm on Mondays to Thursdays, 8am to 6.30pm on Fridays, and 9.30am to 12 noon on Saturdays. The practice also offered appointments with the nurse until 7.30 on Wednesdays, and on Saturdays and Sundays for cervical screening.
  • Clinicians had ‘catch up’ slots during their sessions to help ensure appointments ran on time.
  • The practice has signed up to the Safe Surgeries Initiative to help reduce barriers to registration.

We rated the practice as outstanding for providing well-led services because:

  • The culture of the practice, and the way it was led and managed, drove the delivery and improvement of high-quality, person-centred care.
  • The practice has launched a Diabetes Improvement Project. We saw evidence that this project was replicated across the Lambeth CCG and led to improvements in care delivered by 41 practices.
  • The practice has implemented a Bowel Cancer Screening Improvement Project. We saw evidence that the project led to an increase in screening. The project was implemented across several other practices, who also reported an increase in uptake.
  • There were excellent examples of how the practice’s vision and ethos were implemented by the staff team working together to maintain high standards, deliver positive health outcomes for patients and foster a supportive work environment.
  • The practice has used an inhouse analytical tool to improve the prevalence of patients with learning disabilities on the diabetes and hypertension registers. This has been shared with CCGs, who use the tool to identify patients who could be added to the hypertension registers for 60 other practices.

Whilst we found no breaches of regulations, the provider should:

  • Continue to take action to monitor and improve uptake of childhood immunisations and cervical screening.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 12 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Streatham High Surgery on 12 November 2014. Overall the practice is rated as Outstanding.

Specifically, we found the practice to be outstanding for providing responsive services and for being well led. It was rated outstanding at providing services to two of the six population groups we report on: Working age people and People whose circumstances may make them vulnerable. It was good at providing services for the other four population groups we report on: Older people, Families, children and young people, People with long-term conditions and People experiencing poor mental health. It was good for providing safe, effective and caring services.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from incidents were maximised.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
  • The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

  • Appointments are available at Streatham High Surgery 08.00am to 8.45pm on Mondays to Thursdays, 08.00am to 6.30pm on Fridays, and 09.30am to 12.00noon on Saturdays. The practice had been providing these longer surgery opening hours for a number of years, even before the introduction of this as an enhanced service to their contract.
  • Since July 2014, the practice had been supporting its patient participation group (PPG) to organise and provide Saturday drop in sessions at the surgery. These sessions were health promotion events, and the topics were selected by members of the PPG, responding to issues that mattered to patients. The provider employed a director of patient experience, engagement and community participation, who worked closely with the PPG to ensure the practice understood more about what was important for patients.
  • There were excellent examples of how the practice’s vision and ethos were implemented by the staff team working together to maintain high standards, deliver positive health outcomes for patients and foster a supportive work environment. The practice achieved the Royal College of General practitioners (RCGP) Quality Practice Award (QPA) and an Investor in People (IIP) award. QOF data for this practice showed the practice was performing exceptionally high compared with local and national averages, achieving an overall score of 99.9% in the 2013 /14 year.
  • The practice held multidisciplinary clinical team meetings twice weekly to discuss the needs of complex patients, for example those with end of life care needs or children on the at risk register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice