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Inspection carried out on 2 May 2019

During an inspection to make sure that the improvements required had been made

We carried out this announced comprehensive inspection of North Wood Group Practice on 2 May 2019. We had previously carried out an announced comprehensive inspection prior to the merger of two practices at the Crown Dale site on 27 March 2018. At that time the service was rated as good. It was rated as requires improvement for the responsive domains and good for all other key questions. All population groups were rated as good.

The area where we said that the provider must make improvement were:

  • Ensure that systems and processes are in place to ensure safe care and treatment. This should include ensuring that appointments are accessible to patients.

At the inspection on 2 May 2019 we found that these areas had been addressed by the practice which is now rated as good in all areas.

We have rated this practice as good overall and good for all population groups.

We found that:

  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

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

Review carried out on 30 April 2019

During an annual regulatory review

We reviewed the information available to us about North Wood Group Practice on 30 April 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 27 March 2018

During a routine inspection

This practice is rated as Good overall. The practice was previously inspected by the CQC on 26 November 2014. At that inspection the rating for the practice was good overall. This rating applied to all five domains and all six population groups.

We carried out an announced comprehensive inspection at Crown Dale Medical Centre on 27 March 2018 This inspection was scheduled as part of CQCs ongoing inspection programme.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

  • The practice had implemented defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • Information about services and how to complain was available.

  • Patients told us that they were not always able to make appointments at the practice. The national patient survey also showed that patients found it difficult to make appointments.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

  • The service had piloted the local care co-ordination model for Lambeth CCG in 2017. This targeted patients with three or more long term conditions. This involved a person-centred care assessment and a health and wellbeing care plan. Thirty seven such assessments were completed in the last year.

  • The service managed a borough wide diabetes service including diabetes clinic, Desmond educational events, virtual clinics and support to practices where diabetes management was of concern. The service had improved the number of patients attending structured education events from 800 in 2014/15 to 1,500 in 2016/17.

The areas where the provider must make improvements are:

  • Ensure that systems and processes are in place to ensure safe care and treatment. This should include ensuring that appointments are accessible to patients.

The areas where the provider should make improvements are:

The practice should consider reviewing the level of exception reporting at the practice which is above the national average.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 26 November 2014 and 3 December 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

This is a report of the inspection of the practice which we carried out on 26 November and 3 December 2014. The inspection was planned to check whether the practice is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. The practice had not been inspected before and that was why we carried out this comprehensive inspection.

We rated the practice as ‘Good’ in the five domains relating to it being safe, effective, caring, responsive and well-led. We also rated it as ‘Good’ for the care provided to all six population groups we looked at, including older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • Patients’ needs were assessed and care was planned and delivered in line with current guidance and legislation, including assessing capacity and promoting good health.

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

  • The practice reviewed the needs of its local population and was responsive to patients’ views.

  • There were systems in place to monitor and improve quality and to identify and manage risk.

  • The practice had effective infection control systems and staff received suitable infection control training.

  • The practice had a clear vision and strategy and a stated commitment to provide and improve best care for patients and attain the highest standard of clinical practice.

  • There was a clear leadership structure and staff felt supported by management.

  • Staff members were properly supported to provide good patient care and improve outcomes for patients.

We identified an example of outstanding practice, resulting in improved outcomes for patients. An audit of hospital admissions from one of the care homes to which the practice provides a service led to the introduction of a process of staff reflection on whether the admissions were avoidable. The process was adopted by other care homes across the borough and data showed hospital admissions had reduced as a consequence.

In addition, we noted an example of good practice, again leading to improved patient outcomes. Staff monitored the results of the National Patients Survey 2014. As a consequence of patients’ comments regarding opening hours, the ease of getting through to the surgery by phone and the experience of making an appointment, the practice will be introducing a new phone system in early 2015 and had reviewed its appointments system, resulting in the release of 200 more appointments per week.

However, there was also an area of practice where improvements should be made. Although we found that staff had received most of the training appropriate to their roles and that future training needs had been identified and planned, we were not shown evidence that all staff had received necessary training in child protection or safeguarding vulnerable adults.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice