Swanscombe Health Centre

We carried out an announced comprehensive inspection at Swanscombe Health Centre on 22 and 23 February 2022 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. The overall rating for the practice was Requires Improvement.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Kent and Medway. To understand the experience of GP providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using the telephone / video conferencing.
• Requesting evidence from the provider.
• A short site visit.

Our judgement of the quality of care at this service is based 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.

Our findings:

This practice is rated as Requires Improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? - Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

We rated the practice as Requires Improvement for providing safe services because:

• All staff had not received safeguarding training to appropriate levels for their role.
• The practice’s computer system did not alert staff of all family and other household members of children that were on the risk register.
• Staff vaccination was not always maintained in line with current Public Health England guidance.
• Improvements to fire safety as well as infection prevention and control were required.
• Risks to patients, staff and visitors were not always assessed, monitored or managed effectively.
• The arrangements for managing medicines did not always keep patients safe.
• Significant events were not always reported in a timely manner and learning from them was not always shared with relevant staff.
• Systems for managing safety alerts were not always effective.

We rated the practice as Requires Improvement for providing effective services because:

• Patients’ needs were not always assessed, and care as well as treatment were not always delivered in line with current legislation, standards and evidence-based guidance.
• Patients with long-term conditions were not always receiving relevant reviews that included all elements necessary in line with current best practice guidance and not all patient reviews that we looked at were followed up where necessary in a timely manner.
• The practice did not have an effective programme of quality improvement activity that routinely reviewed the effectiveness and appropriateness of the care provided.
• Performance relating to child immunisations and cervical screening required improvement.
• All staff were not up to date with essential training.
• Staff were not always consistent and proactive in helping patients to live healthier lives.

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

• Staff treated patients with kindness, respect and compassion.
• Staff helped patients to be involved in decisions about care and treatment.
• The practice respected patients’ privacy and dignity.

We rated the practice as Requires Improvement for providing responsive services because:

• The practice organised and delivered services but these did not always meet patients’ needs.
• Not all facilities and premises were appropriate for services being delivered and complaint with The Equality Act 2010.
• Learning from complaints was not shared with relevant staff.

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

• There was compassionate leadership at all levels. However, leaders were not aware of all required improvements to quality, safety and performance.
• Improvements were required to the processes and systems that supported good governance and management.
• The provider’s registration with the Care Quality Commission required updating.
• The practice’s processes for managing risks, issues and performance were not always effective.
• Processes to manage current and future performance were not sufficiently effective. Improvements to care and treatment were required for some types of patient reviews as well as subsequent follow-up activities.
• Clinical audit activity did not demonstrate quality improvement.

The areas where the provider must make improvements are:

• Ensure all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

The areas where the provider should make improvements are:

• Consider displaying notices advising patients that chaperones are available if required at all branch surgeries.
• Consider recording that date that unwanted or unused controlled drugs are returned to the dispensary at Bean Village branch surgery.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.