29 April 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of the practice on 10 June 2015. Breaches of legal requirements were found such that the safe domain was rated as Requires Improvement. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 12 (1) (2) (a) (b) (g) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We undertook this focussed inspection on 30 March 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Rushey Green Group Practice on our website at www.cqc.org.uk.
Overall the practice is now rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.
Our key findings across all the areas we inspected were as follows:
Care and treatment for service users was being provided in a safe way as the practice had taken steps to make suitable arrangements for emergency equipment and infection control and prevention.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
15 October 2015
The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
The practice had clinical leads for a range of long term conditions, including diabetes, respiratory disease, chronic obstructive pulmonary disease (COPD) and asthma.
The practice provided NHS Health checks and acted on those who had identified risks.
15 October 2015
The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to the local area for all standard childhood immunisations.
Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.
The reception team were aware to prioritise access to appointments to young children.
The practice trialled a walk-in clinic in the afternoon to allow for young children to attend but this turned out to be too difficult to manage because of the numbers and overcrowding in the waiting room. This pilot was tried for 6 months but proved not to be popular with patients.
The practice saw young people on their own who are not accompanied by an adult, in order to improve access and to facilitate safeguarding. The doctor then assessed the appropriateness of whether an adult should be contacted or not.
15 October 2015
The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice worked with multi-disciplinary teams in the care of older people. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice nurses carried out weekly house visits to housebound patients, which were over and above any routine appointment requests.
The practice has supported, from its infancy, the Rushey Green Time Bank, which is a community development time-exchange charity, based at the practice.
15 October 2015
The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering extended hours appointments, telephone consultations, online services as well as a full range of health promotion and screening that reflects the needs for this age group.
15 October 2015
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.
The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
The practice provided care and treatment to patients experiencing poor mental health, offering health checks, depo-medications on site and worked closely with the local community mental health team. The practice had a system of outreach, which included working with the pharmacist and keyworkers to ensure patients with mental health needs received health checks.
Until recently, the Lewisham Lead for dementia was one of the salaried GPs at the practice. The practice actively screened for dementia and worked with their social care and community nursing colleagues to provide holistic care.
15 October 2015
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
The practice is situated in central Lewisham, in one of the most diverse and deprived areas of the borough. Many of the practice patients do not speak English as their first language.
The practice held a register of patients living in vulnerable circumstances including homeless people, and those with a learning disability. The practice offered longer appointments for people with a learning disability. The practice accepted registrations of people who were homeless.
The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.
Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. One of the GP partners is the named GP for Lewisham for safeguarding children, and has developed the Safeguarding Children Policy and Procedures for Lewisham as well as the Safeguarding Standards, which were used by services across the borough.
The practice had one of the highest risk profile populations in Lewisham, including a high proportion of patients with long term mental illness. The practice had registered patients from a male homeless unit and several mental health and neurodisability units in the local area. The practice also had registered patients at a probation home with patients with significant forensic histories and a home for looked after young people.
Two of the practice GPs ran a locality-wide drug and alcohol community detoxification service together with a specialist nurse and a key worker. The practice worked closely with the drug and alcohol service for Lewisham and one of the GPs is the Substance misuse Lead for the CCG.