The Care Quality Commission
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Archived: Inner Park Road Health Centre

Overall: Requires improvement read more about inspection ratings

86-88 Inner Park Road, Wimbledon, London, SW19 6DA (020) 8394 7690

Provided and run by:
Dr Ganesan Iyer

All Inspections

16 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Inner Park Road Health Centre on 16 November 2015. Several breaches of legal requirements were found, such that the practice was rated as inadequate overall. The practice was placed in special measures. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

  • Regulation 12, Safe care and treatment

  • Regulation 17, Good governance

  • Regulation 18, Staffing

  • Regulation 19, Fit and proper persons employed

We undertook this inspection on 16 August 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. The practice was in special measures and was rated as inadequate in three domains and as requires improvement in two. Consequently a full comprehensive inspection, rather than a follow up inspection, was undertaken.

Overall the practice is rated as requires improvement.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not sufficiently thorough and learning was not shared.
  • Risks to patients were assessed and well managed.
  • Data showed patient outcomes were in line with the national average. Although some audits had been carried out, they had not yet completed a second cycle so improvement could not be demonstrated.
  • 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 found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Staff felt supported by management. However, staff and patients both commented that at times there was a lack of leadership in the practice. 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 improvements are:

  • Ensure that serious event investigations and recording are formalised and that there are systems in place to share learning with the practice team.

  • Ensure that the leadership structure is clearly set out and understood by staff and that there is leadership capacity available at all times.

  • Ensure that entries in the clinical record are recorded as being from the correct clinician.

In addition the provider should:

  • Continue with the current audit cycle so that the practice will be able to demonstrate quality improvement through a two audit cycle.

  • Consider using interpretation services rather than family members for patients who do not speak fluent English, and consider responding to patients who complain utilising the same medium as the patient, and including details of the Health Service Ombudsman in responses to complaints to ensure that patients are able to escalate the complaint if they do not agree with the finding.

  • Consider formalising meeting minutes so that they are available and accessible to all staff.

  • Consider reviewing patient access to a female GP.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

12 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Inner Park Road Health Centre on 12 November 2015. Overall the practice is rated as inadequate.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

  • Patients were not fully protected from harm because systems and processes were not in place to keep them safe. For example there were no policies for needlestick injuries, infection control, policies for employed staff, recruitment, complaints, information governance and whistleblowing.

  • Patient outcomes were difficult to identify as little or no reference was made to audits or quality improvement and there was limited evidence that the practice was comparing its performance to others; either locally or nationally.

  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

  • The practice had put systems in place to ensure that it was responsive to the needs of it’s patients, but there was no formal complaints system in place.

  • The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

  • Implement formal governance arrangements including systems for assessing and monitoring risks (including significant event analysis) and the quality of the service provisio. Staff must be provided with policies, training and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice. All staff must also have a yearly appraisal.

  • Ensure that all rooms at the Claudia Road premises meet current infection control guidelines.

  • Ensure that formal medicines management systems are introduced at the practice, including a policy and appropriate cold chain processes.

  • Carry out clinical audits including re-audits to ensure improvements have been achieved, and implement formal auditable registers for patients in at risk groups, and review whether or not individualised care plans are required for these patients.

  • Implement a formal complaints policy which is advertised to patients in the waiting area, in the practice leaflet and online.

  • Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements and ensure that meetings in place are formalised. Where patient care and changes to process are discussed, these meetings must be minuted.

  • Ensure that the patient participation group at the practice is restarted.

The areas where the provider should make improvement are:

  • Provide a website for the practice which allows patients to book appointments and request prescriptions online and ensure that health promotion advice is available in the patient waiting room and online.

  • All cleaning schedules should be retained in the practice for audit purposes.
  • A business continuity plan should be in place at the practice.
  • All consents, including those where a chaperone has been offered, should be recorded in patients’ notes.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice