Stockwell Group Practice

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Stockwell Group Practice on 19 January 2016 where the practice was rated good overall. However breaches of regulation 12 (1) and 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified, and we rated the practice to require improvment for providing safe services.

The specific concerns in the previous inspection related to safety were:

• There were no valid Patient Specific Directions in place for the medicinal products administered by healthcare assistants

• Not all staff had completed mandatory training

• The systems in place to safeguard patients from harm were not effective

• Satisfactory pre employment checks had not been completed for all staff.

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 regulation 12 (1) and 17(1).

We undertook this focussed inspection on 20 September 2016 to check that they had followed the action plan provided and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Stockwell Group Practice on our website at www.cqc.org.uk.

Overall the practice is rated as Good.

Our key findings across all the areas we inspected were as follows:

• The practice had drafted a detailed protocol covering the administration of medicinal products by healthcare assistants.

• All staff had completed the appropriate level of safeguarding training.

• Although of the majority of mandatory training had been completed there were still a number of staff who had not received basic life support within the last 12 months; we were provided evidence that this had been completed on 18 October 2016. The practice’s recruitment strategy listed all training that was mandatory for staff. This stated that this training would only be completed annually by clinical staff and every three years by non clinical staff which is not in accordance with current guidance. Two GPs had not completed infection control training and there was no date scheduled for its completion. The practice recruitment strategy also said that this training would be completed annually by the lead and three yearly by all other staff.

• There was a recruitment strategy in place which detailed the requisite employment checks the practice would undertake prior to recruiting a new member of staff including checking identification and gathering reference. We were provided evidence of satisfactory checks were undertaken for one candidate employed by the practice since our last inspection.

Action the service SHOULD take to improve:

• Ensure that policies around training reflect current best practice and that people are receive mandatory training in accordance with this policy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 30 March 2016

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

• One of the nursing staff was specialised in diabetes and ran a diabetes clinic within regular surgery times, and patients at risk of hospital admission were identified as a priority.

• The practice held monthly palliative care meetings.

• GPs ran six monthly virtual clinics for patients with diabetes, chronic obstructive pulmonary disease (COPD) and blood pressure; receiving support from consultants at the local hospital.

• Performance for diabetes related indicators was similar to the CCG and national average. The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months was 68.56% compared to a national average of 77.54%. The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 69.33% compared to 78.03% nationally. The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March was 91.42% compared to 94.45% nationally. The percentage of patients with diabetes, on the register, whose last measured total cholesterol was 77.84% compared to 80.53% nationally. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 89.59% compared to 88.3% nationally. The practice told us that they had a prevalence of diabetes 1.4 times higher than the national average. The practice referred patients to a local diabetes educational service.

• Longer appointments and home visits were available when needed.

• The practice had an on site dietician and podiatry service.

• Patients with long term conditions 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 30 March 2016

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

• 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.

• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months was 72.96% compared to 75.35% nationally.

• 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 81.45% compared to 81.83% nationally.

• 57% of pregnant patients within the practice had received a seasonal flu vaccination compared with 30% within the CCG.

• 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 30 March 2016

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

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

• All housebound patients had a named GP.

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

• The practice worked closely with services based in the community to support older people in their homes.

• The practice undertook holistic health assessments for elderly and housebound patients.

• Extended appointments were available for elderly patients.

Updated 30 March 2016

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

• 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 including sexual health screening and contraceptive services.

• The practice provided an in house phlebotomy service three days per week.

• The practice did not offer extended hours appointments.

• Practice staff attended the residences of a local university once a year and encouraged students to register with the practice.

Updated 30 March 2016

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

• 96.3% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84.01%

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 85.54% compared with the national average of 89.55%. The percentage of patients with physical and/or mental health conditions whose notes record smoking status in the preceding 12 months was 97.03% compared to a national average of 94.1%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 organisation though we were unable to locate any health promotion material for those experiencing mental health problems in the practice waiting area.

• 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.

• The practice hosted a counsellor on a weekly basis.

• Patients with mental health problems were offered longer appointments.

• One of the GPs worked closely with the residents of local sheltered accommodation for adults, many of whom had mental health problems.

Updated 30 March 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for patients with a learning disability and those with carers.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people.

• 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 though some non-clinical staff were not aware how to contact relevant agencies.

• The practice hosted a drug and alcohol addiction clinic with members of the local drug and alcohol service.