Archived: Inner Park Road Health Centre

Updated 29 December 2016

Inner Park Road Health Centre is in Wimbledon in the London Borough of Wandsworth. The practice has a practice principal GP (full time) who manages the practice which is based at two sites, the main site on Inner Park Road and a satellite site on Claudia Place. Since the inspection the practice have confirmed that they are no longer using the Claudia Place site. At the time of the inspection the GP principal was not working and primary management had passed to the practice manager. Both sites were based in purpose built buildings, a main site and a branch surgery with the same patient list.

The practice has approximately 2,400 registered patients. The surgery is based in an area with a deprivation score of 7 out of 10 (10 being the least deprived). The practice population’s age demographic is similar to the national average, although there are slightly higher than average number of patients between the ages of 40-85, and slightly fewer patients under the age of 10.

There are currently one salaried and one locum GPs working to 1.2 whole time equivalent (WTE) and who are providing clinical care at the practice. One of the locums who is working at the practice in the long term is currently clinical lead. There is also a practice nurse who works in the practice two days per week and a healthcare assistant who works three mornings per week. The HCA is supervised by the practice nurse and the locum GP. The practice is managed by a practice manager and there are also five administrative staff.

The practice is contracted to provide General Medical Services (GMS) and is registered with the CQC for the following regulated activities: treatment of disease, disorder or injury and maternity and midwifery services. It was noted during the inspection that the practice should also be registered for diagnostic and screening procedures as these services were being provided in the course of providing General Practice services. The practice manager told us that they would be applying for this to be added to the registration.

The practice is open from 8:00am until 6:30pm Monday to Friday. There are extended opening on Saturday morning from 9:45am until 11:45am. Outside of normal opening hours the practice uses a locally based out of hours provider.

The practice was previously inspected by the CQC in November 2015. At that stage the overall rating for the practice was inadequate. This rating applied to safe, effective, well led and all six population groups. Caring and responsive were rated as requires improvement. Following the inspection the practice was placed into special measures and warning notices were issued. The report stated that the practice must do the following:

• Introduce effective processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

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

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

• Ensure that all staff have received mandatory training and pre-employment checks in line with national and local guidance, and that records of all staff’s training appears on a locally held record. All staff must also have a yearly appraisal.

• Ensure that meetings in place are formalised. Where patient care and changes to process are discussed, these meetings must be minuted.

• 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.

• 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.

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

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision, and provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

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

Updated 29 December 2016

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

Updated 29 December 2016

The practice is rated as requires improvement for the care of people with long-term conditions.

The provider was rated as requires improvement for safety, effectiveness and well led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average. The practice had scored 97% for diabetes related indicators in the last QOF, higher than the national average of 89%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 December 2016

The practice is rated as requires improvement for the care of families, children and young people.

The provider was rated as requires improvement for safety, effectiveness and well led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average of 81% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 29 December 2016

The practice is rated as requires improvement for the care of older people.

The provider was rated as requires improvement for safety, effectiveness and well led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• All patients over the age of 75 had a named GP.

Updated 29 December 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students).

The provider was rated as requires improvement for safety, effectiveness and well led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 29 December 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).

The provider was rated as requires improvement for safety, effectiveness and well led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 72% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average 84%.

• Performance for mental health related indicators was similar to the national average. The practice had scored 100% for mental health related indicators in the last QOF, which was similar to the national average of 93%. The practice had an exception reporting level of 17%, higher than the national average of 11%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 29 December 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

The provider was rated as requires improvement for safety, effectiveness and well led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. Patients on the learning disability register received annual reviews.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.