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Sydenham Green Group Practice Good

Reports


Review carried out on 20 December 2019

During an annual regulatory review

We reviewed the information available to us about Sydenham Green Group Practice on 20 December 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 11 April 2017

During an inspection looking at part of the service

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 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 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