14 July 2014
During a routine inspection
New Cross Health Centre provides NHS primary care services to patients in the New Cross area of Lewisham in London. The practice currently has approximately 6000 patients on its list. The practie is registered with the Care Quality Commission to provide the following regulated activities: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures and treatment of disease, disorder or injury.
We carried out an announced inspection of the service on 14 July 2014. The team, led by a CQC inspector, included a GP, a former practice manager and a second CQC inspector. We spoke with six patients attending the practice on the day of the inspection and collected 28 comment cards which patients had completed about the service in the days running up to the inspection.
The practice had systems in place to manage risks associated with infection control, medicines management, staff recruitment, child protection and medical emergencies. However staff refresher training on adult safeguarding was out-of-date. There were mechanisms to investigate and learn from incidents and complaints.
Patients told us the service was caring. Most patients we spoke with were happy with the service they received at the practice although some patients said it was difficult to see the same doctor and this negatively affected their experience. These findings were echoed in the 2014 national GP patient survey. The practice benefitted from a Patient Participation Group and acted on patient feedback and complaints. Members of the patient participation group were not representative of the wider practice population.
The practice was able to demonstrate an understanding and awareness of the needs of the local population including students, people with enduring mental health needs, frail older people and people in vulnerable circumstances. The practice provided a number of services tailored to particular patient groups and provided additional services for its student population. There was good collaborative working between the practice and other health and social services. The practice had recently implemented an innovative online telehealth system to improve patient access to health information and advice.
There were arrangements in place to monitor quality and patient outcomes and the practice had recently focused on improving child immunisation and cervical screening uptake with success. The practice participated in clinical audits required to meet contractual targets, revalidation and appraisal requirements and external peer group meetings. However, the practice was otherwise making little use of clinical audit to drive improvements in clinical care.
Staff were recruited safely but the practice had been relying heavily on locum doctors to cover a high proportion of clinical sessions for several months following the departure of the lead GP. This had affected patients’ experience of continuity of care. It had also limited the doctors’ access to clinical leadership and support over the same period. At the time of the inspection, the risk was being addressed by using a smaller group of regular locums and the practice had recruited a lead GP who was due to start later in the Summer.
There were governance structures in place and an open reporting culture. The GP partners were located at a different site and, although responsive to staff concerns, were not proactively identifying and managing risks in the absence of a GP lead at the practice. Some aspects of governance and oversight needed improvement. We found that monitoring procedures were in place but not always fully carried out, for example daily fridge temperature checks were incomplete and out of date sterile dressings had not been disposed of. The practice had not formally notified the Care Quality Commission of changes to its partnership arrangements as required.
The provider was in breach of regulations related to:
- Safeguarding people from abuse
- Cleanliness and infection control
- Assessing and monitoring the quality of care
Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.