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Dulwich Medical Centre Requires improvement Also known as DMC Crystal Palace Road

Reports


Inspection carried out on 31 Juy 2019

During a routine inspection

This practice is rated as Requires Improvement overall. (Previous rating December 2016 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

We undertook this comprehensive inspection on 31 July 2019, in response to information of concern we received.

At this inspection we found:

  • There were gaps in systems to assess, monitor and manage risks to patient safety; particularly in relation in the lack of salaried GPs and the lack of comprehensive induction for locum GPs.
  • The practice had systems for the appropriate and safe use of medicines, including medicines optimisation. However, some medicines management arrangements were not operating effectively.
  • 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.
  • There was limited monitoring of the outcomes of care and treatment.
  • The practice did not have a comprehensive induction programme for locum GPs, and there were gaps in staff supervisions.
  • Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people.
  • There was a lack of regular GPs that led to reduced flexibility in the services offered, and a lack of continuity of care.
  • Complaints were listened and responded to.
  • Leadership was complex and did not always function as intended.
  • The practice’s processes for managing risks, issues and performance were not always effective.
  • The practice did not always act on appropriate and accurate information.
  • There was some evidence of systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements as they are in breach of regulations are:

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

  • Carry out a fire drill in line with their fire safety procedures.
  • Provide information about the practice performance for patients and visitors.

Dr Rosie Benneyworth BM BS BMedSci MRCGP


Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 11 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 11 August 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 and an effective system in place for reporting and recording significant events.
  • 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.
  • The practice had two vacant GP posts, and their analysis of GP capacity had found they were regularly failing to fill GP sessions. The practice had taken action to mitigate risks to patients by employing additional health care staff.
  • 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.
  • Some patients said they found it difficult to book appointments. The practice had introduced a new appointment system in April 2016 and were monitoring patient feedback about the new system.
  • There was continuity of care for patients, 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 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.

The areas where the provider should make improvements are:

  • Continue to monitor and take action to improve patient satisfaction with making appointments.

  • Review how they identify carers so they are able to offer appropriate support.

  • Ensure that quality improvement initiatives including audits clearly demonstrate learning and improvement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 5 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dulwich Medical Centre on 05 November 2015. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

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

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Information about how to complain was available and easy to understand.

  • 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 monitored outcomes for patients with long-term physical and mental health conditions. They had taken action to improve the level of care for these patients through the employment of staff with specific responsibilities. Clinical audits were used to check the progress of the improvement programme.

  • The provider was aware of and complied with the requirements of the Duty of Candour.

  • Risks to patients were assessed but not all risks had been well managed. For example, risks relating to emergency medicines and Control of Substances Hazardous to Health Regulations (COSHH; 2002) had not been adequately addressed.

  • The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to. The provider had not adequately responded to patient feedback.

  • Appointment systems were not working well and patients found it difficult to understand how to make an appointment and access services in a timely manner.

The areas where the provider must make improvements are:

  • Analyse and respond to feedback received from patients as part of a process of driving improvements in care and service.

  • Monitor and audit the appointments system in order to drive improvement in the quality of access for patients as well as communicate more effectively with patients around changes to the appointments system, including the triage process and access to emergency appointments.

  • Carry out a Disability Discrimination Act audit to identify whether or not all reasonable adjustments to the premises have been made for wheelchair users and those with limited mobility.

  • Review the emergency medicines list and associated response protocols to ensure that all relevant medicines are kept and are easily and immediately available for use in an emergency.

  • Carry out an assessment of substances that may potentially be hazardous to health in line with the Control of Substances Hazardous to Health Regulations (COSHH; 2002) with a view to preventing or reducing exposures to these substances.

  • Engage clinical staff in a formal appraisal process and ensure that all members of staff have a personal development plan in place.

The area where the provider should make improvements are:

  • Review the complaints process to ensure that all relevant information is recorded and that complaints are acknowledged and responded to in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice