Archived: Ravensbury Park Medical Centre

Updated 30 November 2017

Ravensbury Park Medical Centre is in Merton, south west London. The practice has 5400 patients.

The surgery is purpose built premises, over two floors. There is some patient parking and the area is well served by public transport. The building has level access. The practice rents the premises from a private landlord. Also in the same building are a pharmacy, a café and a private flat (all rented from the same landlord).

Compared to the England average, the practice has more young children as patients (age up to nine) and fewer older children (age 10 – 19). There are more patients aged 20 – 49, and many fewer patients aged 50+ than at an average GP practice in England. The surgery is based in an area with a deprivation score of six out of 10 (1 being the most deprived), and has a higher level of income deprivation affecting older people and children. Compared to the English average, more patients are unemployed.

Although registered with CQC as a sole provider, the practice is run by four partners, three GPs (two male and one female) and one non-clinical partner, who is the managing partner. At the time of the inspection, there were two full time male doctors working at the practice, as the female partner was on leave, supplemented by some sessions from a regular locum GP. The practice offers 22 GP sessions per week. There are two practice nurses, who both work part-time, with working hours roughly equivalent to one full-time nurse (40 hours). One of the nurses is qualified as an independent prescriber.

The practice is open between 8am and 7pm Monday to Friday, with late opening on Tuesday (until 8pm) and Wednesday (until 8.30pm). Appointments with GPs are available between from 8am and 6.30pm Monday to Friday, and until 7.30pm on Tuesday and 8.00pm on Wednesday.

When the practice is closed cover is provided by a local service that provides out-of-hours care.

The practice offers GP services under a Personal Medical Services contract in the Merton Clinical Commissioning Group area. The practice is registered with the CQC to provide family planning, surgical procedures, diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.

This is the second time that the CQC has inspected the practice under this rating methodology. The practice was inspected on 6 February 2014 under the previous methodology, when it was found to be compliant with the regulations in force at that time.

When we inspected on 11 January 2017 we found breaches of regulations related to safety and good governance. We issued warning notices in relation to these issues.

The practice is registered with CQC as a sole provider, although it has been operating as a partnership for more than a year. The practice is also registered as operating from a previous location. When we inspected in January 2017 we reminded the practice that correct registration is a legal obligation and that we would take action if they did not correct their registration. In May 2017 the practice had an application accepted to change the registration, which is being reviewed.

Updated 30 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ravensbury Park Medical Centre on 11 January 2017. The overall rating for the practice was inadequate (inadequate ratings for all key questions apart from caring, which was rated as requires improvement) and the practice was placed in special measures for a period of six months. The previous reports can be found by selecting the ‘all reports’ link for Ravensbury Park Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 26 September 2017. Overall the practice remains rated as inadequate.

Our key findings were as follows:

• The system for managing significant events did not ensure that lessons were learned.
• There were not effective arrangements to safeguard children and vulnerable adults from abuse.
• Arrangements for managing medicines, including emergency medicines and vaccines, in the practice did not keep patients safe.
• Arrangements for emergencies and major incidents still did not ensure that the practice would be able to respond effectively.
• Data showed rates of childhood immunisation and patient outcomes for some long-term conditions were below the national average.
• The practice had failed to act on evidence of deteriorating satisfaction with telephone access.
• There was little evidence of quality improvement activity that resulted in improved patient care.
• There were no governance meetings. Clinical meetings had no evidence of follow up on actions that been agreed.
• There was no evidence of continuous learning and improvement driven from within the practice.

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Review the systems for information governance, to maintain patient confidentiality.
• Develop arrangements to ensure female patients can be treated by a clinician of the same sex.
• Review the impact on patient care of the ‘one issue per appointment policy’.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Improve the complaints system to ensure that all complaints are recorded, including verbal complaints, and that this information is formally reviewed to assess for trends.

This service was placed in special measures in March 2017. As a result, the practice received a package of support from the Royal College of General Practitioners, NHS England and the Clinical Commissioning Group.

Insufficient improvements have been made such that there remain ratings of inadequate for safety, effectiveness, responsiveness and being well led. Therefore the service will remain in special measures. 

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 30 November 2017

The provider was rated as inadequate for safety, effectiveness and for being well-led and requires improvement for being responsive. The issues identified as inadequate overall affected all patients including this population group.

• Data from the Quality and Outcomes Framework showed patient outcomes remained below average in diabetes care and high blood pressure.
• The practice had developed its services for patients with long-term conditions, but this had not yet resulted in improved patient outcomes as measured by the Quality and Outcomes Framework.
• The practice was not prescribing high risk medicines required to manage some long-term conditions safely.

Updated 30 November 2017

The provider was rated as inadequate for safety, effectiveness and for being well-led and requires improvement for being responsive. The issues identified as inadequate overall affected all patients including this population group.

• Immunisation rates were below average for standard childhood immunisations.
• The practice worked with midwives, health visitors and school nurses to support this population group, but information gained about safeguarding concerns was not stored so that it could be accessed when required.
• The practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 82% and the national average of 82%, but arrangements for following up samples were not effective.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

Updated 30 November 2017

The provider was rated as inadequate for safety, effectiveness and for being well-led and requires improvement for being responsive. The issues identified as inadequate overall affected all patients including this population group.

• The practice offered home visits and urgent appointments for those with enhanced needs, including older patients. However, for appointments within the practice, the practice had a policy of only allowing patients to discuss one issue per appointment, which could present difficulties for some older patients, who are more likely to be diagnosed with multiple medical conditions, which can interact.
• Older patients had a named GP to support their care.

Updated 30 November 2017

The provider was rated as inadequate for safety, effectiveness and for being well-led and requires improvement for being responsive. The issues identified as inadequate overall affected all patients including this population group.

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.
• There were issues with accessing the practice by telephone, which the practice had failed to act on, and which were likely to affect working age people whose time is restricted.
• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 30 November 2017

The provider was rated as inadequate for safety, effectiveness and for being well-led and requires improvement for being responsive. The issues identified as inadequate overall affected all patients including this population group.

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 30 November 2017

The provider was rated as inadequate for safety, effectiveness and for being well-led and requires improvement for being responsive. The issues identified as inadequate overall affected all patients including this population group.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable, but the practice’s overall systems for ensuring patients were safeguarded from abuse were not effective as recent information was not available for clinical staff.
• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.