The Care Quality Commission
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Archived: Park Lodge Medical Centre

Overall: Requires improvement read more about inspection ratings

808 Green Lanes, London, N21 2SA

Provided and run by:
Park Lodge Medical Centre

Important: This service was previously registered at a different address - see old profile

All Inspections

18 May 2021

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Park Lodge Medical Centre on 18 May 2021 and a remote clinical review on 12 May 2021 to follow up on breaches of regulations. Overall the practice is rated Requires Improvement, with the following ratings for each key question:

Safe - Requires Improvement

Effective - Good

Caring - Good

Responsive - Good

Well-led - Requires Improvement

Why we carried out this inspection

This inspection was a comprehensive follow-up inspection to follow up on:

  • Breaches of regulation found at our last inspection; and,
  • Action the practice had taken in regard to areas where it should make improvements.

The practice was previously inspected on 28 November 2019. Following that inspection, the practice was rated Requires Improvement overall (and for the key questions including: Safe, Effective, Responsive and Well-led, it was ratedGood for providing a Caring service) for issues relating to medicines management, Safety alerts, Fire drills, patient follow-up, prescription management, staff training, maintaining staff records, safe premises, Medication reviews, quality outcomes forchildhood immunisations, patients with diabetes and hypertension, booking appointments and telephone access. It was also rated as requires improvement for all population groups.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Park Lodge Medical Centre on our website at www.cqc.org.uk

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our Findings

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 requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

  • The practice was not recording evidence on patients records of regular blood test monitoring for all patients being prescribed high-risk medicines.
  • When issuing prescriptions for one high risk medicine the practice did not indicate the day of the week patients should take the medicine, contrary to a medicine’s safety alert issued in September 2020.
  • Medical alerts and minutes of meetings were distributed to all relevant staff, and copies of alerts were added to the shared computer files so all were able to access them. However, there was no requirement for staff to confirm they had received and read medical alerts or meeting minutes.

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

  • The practice had implemented an effective system to ensure regular medicines and health reviews were undertaken for elderly patients and patients with gestational diabetes.
  • Child immunisation uptake rates remained below the World Health Organisation (WHO) targets; however, the practice had significantly improved its performance.

We rated the practice as Good for providing caring services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice carried out its own patient surveys to gain patient feedback.
  • During the Covid-19 Pandemic:
    • the practice was a vaccination’s hub for its own and other local practices’ patients. It had conducted a survey of patient’s experiences of attending the practice and found: 100% (165 out of 165 patients) responded positively about their overall experience of attending the practice.
    • it had delivered in excess of 35,000 vaccinations to patients. It had achieved a 0% wastage, with every vaccine dose it received being used in the vaccination of a person attending for vaccination.
  • During the 2020-2021 flu season the practice administered vaccinations to its patients. It had also conducted a survey and found: 97% (63 out of 65 patients) responded positively about their overall experience of attending the practice.

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

  • The practices’ own survey and the 2021 GP Patient Survey found significantly higher levels of patient satisfaction than at the time of our previous inspection.

We rated the practice as Requires Improvement for being well-led because:

  • The practice had revised its policies and procedures. However, it did not always have clear and effective processes for ensuring safe care and treatment and managing risks, issues and performance. In particular, the practice procedures for distribution of medical alerts and minutes of meetings did not ensure all clinicians were made aware of these.
  • Patient notes did not record up to date blood test monitoring for all patients being prescribed high-risk medicines.

We have rated this practice as Requires Improvement overall and Good for all population groups except for People with long-term conditions which we have rated as Requires Improvement.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Continue to work to improve uptake by eligible patients of childhood immunisations and cervical screening.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Consider recording whether do not attempt cardiopulmonary resuscitation (DNACPR) records are either subject to a review date, or state that the decision was indefinite.

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

28 November 2019

During a routine inspection

We carried out this announced comprehensive inspection at Park Lodge Medical Centre on 28 November 2019 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.

The practice was previously inspected in April 2018 and rated as good in all domains and population groups.

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 requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

  • Two safety medication alerts had not been actioned.
  • The practice did not follow best practice guidelines with regards to vaccination storage.
  • The practice did not offer immunisations or hold a record of immunisation status for non-clinical staff members.
  • Fire drills had not been regularly carried out and fire marshals had not received appropriate training.
  • All patients were not followed up after being referred into the two-week wait (TWW) cancer referral system.
  • Comprehensive health and safety risk assessments had not been carried out.
  • The serial numbers of blank prescription pads given to specific prescribers were not recorded.

We rated the practice as requires improvement for providing effective services because:

  • The practice’s QOF performance was lower than local and national averages for the long-term conditions’ indicators relating to diabetes and hypertension.
  • Child immunisation uptake rates were below the World Health Organisation targets.
  • We were not satisfied that the practice had an effective system in place to ensure regular medicines and health reviews were undertaken for elderly patients and patients with gestational diabetes.
  • We were not satisfied the practice had an effective system for sharing and cascading clinical learning amongst relevant staff.

We rated the practice as requires improvement for providing responsive services because:

  • Since the last inspection in April 2018 there was continuing concerns and patient dissatisfaction regarding; timely access to the practice via telephone; experience of making an appointment; and the appointment times offered.

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

  • The overall governance arrangements required improvement.
  • The practice did not always have clear and effective processes for managing risks, issues and performance.
  • The practice did not always act on appropriate and accurate information.

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

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

For the responsive domain, we rated all the population groups as requires improvement as we identified continuing concerns regarding timely access to the service which affected all patients.

For the effective domain, we rated people whose circumstances may make them vulnerable and people experiencing poor mental health as good. We rated older people as requires improvement because medication reviews for all older patients had not been carried out. We rated people with long-term conditions as requires improvement because performance indicators for diabetes and hypertension were below national and local averages. We rated working age people as requires improvement because the cervical screening uptake rate was below the national target. We rated families, children and young people as requires improvement because performance in the uptake of childhood immunisations were below the World Health Organisation targets.

The above ratings of the population groups across the effective and responsive domains resulted in all the population groups being rated as overall requires improvement.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way (Please see the specific details on action required at the end of this report).
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review how the practice will respond to and meet the needs of patients who request to see a male clinician.
  • Continue with efforts to improve the up-take of cervical screening.
  • Continue with efforts to improve the uptake for the childhood immunisation programme.

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

10/04/2018

During a routine inspection

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable– Good

People experiencing poor mental health (including people with dementia) – Good

We carried out an announced comprehensive inspection at Park Lodge Medical Centre on 10 April 2018. The location registered with CQC in April 2017 and this was the first inspection of the location under this registration. The practice was previously registered to a different provider and had been inspected under that registration on 31 March 2016.

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Patient feedback indicated that people sometimes found it difficult to gain access to the practice by telephone, although they were usually able to get an appointment when they did get through.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • The practice should review its telephone system and staffing level at reception in response to patient feedback.
  • The practice should review its processes for ensuring all staff are up to date with mandatory training.
  • The practice should review its policy on exception reporting and consider making arrangements to remove patients no longer with the practice.
  • The practice should review processes used to manage patient related correspondence with a view to ensuring that that all correspondence, including non-urgent items, are managed in a timely manner.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice