Archived: Lambeth Walk Group Practice

Letter from the Chief Inspector of General Practice

Lambeth Walk Group Practice provides primary medical services to approximately 7,400 patients in the London borough of Lambeth. This is the only location operated by this provider, a partnership that was created in 2006.

We visited the practice on 19 November 2014 and carried out a comprehensive, announced inspection of the services provided.

The practice is rated as “good” overall. Whilst we found some areas that require improvement, we also found some examples of outstanding care being provided. The practice was rated as “outstanding” for its responsiveness, “good” for its effectiveness, leadership and how caring it was to its patients. However, the practice “requires improvement” for safety.

Our key findings were as follows:

• Patients were mostly positive about the practice and the services provided. The daily walk-in clinic meant that people could see a GP when they needed to and extended opening hours were offered three mornings a week, which particularly suited those of working age.
• Some systems were in place to keep people safe; there was a system for reporting incidents, responding to safeguarding concerns and managing medicines safely. However, we found some improvements were needed in relation to infection control, recruitment procedures and ensuring lessons learnt from incidents were documented and disseminated widely.
• Staff were appropriately qualified to deliver effective care. It was a training practice for trainee GPs as well as providing training to undergraduate medical students. The practice’s performance against clinical outcomes and patient experience was either in line with or above other practices in the area.
• The practice proactively worked and engaged with third party organisations to meet the emotional well-being of their patient group. Some of this work was outstanding.

We saw several areas of outstanding practice including:

• The practice had won the Royal College of General Practice’s Quality Practice Award in 2013, which is the highest award attainable. It involves the participation all practice staff and thus recognises the team’s commitment to reflection, learning and improving in order to provide quality care. Practices are judged against six modules which examine how the practice ensures it is patient-centred, how it meets the needs of different groups, how it manages illness and how it is a learning organisation.

• The practice had undertaken an audit in 2013 for patients with high blood pressure to assess whether their medicines were being optimised. The results confirmed that the number of patients with well treated hypertension had improved as a result of actions taken following an initial audit in February 2013. A re-audit in November 2013 found that 95% of patients in the audit now had blood pressures within the recommended range, an increase from 60%.
• The practice was outstanding in how it responded to the needs of its patients, which were central to the planning and delivery of care. It had been innovative and proactive in its approach to healthcare, recognising the importance of meeting a patient’s emotional needs as well as their physical needs, organising initiatives at the practice and signposting patients to activities and groups within the community. The practice was the first in Lambeth to have a reading group and the first to develop a gardening co-operative where patients can come and grow vegetables in the practice garden with the aim of providing other health services in the area. An annual Christmas party was held for patients aged over 80. In addition, the practice had recently engaged with a voluntary organisation that promoted mental well-being through creativity and hosted sessions at the practice.
• The practice had begun to produce information and correspondence in large font for those that required it.
• There were outstanding examples of multidisciplinary working for patients with diabetes and chronic obstructive pulmonary disease (COPD). Virtual clinics were held with community nurse specialists and a hospital consultant during consultations with complex patients.
• The practice offered extended opening hours three mornings a week from 07:00 to 08:00 to meet the needs of patients that worked. These appointments were heavily utilised by this population group.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that the appropriate pre-employment checks are carried out before staff commence work at the practice. Ensure that all staff acting as chaperones have had a Disclosure and Barring Service check.
• Ensure there are appropriate systems and processes in place to protect people from the risk of infection and that all single-use items are within their expiry date.

In addition the provider should:

• Ensure that all nursing and administrative staff are appraised annually and that personal development plans are in place.
• Review the roles and responsibilities of the management team to ensure leadership is as effective as it can be.
• Ensure clinical meeting minutes contain sufficient detail of the discussion so that it is clear what action is required and by which individual.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice