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The Clapham Family Practice Good

Reports


Inspection carried out on 03 Dec 2019

During a routine inspection

We carried out an announced comprehensive inspection at Clapham Family Practice on 3 December 2019 to follow up on the breaches of regulations identified in the last inspection (November 2018).

At the last inspection in November 2018 we rated the practice as requires improvement overall with requires improvement in safe and effective because:

  • The provider did not have systems in place for safe management of high-risk medicines and security of prescriptions.
  • Systems in place to manage infection prevention and control required improvement.
  • The practice did not have a formalised risk register in place, but individual risk strategies were in place where they had been identified.
  • The practice was not able to provide appraisal documentation for some staff.
  • The practice had undertaken a number of audits, but only one was two cycle, and this had not shown improvement from the first cycle to the second.
  • There was no formal system in place to follow-up two week wait referrals.

At this inspection, we found that the provider had addressed these areas; however, we identified some new issues.

We based our judgement of the quality of care at this service 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.

We have rated this practice as good overall, with requires improvement for effective and outstanding for the population group people whose circumstances make them vulnerable.

We found that:

  • There were appropriate processes in place to keep patients safe.
  • The provider had not considered some incidents as significant events.
  • Some of the staff had not received training relevant to their role.
  • Patients received effective care and treatment that met their needs; however, the uptake for cervical screening and childhood immunisations were slightly below average.
  • Staff dealt with patients with kindness and respect and patients we spoke to indicated that they were involved in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. However, some of the patients we spoke to indicated it was difficult to get appointments.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care; however, governance systems in place required some improvement.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.

We rated the practice as outstanding for providing responsive services to people whose circumstances make them vulnerable because:

  • Services were tailored to meet the needs of patients within this group. They were delivered in a flexible way that ensured choice and continuity of care, particularly for people in the LGBT community.
  • There were innovative approaches to providing integrated person-centred care.
  • The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

We observed one area of outstanding practice:

  • The practice had recently won a Gold Award for excellence in lesbian, gay, bisexual and trans healthcare. To win this award, the practice had created a Trans register and had developed new patient registration forms to include sexual orientation and trans status monitoring. They also redesigned their website to include information on health screenings specific to trans people who might otherwise be missed. The practice assigned a nominated GP LGBT Staff Champion and updated their policies to be more LGBT inclusive.
  • Patient feedback indicated that GP’s were very supportive of Trans people and especially the correct use of pronouns when addressing them. They also stated that they had been referred to specific LGBT trans counselling and support groups and had signposted friends in the LGBT community to the Clapham Family Practice.
  • A Pride in Practice co-ordinator who the practice works with also spoke highly of the level of training and commitment to the LGBT community the practice have shown and acknowledged that many patients have commented with positivity, pride, thanks and enthusiasm on the work and the service being provided for LGBT patients.

The areas where the provider must make improvements:

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

The areas where the provider should make improvements are:

  • Continue with current staff recruitment drive to increase staffing levels and help improve staff satisfaction.
  • Review procedures for the recording of meeting minutes.
  • Review procedures in place for identifying carers so they are identified, and their specific needs can be met.
  • Consider ways to improve uptake for childhood immunisations and cervical screening.
  • Review procedures for the recording of induction procedures for new staff.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 6 November 2018

During a routine inspection

This practice is rated as Requires Improvement overall.

The practice consists of what was two former practices which merged in July 2018. Both practices had previously been inspected by CQC. The main site which has always been known as Clapham Family Practice was inspected in October 2016 and was rated as good in all areas. The site at 86 Clapham Manor Street was inspected in April 2018 and was rated as requires improvement overall. It was rated as inadequate for safe, requires improvement for effective and well led and as good for caring and responsive. All population groups were rated as requires improvement.

The report stated where the practice must make improvements:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure that systems and processes are established and operated effectively to ensure compliance with the requirements of good governance.

In addition, the provider should:

  • Review the arrangements for identification of patients with caring responsibilities so they can provide and signpost them to the appropriate support.

We carried out an announced comprehensive inspection at The Clapham Family Practice on 6 November 2018. The inspection was a comprehensive inspection of the newly merged organisation, but also a follow up of the inspection at the Clapham Manor Street site.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

At this inspection we found:

  • 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 had some implemented defined and embedded systems to minimise risks to patient safety, although the management of sharps was not in line with national guidance.
  • The practice did not have systems in place to ensure the safe management of high risk medicines and the security of prescriptions.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, some members of staff had not been appraised.
  • 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 and treated patients with compassion, kindness, dignity and respect.
  • Information about services and how to complain was available.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • Governance systems were in place in most areas, but clinical meetings were not documented.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure that systems and processes are in place to ensure compliance with the requirements of good staffing.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 29 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 29 June 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety.
  • There was a system in place for reporting and recording significant events.
  • Risks to patients were assessed and generally well managed but the practice was not effectively managing its patient group directions.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and 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.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • Review and monitor the management of patient group directions to ensure they cover all relevant medicines and they are all signed and up to date.

  • Ensure health and safety risks in the premises are assessed, and mitigating action is taken in respect of these risks.

  • Keep adequate records of safeguarding meetings with health visitors and social workers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 31 January 2014

During a routine inspection

People who used the service told us, “The service is fantastic,” and there are “good doctors.” Another person told us it’s an “excellent practice.” Some people were unable to speak to us during the inspection day but had left comments on the NHS choices website. The comments included, “Doctor is fantastic - very understanding, friendly and never condescending or patronising. Can't speak highly enough.” Another person stated, “My GP is exceptional and extremely helpful, the staff when you walk in are friendly and cheerful.” Another person stated, “The doctor was unrushed, made a thorough examination and gave full immediate care and a referral to the hospital of my choice.” Many of the comments on NHS choices from people over the last month were about difficulties they had experienced in getting an appointment. One person stated, “The issue with this practice is that it's impossible to call in and many times I had to give up.” Another person stated, “Trying to get an appointment with this surgery is almost impossible,” and a person reported “being on hold for 20 minutes.”

The practice was improving the system. In response to feedback from people who used the service, the appointment schedule had been reviewed and the number of appointments that were available to be booked 48 hours in advance and a week in advance had increased. In addition, the practice had introduced daily appointments for emergencies.

The practice had systems in place to maintain the safety and welfare of people using the service.

There were processes in place to protect people using the service from abuse. Staff were knowledgeable in recognising signs of potential abuse and the relevant reporting processes.

There were appropriate recruitment and selection processes in place. The records we saw showed that staff had the appropriate skills, knowledge and experience to support people using the service.

There were processes in place to monitor the quality of the service. Learning from complaints and significant events was shared amongst the staff team.