Archived: Park Lodge Medical Centre

Updated 4 August 2016

Park Lodge Medical Centre provides primary medical services in the London Borough of Enfield to approximately 8700 patients and is one of 49 member practices in the NHS Enfield Clinical Commissioning Group (CCG).

The practice population is in the third less deprived decile in England. There is lower than national average income deprivation affecting children (income deprivation affected 14% of children in the practice population compared to a national average of 20%). The practice had surveyed the ethnicity of approximately 85% of the practice population and had determined that 40% of patients identified as having white ethnicity, 4% Asian, 3% black and 38% as having mixed or other ethnicity.

The practice operates from a converted residential property with patient facilities on the ground and first floors. The ground floor is wheelchair accessible. There are offices for administrative and management staff on the first and second floors. All three floors are accessed via stairs.

The practice operates under a General Medical Services (GMS) contract (a contract with NHS England under which general practices deliver general medical services. This contract allows the flexibility to offer local and enhanced services within the contract) and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract). The enhanced services it provides are: extended hours access; facilitating timely diagnosis and support for people with dementia; improving patient online access; influenza and pneumococcal immunisations; minor surgery; risk profiling and case management; rotavirus and shingles immunisation; and unplanned admissions.

The practice team at the surgery is made up of two full-time male GP partners. There are five part-time female salaried GPs, and a part-time GP providing maternity cover. Park Lodge Medical Centre is a teaching and training practice with, at the time of our visit, one medical student and a full-time female GP registrar. The doctors provide 46 clinical sessions per week. The nursing team consists of two part time female practice nurses.

There are 10 administrative, clerical and administrative staff including one full-time practice manager, and a part-time practice secretary.

The practice is open between 8.00am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am and from 4.00pm to 6.30pm daily. Extended surgery hours are offered from 6.30pm until 8.00pm on Tuesdays, and from 8.00am to 11.00am on Saturdays. The practice has opted out of providing out of hours (OOH) services to their own patients between 6.30pm and 8.00am and directs patients to the OOH provider for NHS Enfield CCG.

Park Lodge Medical Centre is registered as a partnership with the Care Quality Commission to provide the regulated activities of maternity and midwifery services; surgical procedures; treatment of disease, disorder or injury; family planning; diagnostic and screening procedures.

Park Lodge Medical Centre has been inspected twice before by CQC under its old inspection methodology. The first inspection on 21 January 2014 found it non-compliant because there had been no recent infection control audit undertaken or risk assessment of infection control. This meant that there was no effective system in place to assess the risk of and to prevent, detect and control the spread of health care associated infections. On being re-inspected on 15 May 2014 the practice had undertaken an infection control audit and established a risk assessed action plan.

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Lodge Medical Centre on 31 March 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Patients always received a verbal and written apology.
• Patients said they were treated with compassion, dignity and respect.

• Information about services and how to complain was available and easy to understand.

• Urgent appointments were available on the day they were requested.
• The practice had proactively sought feedback from patients and had an active patient participation group.
• Risks to patients were not all well managed, in particular, the practice was deficient in regard to: recruitment checks; chaperone training; disclosure and barring service checks; safeguarding training; infection control training; failing to act on recommendations in its fire risk assessment; basic life support training for all staff; failing to act on recommendations in its legionella report; and it did not have a defibrillator on the premises or a suitable risk assessment of the need for one.
• Data showed patient outcomes were low compared to the locality and nationally. However, audits had been carried out, and we saw evidence that audits were driving improvement in performance to improve patient outcomes.

The areas where the provider must make improvements are:

• Ensure that recruitment arrangements include all necessary employment checks for all staff, and that staff follow a suitable induction programme following appointment, and thereafter receive appropriate professional development, supervision, and appraisals, as necessary to enable them to carry out their duties.

• Ensure that staff receive appropriate training and updates, including: chaperone training for all non-clinical staff who act as chaperones; safeguarding of vulnerable children and adults; basic life support training; and infection control.

• Ensure that all staff undergo Disclosure and Barring Service (DBS) checks or have a suitable risk assessment in place.

• Ensure that it addresses concerns identified in regard to: infection prevention and control including legionella assessments; and fire risk assessment including holding fire drills
• Ensure that there is a defibrillator available on the premises in the event of a medical emergency, or carry out a suitable risk assessment.

In addition the provider should:

• Review its QOF achievement (Quality and Outcomes Framework) (QOF rewards practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care) to identify ways to improve patient treatment.

• Review provision for non-urgent appointments to meet patient demand.

• Review how it identifies and records patients with caring responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 4 August 2016

The provider was rated as requires improvement for safety and for effective. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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, and all these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met.

• However, only 51% of patients with diabetes, on the register, had a last blood pressure reading (measured in the preceding 12 months) of 140/80 mmHg or less, compared to a national average of 78%.

Updated 4 August 2016

The provider was rated as requires improvement for safety and for effective. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 for the standard childhood immunisations were worse than local averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 15% to 20% (CCG averages 11% to 60%) and five year olds from 59% to 95% (CCG averages 65% to 86%).

• Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• 79% of women aged 25-64 had had a cervical screening test performed in the preceding 5 years, compared to a national average of 82%.

Updated 4 August 2016

The provider was rated as requires improvement for safety and for effective. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Care and treatment of older people did reflect current evidence-based practice, and older people did have care plans where necessary.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice offered personalised care to meet the needs of the older people in its population.

Updated 4 August 2016

The provider was rated as requires improvement for safety and for effective. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 4 August 2016

The provider was rated as requires improvement for safety and for effective. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• However, only 46% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months, compared to a national average of 88%.

Updated 4 August 2016

The provider was rated as requires improvement for safety and for effective. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice informed 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 in reporting any concerns, however, not all of them had received training in safeguarding.