The Parkview Surgery

Background to this inspection

Updated 1 September 2017

The Parkview Surgery provides primary medical services through a General Medical Services (PMS) contract within the London Borough of Hillingdon. The practice is part of NHS Hillingdon Clinical Commissioning Group. The services are provided from a single location to around 6000 patients. The practice serves a diverse ethnic, cultural, demographic and socio-economic mix and has broadly average numbers of patients in all age groups. In the last two years there has been an increase in Polish patients registering at the practice. One of the GPs is Polish.

At the time of our inspection, there were three permanent GPs (one male and two female) and a regular locum GP employed at the practice who normally provide 22.5 clinical sessions per week. The practice also employed a practice manager, two part-time practice nurses, a practice administrator, and four reception staff.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8am to 1pm and 2.30pm to 6.30pm Monday to Friday. Extended hours GP clinics are offered by appointment on Tuesday between 6.30pm – 7pm and two separate clinics on Thursdays between 7.15am - 8am and 6.30pm – 7.15pm. There is also an extended hours nurse clinic on Thursday between 6.30pm – 7.30pm. In addition to pre-bookable appointments, urgent appointments are also available for people that needed them.

There are arrangements to ensure patients received urgent medical assistance when the practice was closed. Out of hours services are provided by a local provider. Patients are provided with details of the number to call.

The practice is also part of a network of eight local practices which allows it to offer services such as week-end cover for over 75 year old patients, a trained Chronic Obstructive Pulmonary Disease (COPD) nurse and an integrated care plan co-ordinator to improve care for patients with chronic conditions and at risk of admission to hospital.

The practice is registered to carry on the following regulated activities:

Diagnostic and screening procedures

Family Planning

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

Overall inspection

Good

Updated 1 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Parkview Surgery on 16 June 2016. The overall rating for the practice was good. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Parkview Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

At the inspection on 16 June 2016, the practice was rated overall as ‘good’. However, within the key question safe, areas were identified as ‘requires improvement’, as the practice was not meeting the legislation around ensuring adequate arrangements were in place to ensure care and treatment to patients was provided in a safe way in relation to: medicines management; the provision of medical equipment; and in ensuring patients were fully protected against the risks associated with the recruitment of staff. There were deficiencies in the stocking of emergency medicines and prescription security; in ensuring clinical items and equipment were up to date; and in the recording of recruitment information, in particular in ensuring the documentation of appropriate pre-employment checks. The practice was issued requirement notices under Regulation 12, Safe care and treatment, and under Regulation 19, Fit and proper persons employed.

Other areas identified where the practice was advised they should make improvements with the key question of safe included:

Ensure all staff are aware of the practice specific policy on safeguarding of vulnerable adults.
Ensure the completion of action already initiated of Disclosure and Barring Scheme (DBS) checks for staff who carry out chaperoning duties, or risk assess the need and put in place mitigating arrangements.
Carry out and record monthly water temperature checks, identified as necessary as a result of the latest legionella risk assessment of the practice.
Review vaccine cold storage processes to ensure they conform to Public Health England guidance regarding packaging.
Arrange for regular fire evacuation drills to be completed and documented.

At our July 2017 inspection we reviewed the practice’s action plan submitted in response to our previous inspection and a range of supporting documents which demonstrated they are now meeting the requirements of Regulation 12, Safe care and treatment, and Regulation 19, Fit and proper persons employed, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice also demonstrated improvement in the other areas identified in the report from June 2016 which did not affect ratings. These improvements have been documented in the safe section, showing how the registered person has demonstrated continuous improvement since the full inspection.

Areas identified at the June 2016 inspection where the practice was advised they should make improvements within other key questions of effective and caring included:

Put in place a documented induction programme for all staff to monitor progress and record the completion of the induction process; and
Review the system for the identification of carers to ensure all carers have been identified and provided with support.

At our July 2017 inspection we found there was now a documented induction programme in place and, in relation to recently recruited staff, a record of their completion of the induction process was on their personnel files.

Since the previous inspection the practice had taken further action to proactively identify and support carers. The practice had identified now identified 155 patients as carers (just above 2.5% of the practice list).

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

Ensure the policy for reporting when vaccination fridge temperatures varied from the allowable range was strictly adhered to in all cases.
Dispose of out of date medical items when new items are purchased to replace them.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice