Background to this inspection
Updated
11 September 2019
Park House Medical Centre is located at 18 Harvist Road, London, NW6 6SD, with good transport links. The provider is registered with CQC to deliver the Regulated Activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury. The practice is located within the Brent Clinical Commissioning Group (CCG) and provides services to 5,257 patients under the terms of a General Medical Services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.
Information published by Public Health England, rates the level of deprivation within the practice population group as five, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 81 years compared to the national average of 79 years. Female life expectancy is 87 years, compared to the national average of 83 years. Information from Public Health England states that 58% of the practice population is of a White background with a further 16% of the population originating from the black background. The practice has a higher than the national average number of patients below 18 years of age and a lower than the national average number of patients over 85 years of age.
The practice team comprises of two female GP partners, one sessional GP and two locum GPs, who provide a combination of 26 clinical sessions a week. Also employed is full-time practice nurse and one healthcare assistant who provides 29 hours a week. Non-clinical staff employed include one practice manager, and six administration and reception staff. The practice was part of a network of four practices.
The practice opening hours are between 8.00am and 6.30pm on Monday to Friday. Extended hours are provided between 6.30pm and 8.00pm on Monday and Wednesday. The out of hours services is provided by Care UK. When the practice is closed the details of the 'out of hours' service are communicated in a recorded message accessed by calling the practice and can also be found on the practice website.
Services provided include chronic disease management, phlebotomy, child health surveillance, joint injections and cryotherapy, sexual health counselling and family planning services, ECG monitoring, spirometry, depot injections, TB screening service and cervical screening.
Updated
11 September 2019
We carried out an announced comprehensive inspection at Park House Medical Centre on 21 May 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 inadequate overall.
We rated the practice as inadequate for providing safe services because:
- The practice did not have clear systems and processes to keep patients safe.
- Monitoring was required to ensure that appropriate standards of infection control were met.
- There were gaps in systems to assess, monitor and manage risks to patient safety.
- Staff did not always have the information they needed to deliver safe care and treatment.
- The practice did not have appropriate systems in place for the safe management of medicines.
- The practice did not learn and make improvements when things went wrong.
We rated the practice as inadequate for providing effective services because:
- There was limited monitoring of the outcomes of care and treatment and clinical audits did not demonstrate quality improvement.
- The practice was unable to show that staff always had the skills, knowledge and experience to carry out their roles.
- Patient care needs were not always delivered in line with current standards. We were not assured that there was a robust process for patients with long-term conditions to receive a structured annual review to check their health and medicines needs were being met.
- The practice was unable to provide evidence that it always obtained consent to care and treatment.
- Some performance data was significantly below local and national averages and there was insufficient evidence to demonstrate how the practice had analysed and improved on this data. Key staff absence led to low performance in some clinical indicators.
We rated the practice as inadequate for providing well-led services because:
- Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
- While the practice had a clear vision, that vision was not supported by a credible strategy.
- The practice culture did not effectively support high quality sustainable care.
- The overall governance arrangements were ineffective.
- The practice did not have clear and effective processes for managing risks, issues and performance.
- The practice did not always act on appropriate and accurate information.
- We saw little evidence of systems and processes for learning, continuous improvement and innovation.
We rated the practice as requires improvement for providing responsive services because:
- Services provided did not always meet the patient’s needs.
- Patients with multiple conditions did not have their needs reviewed in one appointment. They had to attend reviews on more than one occasion.
- Complaints were not always used to improve the quality of care.
These areas affected all population groups so we rated all population groups as inadequate.
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.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
The areas where the provider must make improvements are:
- Ensure that care and treatment is provided in a safe way.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure fit and proper persons are employed.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Develop a staff rota to ensure adequate staff cover.
- Take action to review performance in areas of low patient satisfaction.
- Try to promote privacy at the reception desk.
- Consider updating the practice website so that patients have access to timely information.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care