Bexley Medical Group

Bexley Medical Group is a provider registered with CQC.

We carried out an inspection of Bexley Medical Group on 12 and 27 November 2019 because of concerns we received about the provider.

This inspection focussed on the key questions of Safe, Effective and Well-led.

Because of the assurance received from our review of information we carried forward the ratings for the key questions caring and responsive.

We rated the practice as good overall with the following key question ratings:

Safe – Requires improvement

Effective – Good

Well-led – Good

The practice had previously been inspected 24 April 2019 and had been rated as good overall and in four of the five key questions; safe was rated as requires improvement.

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: safe remains rated as requires improvement and we rated them as good for being effective and well led. Whilst they are rated as good for providing effective services, the population group of people experiencing poor mental health (including people with dementia) was rated as requires improvement.

We rated the practice requires improvement for providing safe services because:

• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse. However, some health and safety systems did not operate effectively; particularly in relation to some aspects of fire safety, infection prevention and control, dealing with medical emergencies, and managing prescription stationery.
• The practice had partial arrangements in place to ensure staff vaccinations were completed in accordance with published guidance.
• Appropriate standards of cleanliness and hygiene were met but the service had not assessed risks associated with infection control at all their practice sites
• There were adequate systems to assess, monitor and manage risks to patient safety, but some arrangements for dealing with medical emergencies were in need of review.
• The practice had systems for the appropriate and safe use of medicines, including medicines optimisation. However, the management of prescription stationery was in need of further review.

We have rated the practice as good for providing effective services because:

• Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
• The practice was able to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
• However, we have rated the practice as requires improvement for providing effective services for people experiencing poor mental health (including people with dementia) as they had high exception reporting rates for patients in this population group, and these rates were higher than the previous year.

We rated the practice good for being well led because:

• There was compassionate, inclusive and effective leadership at all levels.
• There were clear responsibilities, roles and systems of accountability to support good governance and management.
• There were clear and effective processes for managing most risks, issues and performance. However, staff did not have oversight of some health and safety risks.

The areas where the provider must make improvements are:

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

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to review areas of high QOF exception reporting to ensure they are taking all practical steps to provide people with the care and treatment they need.
• Continue with their current work programme to improve the service offered to patients with learning disabilities.
• Continue to review physical access arrangements at the King Harold’s Way location.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

Bexley Medical Group is a provider registered with CQC.

We carried out an inspection of the provider on 24 April 2019 as part of our inspection programme.

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 and good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• The practice had systems in place for the safe management of patient’s medicines. However prescription stationary usage was not being tracked and IT systems were not being updated with patients’ review dates.
• Risk management systems for premises were lacking. For example at one branch site the premises were managed by a third party and the practice had limited oversight or awareness of risk management activities at this site. Action had not been taken to mitigate risks associated with legionella. Infection control risks had not been assessed within the last 12 months and not all staff had completed fire safety training.
• Comprehensive recruitment checks were in place for staff including locum staff. However not all staff whose files we reviewed had records of immunisations against common communicable dieases.
• Safeguarding systems and processes were clear and effective.
• Staff were not all aware of the systems and process for reporting signficant events although we saw good examples of action and learning stemming from events that had been reported.

We rated the practice as good for providing effective services because:

• There was evidence of quality improvement activity.
• Staff were receiving regular appraisals.
• Effective joint working was in place. The practice held monthly multidisciplinary meetings and detailed records of discussions and action points were retained.
• Patients were receiving regular reviews and the treatment provided was in line with current guidelines this was reflected in high levels of achievement against local and national targets. Although there were instances of above average exception reporting; the sample of records we reviewed showed that the exception reporting was appropriate.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care. Some patient feedback was below local and national averages. Staff attributed this to problems with the practice’s IT system.
• The practice had a carers register and staff were actively trying to increase the identification of patients with caring responsibilities and improve the support offered to these patients.

We rated the practice as good for responsive services because:

• The practice had worked to accommodate an influx of patients from a nearby surgery which had recently closed. Care had been taken to optimise the care and treatment of these patients.
• Complaints were managed in a timely fashion and detailed responses were provided.
• Feedback from both the patient survey and comment cards received by CQC indicated that it was easy to access care and treatment at the practice. The practice was continually reviewing and adjusting the appointment system to cater to the needs of patients.

We rated the practice as good for providing well-led services because:

• There were effective governance arrangements in most areas.
• The provider had adequate systems in place to assess, monitor and address most risks.
• The provider had an active patient participation group and there were structured feedback and engagement mechanisms for patients.
• There was evidence of continuous improvement or innovation.
• Staff provided positive feedback about working at the service which indicated a good working culture.
• The practice had taken action to ensure the sustainability of the service and responded well to challenges associated with the dispersal of the patient list from a nearby service which closed and problems associated with migration to a new IT system.

The areas where the provider must make improvements are:

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

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review areas of high QOF exception reporting to ensure that exception reporting is appropriate.
• Update the practice’s locum pack.
• Review areas of the national patient survey which are below local and national averages and act to improve patient satisfaction in these areas.
• Continue with planned work to improve the service offered to patients with learning disabilities.
• Continue to review the system for coding patient who act as carers.
• Review physical access arrangements at the King Harold’s Way location.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.