Lewisham Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lewisham Medical Centre on 7 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report from the 7 December 2016 inspection can be found by selecting the ‘all reports’ link for Lewisham Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 October 2017 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 7 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection undertaken on 7 December 2016, we rated the practice as requires improvement for providing safe and responsive services as:

• The systems to manage the security of NHS smart card and printer prescriptions were not effective.

• The practice was not undertaking periodic checks of their defibrillator to confirm that this was working.

• The practice was not dealing with complaints in line with recognised guidance and contractual obligations.

In addition as to the breaches of regulation identified we also recommended that the practice should make the following improvements:

• Ensure effective security and monitoring arrangements for prescription forms.

• Monitor and act on patient feedback on waiting times after appointment time.

• Identify clear actions in all meeting minutes, so that follow-up can be checked.

Overall the practice is now rated as good for providing services that are safe and responsive:

In respect of the breaches of regulation we found that:

• Systems had been put in place to manage the security of NHS smart cards.

• The practice had confirmed with the manufacturer the mechanisms for testing the working status of the practice’s defibrillator and had implemented monthly visual checks to confirm the working status.

• The complaints reviewed indicated that complaints were dealt in line with recognised guidance and contractual obligations.

In addition the practice had:

• Improved the arrangements to monitor and ensure the security of prescriptions.

• Had taken action in an effort to improve patient feedback regarding waiting times which was reflected in improved national GP Patient Survey scores including improving systems to ensure that patients were notified when clinicians were running late.

• Action points from practice meetings were clearly noted on both clinical and practice meeting minutes. Though discussion of follow up action was not documented in subsequent meeting minutes.

We identified too minor areas where the provider should make improvement:

• Document discussion of action points in subsequent clinical and practice meetings

• Include details of organisations that patients can contact if they are unsatisfied with the practice’s complaint response.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lewisham Medical Centre on 7 December 2016. 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.
• Most risks to patients were assessed and well managed, but there were some that were not well managed (prescription and smart card security and checks of the defibrillator). After the inspection, the practice sent us details of new arrangements for prescription security and for more frequent formal checks of the defibrillator, but not for smart card security.
• 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.
• 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 generally found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.

• Some patients told us they sometimes had to wait a long time after their appointment to be seen. Patients who responded to the national GP patient survey also reported waiting longer than those at other practices.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Evidence showed the practice responded to issues raised, but were not following their own policy or national guidance when responding, and information provided to patients about how to escalate complaints was incorrect.
• 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 must make improvement are:

• Ensure effective arrangements are in place to manage the security of NHS smart cards and that emergency equipment, including the defibrillator, is ready for use.

• Ensure that complaints are managed according to recognised guidance and contractual obligations, with full records kept of all communication.

The areas where the provider should make improvement are:

• Ensure effective security and monitoring arrangements for prescription forms.

• Monitor and act on patient feedback on waiting times after appointment time.

• Identify clear actions in all meeting minutes, so that follow-up can be checked.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice