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Inspection Summary


Overall summary & rating

Good

Updated 5 January 2017

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at Grove Medical Centre on 29 July 2016. Overall the practice is rated as good.

  • There was an open and transparent approach to safety and an effective system in place for reporting, recording and investigating significant events.

  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance; however the practice was an outlier for exception reporting for several indicators in relation to the Quality and Outcomes Framework (QOF).
  • 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 a strong focus on continuous improvement at all levels. There were high levels of staff satisfaction and staff felt supported by the practice’s leaders. 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.

There were some areas of outstanding practice:

  • The practice engaged with the local community through being a member of South London Citizens (SLC), an organisation that organises communities to act together for social justice and the common good. Their work with SLC included successfully approaching Lewisham council with to repair faulty street lighting in order to improve security in the local area, and being accredited as a ‘City Safe Haven’ where they could keep people who were fleeing threatening situations safe until the police or other appropriate support arrived. In addition, staff had received in-house training to enable them to identify female patients who may be at risk of undergoing female genital mutilation, and to understand the legal implications of this practice and their responsibilities in reporting such cases to the appropriate bodies. The lead GP visited multi-faith communities in the locality to raise awareness of the legal, moral and psychological implications of this practice.

There is one area in which the practice should make improvements:

  • Whilst acknowledging the practice’s high patient turnover rate, the practice should put into plan actions to address the high levels of exception reporting.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 January 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting, recording, investigating and learning from significant events. Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

  • The practice had very robust processes to ensure staff were adequately prepared to respond to emergencies.

Effective

Good

Updated 5 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with or above local and national averages for several indicators.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 5 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in July 2016 showed patients rated the practice in line with others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 5 January 2017

The practice is rated as good for providing responsive services.

  • Practice staff participated in a variety of activities to meet the needs of, and improve outcomes for, people in the local community and their staff. For example, they raised awareness of the dangers and legal implications of Female Genital Mutilation (FGM) through staff training and in local Islamic centres.

  • Travel vaccines, for which there would usually be a fee, were provided free to patients in order to encourage patients from deprived areas of the community to ensure they were adequately vaccinated before travelling.
  • Data from the national GP patient survey published in July 2016 showed patients rated the practice in line with others for several aspects of accessibility, and significantly above average for telephone access to the practice. 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.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. The provided phlebotomy (blood taking) and blood pressure monitoring in-house.

  • The practice offered a range of online services such as appointment booking and repeat prescription ordering.

  • Extended hours appointments were available every Tuesday and Wednesday until 7.30pm for working patients that were unable to attend during normal opening hours.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. The practice had analysed trends in complaints and shared learning from complaints with staff and other stakeholders.

  • Staff had received in-house training delivered by a GP on delivering good customer service and telephone manner to improve patients’ experiences of the service.

Well-led

Outstanding

Updated 5 January 2017

The practice is rated as outstanding for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for both patients and staff. Staff were clear about the vision and their responsibilities in relation to it, and there were high levels of staff satisfaction.

  • There was a clear leadership structure and staff told us they worked collaboratively and had high levels of support. Staff at all levels were engaged in the running of the practice and encouraged to identify areas for improvement and raise concerns.

  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on; they demonstrated positive examples of where they had done this to improve their service. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels. The practice’s leaders had a proactive approach to seeking improvements to benefit patients and staff within the practice, and people in the local community. Staff had received training to improve their awareness of the risks of Female Genital Mutilation and radicalisation and their responsibilities in relation to it, and the practice was accredited as a city safe haven for vulnerable people fleeing actual or perceived threat of violence. They had worked with local organisations to improve street lighting in the immediate area.

Checks on specific services

People with long term conditions

Good

Updated 5 January 2017

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.

  • Nationally reported data for showed that outcomes for patients with diabetes were above national averages. For example in the previous 12 months, 86% of patients with diabetes had well-controlled blood sugar (national average 78%). However, exception reporting was higher than expected.

  • Nationally reported data showed that outcomes for conditions commonly found in older people were in line with national averages. For example in the previous 12 months, 81% of patients with hypertension had well-controlled blood pressure (national average 83%). However, exception reporting was higher than expected.

  • Longer appointments and home visits were available when needed.

  • All patients with a long-term condition had a named GP and the majority had received a structured annual review to check their health and medicines needs were being met.

  • In the previous 12 months, 85% of patients with asthma had an asthma review. This was above the national average of 75%).

  • In the previous 12 months, 91% of patients with chronic obstructive pulmonary disease had a review of their condition. This was in line with the national average of 90%; however, exception reporting was higher than expected.

  • 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 5 January 2017

The practice is rated as good for the care of families, children and young people.

  • Staff had received training to enable them to recognise signs of radicalisation in young people and adults.

  • 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 attendances to Accident & Emergency.

  • Immunisation rates for vaccines administered to young children were relatively high in comparison with local averages.

  • 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.

  • In the previous 12 months, 86% of women aged between 25 to 64 years had a cervical screening test. This was in line with 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 5 January 2017

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. All patients aged over 75 years had a named GP.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. They provided care to patients in two local care homes where they had scheduled a joint visit with a consultant geriatrician to address any complex care needs.

  • The practice had a red light reminder system beside the staff exit which ensured that all scheduled home visits were completed for each day.

Working age people (including those recently retired and students)

Good

Updated 5 January 2017

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.

  • 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.

  • Extended hours opening was available until 7.30pm every Tuesday and Wednesday for working people who were unable to attend during normal opening hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 January 2017

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

  • The practice provided training to raise awareness of mental health issues in the local community and in Africa.

  • In the previous 12 months, 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting, which was above the national average of 84%. However, exception reporting was higher than expected.

  • In the previous 12 months, 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan in their record. This was in line with the national average of 89%. However, exception reporting was higher than expected.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 5 January 2017

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

  • The practice participated in activities that raised awareness of the legal and psychological implications of Female Genital Mutilation in the local community.

  • The practice had been accredited as a ‘City Safe Haven’ where they could keep people who were fleeing threatening situations safe until the police or other appropriate support arrived. They gave us examples of where this service had been successfully used by two patients.

  • 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, and 69% of 29 patients with a learning disability had received a review of their care in the previous 12 months.

  • 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.

  • Staff had received training to improve their awareness of the risks of radicalisation and their responsibilities in relation to it.