Background to this inspection
Updated
21 March 2018
Park Road Surgery is situated in Harlesden in the London Borough of Brent. The premises are in a converted residential building based over two floors, with consulting rooms situated on both floors. The practice provides NHS services through a General Medical Services (GMS) contract to around 2,100 patients. It is part of the NHS Brent Clinical Commissioning group (CCG).
There are two partners, a non-clinical business manager partner and a GP partner. The GP partner provides eight GP sessions per week whilst a salaried female GP provides two GP sessions per week. There is a practice nurse (female) who provides two sessions per week and two health care assistants (female) who provide a combined total of four sessions per week. The practice’s administration and reception team consists of a business manager, three receptionists one who works full time and two who work park-time and an administrator who also works part-time.
The practice opening hours for the surgery are:
Monday 8:30am to 1pm and 2:30pm to 6:30pm
Tuesday 8:30am to 1pm and 2:30pm to 7:30pm
Wednesday 8:30am to 1pm and 2:30pm to 6:30pm
Thursday 8:30am to 3:30pm
Friday 8:30am to 1pm and 2:30pm to 6:30pm
Saturday Closed
Sunday Closed
GP appointments are available at the following times:
Monday 9am to 1pm and 2:30pm to 6:30pm
Tuesday 9:30am to 1pm and 2:30pm to 7pm
Wednesday 8:30am to 1pm and 2:30pm to 7:30pm
Thursday 8:30am to 1pm
Friday 8:30am to 1pm and 2:30pm to 6:30pm
Saturday Closed
Sunday Closed
Practice nurse appointments are available on Mondays between 10am and 1pm and 2:30pm and 6:00pm. Appointments can be pre-booked up to four weeks in advance. There are same day and emergency appointments available and these can be accessed in person, by telephone or using the online booking system.
The practice is a member of a federation of local GP practices which offers bookable appointments at hub GP locations around Brent.
When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on
its website and on a recorded telephone message. The practice offers telephone consultations and home visits are available.
The patient profile for the practice indicates a population of working age people comparable to the national average, with a higher proportion of adults in the 35 to 44 age range. There are a higher proportion of children and young people but fewer older people compared to the national average.
Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. This information also shows that Income Deprivation Affecting Older People (IDAOPI) at the practice is higher (38%) than the national average of 16% whilst Income Deprivation Affecting Children (IDACI) is also higher at 37% (national average 20%).
The practice population is ethnically diverse and with significant populations of Caribbean, Asian and African origin.
The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; maternity and midwifery services and treatment of disease, disorder and injury.
Updated
21 March 2018
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Park Road Surgery over two days, 21 January 2016 and 15 February 2016 and rated the practice as requires improvement for providing effective services, good for providing safe, caring, responsive and well led services with an overall rating of good.
We carried out an announced follow-up inspection at Park Road Surgery on 16 May 2017 to check that the practice had taken action to bring about improvements. At that inspection we found that working relationships between partners had become strained and dysfunctional and this had had an impact on the management capacity at the service. Following this inspection, the practice was rated as inadequate for providing safe, effective and well-led services and was rated inadequate overall. We issued requirement notices in respect of breaches of regulations and the practice was placed into Special Measures for a period of six months. Subsequent to this the provider submitted an action plan detailing how it would make improvements and when the practice would be meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
The reports from the inspection of January and February 2016 and the inspection of May 2017 can be found by selecting the ‘Reports’ link for Park Road Surgery on our website at www.cqc.org.uk/location/1-571411376
This inspection was an announced comprehensive inspection on 13 December 2017 and was undertaken following the period of special measures to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as requires improvement.
Our key findings at the inspection on 13 December 2017 were as follows:
- When we inspected in May 2017, we found that the practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements. At this inspection we found that the partnership arrangements had changed and a new partnership management team had brought stability and leadership to the practice. Governance arrangements had been reviewed and protocols had been put in place to ensure that management had effective oversight of practice performance.
- At our inspection in May 2017, we found that patients were at risk of harm because the practice did not have an effective system in place to ensure all clinicians, a significant number of whom were locum staff, were kept up to date with national guidance and guidelines. At this inspection, we saw that the practice had significantly reduced the use of locum staff and had established a system to ensure that guidelines, updates and patient safety alerts were distributed to all clinical staff and were discussed at clinical meetings.
- The practice had reviewed arrangements in place to safeguard children and vulnerable adults from abuse to ensure that all staff were clear about their own roles and that of the safeguarding lead. All staff who carried out chaperoning duties had now received appropriate training.
- The practice was put a system in place to ensure that prescriptions awaiting collection were monitored regularly and GPs made aware when prescriptions remained uncollected for more than four weeks. Prescriptions for high risk medicines or those for patients with mental health or other serious conditions were monitored more closely and GPs made aware if a prescription had not been collected within one week.
- When we inspected in May 2017, we found that although staff were clear about reporting incidents, near misses and concerns, there was no evidence of learning and communication with staff. At this inspection we found that the practice had established regular practice meetings and used a standard agenda which included serious incidents and significant events as a standing item and used this as an opportunity to discuss incidents and share learning points and suggestions for improvement.
- The practice had consulted best practice guidelines around emergency medicines for a GP practice and could demonstrate that an appropriate schedule of medicines had been maintained since the previous inspection and there was a process in place to ensure these were regularly reviewed to ensure they were available and fit for purpose when required.
- When we inspected in May 2017, we found that clinical letters received electronically into the patient document management systems were not always reviewed or acted upon in a timely way. At this inspection, we saw the new practice management team had worked with an external adviser to review the document management process and had identified areas where the practice had not been using the practice computer system to its full potential. Measures had been put in place to ensure that patient related correspondence was reviewed daily.
- At our inspection in May 2017, data showed patient outcomes were low compared to the national average in key clinical areas such as Diabetes. At this inspection, we noted the new practice management team had prioritised improving patient outcomes as a key area for development and had reduced the use of locum GPs in order to improve continuity of care and an effective patient recall system had been put in place. Although the most recently published data showed that patient outcomes for some clinical areas were still lower than the national average, unvalidated year to date performance data for 2017/2018 indicated that practice performance had increased significantly in each of these areas and the practice was in line to improve performance further in the remaining quarter of the current measuring period.
- The practice had started to develop a quality improvement programme and had recently completed two audit cycles.
- Patients were positive about their interactions with staff and said they were treated with compassion, dignity and respect and the practice had put in place an effective system for proactively identifying patients who were carers to offer them additional support.
- Results from the national GP survey showed that patient satisfaction around access to the service was lower than local and national averages. In response to this, the practice had reduced the use of locums by 80% and had increased the number of staff employed in the reception team and had
The areas where the provider should make improvement are:
- Continue to assess and monitor the performance of the practice by following through with plans to reduce high exception reporting and an action plan to continue to improve outcomes for patients.
- Continue to monitor patient satisfaction and consider taking further actions to bring about improvements so that practice performance is in line with national survey results.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice