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Sydenham Green Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 11 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sydenham Green Group Practice on 29 June 2016. The overall rating for the practice was good, but requires improvement for providing safe services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Sydenham Green Group Practice on our website at www.cqc.org.uk.

This inspection was carried out on 11 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 29 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • Action had been taken to address all of the areas we identified for improvement.
  • There was a written policy to make clear the purpose and process of significant event analysis, and this had been shared with staff. We saw minutes of meetings and significant event records, which showed discussion and learning.
  • There was a documented system of review and action on safety alerts, for example, on medicines.
  • There was a 'failsafe' system for urgent referrals to ensure patients received a swift appointment.
  • Arrangements for prevention and control of infections had been strengthened. The practice lead had received specialist training and had dedicated time for the role. An audit was underway.
  • The practice had medicines and equipment to treat medical emergencies, and these were checked regularly.
  • Complete recruitment checks had been undertaken for the two new staff members we checked. Not all of the checks had been documented for one member of staff.
  • New staff members had received an induction, appraisals were underway for all staff members.  A training policy was being developed.

The practice were still working on some of the actions we recommended, therefore the practice should:

  • Complete the planned appraisal programme.
  • Ensure that all recruitment checks are documented.
  • Continue to monitor the new infection control arrangements to ensure these are working effectively.
  • Complete the training policy to provide a structure for oversight of training.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 May 2017

Action had been taken to address the issues identified at the previous inspection. The practice is now rated as good for providing safe services.

  • There was a written policy to make clear the purpose and process of significant event analysis, and this had been shared with staff. We saw minutes of meetings and significant event records, which showed discussion and learning.
  • There was a documented system of review and action on safety alerts, for example, on medicines.
  • The practice ensured that  the hospital had made appointments for patients referred for urgent tests.
  • Arrangements for prevention and control of infections had been strengthened. The practice lead had received specialist training and had dedicated time for the role. An audit was underway.
  • Complete recruitment checks had been undertaken for the two new staff members we checked. Not all of the checks had been documented for one member of staff.
  • The practice had medicines and equipment to treat medical emergencies, and these were checked regularly.

Effective

Good

Updated 11 May 2017

Caring

Good

Updated 11 May 2017

Responsive

Good

Updated 11 May 2017

Well-led

Good

Updated 11 May 2017

Checks on specific services

People with long term conditions

Good

Updated 20 October 2016

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.
  • Performance for some diabetes related indicators was below the national average. We saw evidence that the practice had improved its QOF performance for three consecutive years, and that (based on unvalidated QOF data for 2015/16) performance in diabetes indicators had also improved.
  • The practice was part of a Lewisham practice improvement scheme. As part of this, clinical staff had had care planning training, which increased the number of patients receiving education about their diabetes.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 20 October 2016

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 relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 81%, which was comparable to the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 20 October 2016

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The Elderly Care nurse provided a valuable service for older patients. Research carried out by the practice suggested that in a three month period the work of the elderly care nurse meant that 23 patients avoided hospital admission. The nurse explained to us that her knowledge of individual patients’ normal state of health allowed her to make a rapid and effective assessment when they are unwell. We heard of examples of how the elderly care nurse had acted as an effective co-ordinator for health and community services for older people, and avoided them being admitted to hospital.

Working age people (including those recently retired and students)

Good

Updated 20 October 2016

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.
  • Appointments were available at times to make it easier for working people to attend.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Performance for mental health related indicators was generally in line with the national average.
  • 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The practice was instrumental in the setting up of Sydenham Gardens, a charity which uses gardening and nature to help people in their recovery from mental and physical ill-health, and which was originally set up on land belonging to the practice. The charity carried out annual evaluation of its work, which showed significant improvement in patient outcomes.

People whose circumstances may make them vulnerable

Good

Updated 20 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • 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 regularly worked with other health care professionals in the case management of vulnerable patients.
  • 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 regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.