Background to this inspection
Updated
4 April 2018
The Trafalgar Surgery provides primary medical services in the London Borough of Southwark to approximately 4,180 patients and is one of 38 GP surgeries in Southwark Clinical Commissioning Group (CCG). The practice operates at 10 Trafalgar Avenue, London, SE15 6NR in the London Borough of Southwark. The practice is in premises converted from a residential property, and there are consulting rooms on two floors of the building, with a third floor used for administrative offices.
The practice population is in the second most deprived decile in England. The practice population’s age demographic is broadly in line with the national average. However, there are proportionally more patients aged between zero and 49 years and proportionally fewer patients aged over 60.
The GP team at the surgery is made up of one practice principal GP and one locum GP. In total there is one female GP and one male GP working at the practice, providing a total of 17 GP sessions per week. There is one locum Practice Nurse (3 days a week) at the practice. The clinical team is supported by a practice manager, an assistant practice manager, one secretary and four reception staff. The practice operates under a Personal Medical Services (PMS) contract.
The practice reception is open between 8:00am and 6:30pm Monday to Friday. Extended hours are available between 6:30pm until 7:30pm on Wednesdays. Appointments are from 9am to 1pm and from 2:30pm to 6:00pm on week days. When the practice is closed patients are directed to contact the local out of hours service.
The practice is registered as an individual provider with the Care Quality Commission to provide the regulated activities of family planning; treatment of disease, disorder or injury; diagnostic and screening services; maternity and midwifery services.
The service was previously inspected on 25 April 2017 where the overall rating was found to be Inadequate. At that inspection it was found that the practice must make improvements in the following areas:
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Develop effective systems and processes to ensure safe care and treatment including ensuring that staff have access to safeguarding policies and significant event processes are clear and are reviewed. This should also include ensuring that clear risk management is in place (including in relation to infection control), and improving medicines management processes and medicines storage.
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Develop effective systems and processes to ensure good governance including development of formal recall systems, development of quality improvement systems, a clearer complaints service, an improvement of the governance framework (including clarifying access to policies and procedures) and developing patient participation.
Updated
4 April 2018
Letter from the Chief Inspector of General Practice
This practice is rated as Good overall. The practice was previously inspected by the CQC on 25 April 2017. At that inspection the rating for the practice was Inadequate overall. This rating applied to Safe, Well- led and all six population groups. Safe, Effective and Responsive were rated as requires improvement and caring was rated as Good. Following the inspection the practice was placed into special measures for six months and warning notices were issued. The report stated that the practice must address the following issues:
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The practice did not discuss serious untoward incidents either in a designated meeting or as a standing item in clinical meeting. The policy had not been updated in line with the practice’s own review timelines.
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Some equipment, specifically all but one of the blood pressure monitors, had not been calibrated in the last year.
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None of the staff who acted as chaperones had received chaperone training. They had not received DBS checks.
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The practice was clean. However, the practice did not have a cleaning checklist in place and sharps bins were not fixed or dated.
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All emergency drugs were stored outside of their boxes in small quantities, and as such it was impossible determine the expiry dates of any medicines in pill form. The vaccine fridge was overstocked and medicines were pushed to the side and the back.
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The practice did not have a failsafe system for monitoring 2 week wait referrals.
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The practice did not have a system of audit in place outside of medicines audits requested by the CCG, and were not able to provide copies of completed audits.
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The practice received updates from NICE, MHRA and the GMC but there were no formal mechanisms to review them.
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The practice held MDT meetings with health visitors and had attempted to arrange regular meetings with district nurses. However, there were no meetings with palliative care or mental health team.
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There was no PPG in place, although the practice was small and had been trying (on an ad hoc basis) to recruit members for a meeting.
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Policies were overdue review and on the day of the inspection management staff were unable to locate policies and procedures quickly. Safeguarding policies and procedures were not available on the day of the inspection but were provide the following day.
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The practice was not fully advertising it’s complaints procedure. There had been no complaints in the last 18 months.
The areas where the provider should make improvements were:
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Improve the identification of carers among the patient list.
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Review accessibility of services for patients with a hearing disability and those patients that do not speak English as their first language.
We carried out an announced comprehensive inspection at The Trafalgar Surgery on 30 January 2018. We found that the practice had made improvements following the last inspection, and it is now rated as Good overall.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students) – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at The Trafalgar Surgery on 30 January 2018 as part of our inspection programme. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
At this inspection we found:
- The practice had implemented defined and embedded systems to minimise risks to patient safety.
- Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
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The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
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Staff involved and treated patients with compassion, kindness, dignity and respect.
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Information about services and how to complain was available.
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Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
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There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider should make improvements are:
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