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Archived: Bexley Group Practice Good

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Reports


Inspection carried out on 15 May 2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection November 2017 – Inadequate)

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

We carried out an announced comprehensive inspection at Bexley Group Practice on 15 May 2018 to check that the regulatory breaches in their previous inspection had been addressed, and to consider whether sufficient improvements had been made to bring the practice out of special measures. At this inspection we found significant improvements had been made. Overall the practice is now rated as good. I am taking this practice out of special measures.

At this inspection we found:

  • The provider had addressed all the issues that led to the breaches of regulations at their last inspection
  • The provider had moved its main practice location, and closed two of its three branch locations.
  • 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.
  • Staff involved patients in their treatment and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that there had been improvements in them being able to access care when they needed it. However, some patients still felt there were further improvements needed in accessing appointments and waiting for appointments.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • The practice had greatly improved their identification and offer of support to people with caring responsibilities
  • The practice provided regular health promotion poster campaigns and talks to people in the local community, which has raised awareness and increased diagnosis of the diseases focussed on during their campaigns.

The areas where the provider should make improvements are:

  • Review arrangements for the audit of clinical decision making for non-medical prescribers.

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

Inspection carried out on 26 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bexley Group Practice’s main site at Upper Wickham Lane on 11 August 2015 and at its Nuxley Road site on 25 August 2015. The two sites were registered as separate locations at the time of our inspections so received individual reports and ratings. At the main site (Upper Wickham Lane), the location was rated as requires improvement in Safe domain, but was rated Good in all other domains and rated Good overall. The Nuxley Road site was rated requires improvement in Safe and Well-led domains and was rated requires improvement overall. The full comprehensive reports of the August 2015 inspections can be found by selecting the ‘all reports’ link for Bexley Group Practice on our website at www.cqc.org.uk.

This inspection was undertaken as an announced comprehensive inspection on 26 June 2017. Overall the practice is now rated Inadequate

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. Equipment recommended for treating certain medical emergencies was not available in the practice, and the practice did not have suitable systems and processes in place to ensure medicines were available, appropriately stored and fit for use.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when systems and processes did not work properly, such as when they led to the inappropriate storage of medicines, reviews and investigations were not always properly carried out and lessons learned were not communicated widely enough to support improvement.

  • The practice had addressed the matters that led to breaches in regulations at our last inspections of Upper Wickham Lane and Nuxley road, with the exception of the lack of suitable risk assessments in place to mitigate against the risks of the lack of defibrillators at the branch sites.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average. However,

  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

  • Some patients reported that the appointment systems were not working well so they did not receive timely care when they needed it.

  • There were improvements needed in the management oversight of the governance arrangements, particularly in relation to the management of medicines.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvement are:

  • Review patient record keeping to ensure the most up to date test results are appropriately stored and available to clinicians when carrying out patient consultations

  • Review practice procedures to ensure there are arrangements in place to improve childhood immunisation rates

  • Improve systems and processes that support the identification of patients with caring responsibilities to enable appropriate support and signposting to be provided.

  • Consider ways to improve patient satisfaction with access to appointments

  • Consider ways to improve patient satisfaction with the areas of nurse consultations and interactions with reception staff where they scored poorly in the most recent GP patient survey

  • Review practice procedures to ensure feedback is obtained from patients and staff

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 11 August 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bexley Group Practice- Upper Wickham Lane on 11 August 2015.Overall the practice is rated as good.

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.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must

  • Ensure that health and safety building checks are undertaken and staff are adequately trained and updated in Fire safety.

Importantly the provider should

  • Ensure recruitment arrangements include all necessary employment checks for all staff
  • Ensure that lessons learnt from incidents are shared with all appropriate staff.
  • Ensure arrangements are in place for formal staff induction.
  • Ensure non-clinical staff attend the scheduled child protection training so they are trained to the appropriate level

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice