Archived: Dr John Livingstone Also known as Eltham Park Surgery

We carried out an announced comprehensive inspection at Dr John Livingstone on 1 March 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 requires improvement overall, requires improvement for providing safe, effective and well led services and good for providing caring and responsive services.

Due to underlying issues with the provision of effective services, this means that the practice is rated as requires improvement for providing effective and responsive care to older people, people with long term conditions, families, children and young people, working age people, those whose circumstances may make them vulnerable and those experiencing poor mental health.

We rated the practice as requires improvement for providing safe services because:

• The practice did not have effective systems in place for the safe management of health and safety including an active process to identify and control areas of risk.
• Some staff records that we saw did not contain evidence of staff immunisations in line with Public Health England guidance.
• Not all staff had up to date safeguarding training appropriate to their roles.
• We saw no evidence of staff completing fire training.
• We did not see evidence of an infection control audit being completed.
• We did not see any evidence of recommendations of a legionella risk assessment that had been completed in 2012 being carried out since March 2016.
• Staff had not been trained in the identification and management if sepsis.
• The outcomes of safety alerts required clear evidence of the follow-up actions taken to keep patients safe.
• We saw no evidence of staff being trained as chaperones.
• We could not find any evidence of the electrical system having been inspected since 2012.
• The fire alarm was last serviced in September 2017.
• The practice didn’t have some recommended medicines, or risk assessments to justify why they were not present.
• We found glyceryl trinitrate (GTN), a spray used to relieve angina (chest pain) which had expired in June 2015.

We rated the practice as requires improvement for providing effective services because:

• The practice was below the local and national averages in most areas related to the management of diabetes and other long-term conditions.
• We saw two audits that had been completed but these were not two cycle audits but rather patient searches over a three-year period.

We rated the practice as requires improvement for providing well-led services because:

• The practice’s governance arrangements required improvement to ensure that there was clarity in terms of responsibilities for site management, with the provider maintaining evidence to demonstrate their ongoing compliance with regulations.
• The practice did not have regular meetings where learning and dissemination from significant events could occur.
• Those meetings which did take place were not minuted.
• We were told of two audits being completed but these were not two cycle audits and did not show any evidence of quality improvement.
• Many of the policies were out of date or contained insufficient or inaccurate detail.

We rated the practice as good for providing caring and responsive services because:

• Patients received effective care and treatment that met their needs. The practice could demonstrate good patient outcomes were delivered.
• Staff treated patients with kindness and respect and involved them in decisions about their care. The practice ethos was to provide an accessible and approachable patient-orientated service.
• Patients could access care and treatment in a timely way. The practice organised and delivered services to meet their patients’ needs.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way (Please see the specific details on action required at the end of this report).
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (Please see the specific details on action required at the end of this report).

In addition, the provider should:

• Review and action the needs of those patients with long term conditions, so as to improve their clinical outcomes.
• Ensure that carers are correctly identified and coded so they can be supported effectively and adequately signposted.
• Continue to collate the evidence of staff immunisations in line with Public Health England guidance.
• Review and update training for staff which is relevant to their role.

Please refer to the detailed report and the evidence tables for further information.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care