Sydenham Green Group Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sydenham Green Group Practice 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, although this was not familiar to all staff or documented comprehensively or consistently.
• Risks to patients were assessed and well managed.
• 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.
• Most patients said they were able to make appointments when they needed to, with urgent appointments available the same day. The practice recognised that patients felt that it was difficult to make appointments further in advance and had re-arranged its appointment system to provide more pre-bookable appointments. To relieve the pressure for same day appointments, the practice was providing patients with information about other sources of support for minor ailments.
• 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.

We saw two areas of outstanding practice:

• The practice decided to retain the role of Elderly Care nurse when local funding was withdrawn. The practice carried out its own research that showed that (over a three month period) the work of the elderly care nurse meant that 23 patients avoided unnecessary hospital admissions, and we were given several examples. 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. It is generally recognised that accident and emergency attendance and hospital admission should be avoided where possible, and particularly for vulnerable older people, who suffer particularly when moved to this stressful and unfamiliar environment.
• 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 has now grown and has two gardens, a nature reserve and activity rooms and runs four main projects, along with many supplementary activities and clubs. Three of these projects are focused on adult mental health and include gardening, art & craft, cooking and opportunities to achieve recognised qualifications. The fourth project is focused on dementia and includes all the same elements but with specific therapy for people with dementia. The charity carried out an annual evaluation of its work, including robust quantitative and qualitative measures of improvement in patients’ health and wellbeing. This showed statistically significant improvement in patient outcomes, which compared favourably with other types of intervention. For example, in 2015/16 the mental wellbeing of participants in the garden project increased by five points on the Warwick Edinburgh Mental Wellbeing Scale questionnaire. A change of three points is considered clinically significant. The rate of improvement ranged from 46% to 68%, which is strong when considering rates from established and targeted interventions, which very rarely go over 50%.The practice remained involved with the charity, and one of the GPs is the Chair of Trustees for the charity.

The areas where the provider must make improvement are:

• Review arrangements for managing medical emergencies (to ensure that emergencies including complications of minor surgery can be managed) and that records are kept of checks of emergency equipment.
• Strengthen arrangements for review of safety alerts, significant event analysis and urgent hospital referrals.
• Ensure staff recruitment is in line with regulations.

The areas where the provider should make improvement are:

• Strengthen arrangements to prevent and control the spread of infections.
• Complete an induction and annual appraisal for all staff. Review staff training policy to ensure that all staff receive the required training at the expected frequencies.
• Consider providing customer service training for reception staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice