We carried out a review of the data available to us about The Greenwood Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Greenwood Practice, you can give feedback on this service.
We carried out an announced comprehensive inspection at The Greenwood Practice on the 11 September 2019, to follow up the breaches of inspection found in the inspection of 19 February 2019.
We based our judgement of the quality of care at this service on a combination of:-
• what we found when we inspected,
• information from our ongoing monitoring of data about services,
• information from the provider, patients, the public and other organisations.
We have rated this practice as good overall
We rated the practice as good for providing a well led services because:
The practice had responded to our the findings of the CQC inspection in February 2019 and made improvements.
The areas where the provider should make improvements are:
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth
BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services
We carried out an announced comprehensive inspection at Drs. Zachariah, Lee, Acheson and Sinha on 25 February 2019.
At this inspection we followed up on breaches of regulations identified at a previous inspection on 6 April 2018.
We based our judgement of the quality of care at this service on a combination of: -
We have rated this practice as good overall and good for all population groups.
We have rated the provider good in safe, effective, caring, and responsive because: -
We rated the practice as requires improvement for providing well-led services because:
The areas where the provider must make improvements are:
(Please see the specific details on action required at the end of this report)
The areas where the provider should make improvements are:
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice
This practice is rated as Requires Improvement overall.
At our previous comprehensive inspection on the 11 November 2016 we rated practice as requires improvement overall. We carried out a follow up inspection to review the area of safe, responsive and well-led on the 21 August 2017 and found the practice had made some improvements, however the overall rating remained as requires improvement and we found the practice remained requires improvement for safe, responsive and inadequate for well-led. We issued a warning notice that required the practice to make improvements to their governance.
At this inspection on the 5 March 2018 we found the rating for the overall practice as requires improvement.
The key questions are rated as:
Are services safe? – Requires Improvement
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires Improvement.
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 – Requires Improvement.
People with long-term conditions – Requires Improvement.
Families, children and young people – Requires Improvement.
Working age people (including those retired and students – Requires Improvement.
People whose circumstances may make them vulnerable – Requires Improvement.
People experiencing poor mental health (including people with dementia) - Requires Improvement.
We carried out an announced comprehensive inspection at Drs Zachariah, Lee, Acheson and Sinha on the 5 March 2018. We carried out a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was now 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 clear systems to keep patients safe and safeguarded from abuse.
The practice ensured that facilities and equipment were safe and that equipment was maintained according to manufacturers’ instruction.
There was a system for receiving and acting on safety alerts. The practice learned from external safety events as well as patient and medicine safety alerts.
The practice had made some improvements to the premises to enable it to comply with infection control standards and staff had completed infection control training.
The practice had systems to keep clinicians up to date with current evidence-based practice.
Staff had the skills, knowledge, and experience to carry out their roles.
Staff worked together and with other health and social care professionals to deliver effective care and treatment.
Staff involved and treated patients with compassion, kindness, dignity and respect.
Clinicians understood the requirements of legislation and guidance when considering consent and decision-making.
Forty-two patients completed the CQC comment cards; many commented that the receptionists were friendly and caring. All but one had made positive comments about the doctors and nurses. We spoke with 11 patients, ten told us the overall attitude of staff was good and they were treated with respect.
Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
Following the previous inspection, the practice manager carried out monthly and quarterly audits to identify and follow up the non-attendance of appointments. For example, for shingles, coil recalls, surgical biopsies return from the laboratory, child immunisation, and annual health checks. The doctor had carried out a clinical audit regarding the prescribing of patient’s antipsychotic drugs, and a two cycle audit for minor surgical procedures
The practice manager following the previous inspection had encouraged the start-up of a patient participation group (PPG). At present it had five members and further members were encouraged to join on the practice website. The PPG held their first meeting on the 9 January and minutes were produced and circulated.
The areas where the provider must make improvements as they are in breach of regulations are:
Ensure care and treatment is provided in a safe way to patients. In particular there was no proper and safe management of medicines and staff had not adhered to the infection control and waste management recommendations.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are: [include as needed]
Review the recruitment procedure to ensure that staff do not commence work without a current DBS check.
Review the procedure for checking the defibrilator to ensure it meets the Resuscitation Council guidance.
Review the storage of patient medicines to ensure that it is auditable.
Review the procedure for cleaning the treatment room and consultation room curtains to ensure it meets The Health and Safety Executive guidance.
Provide patients with information about how to access the services offered.
Review the policies and procedures to ensure staff capture the system for recording and responding to test results and the Duty of Candour. In addition to ensure all staff are aware of any lessons learnt from significant events.
Review the organisational structure to ensure the nursing staff participate in clinical meetings and receive clinical support and supervision.
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Drs. Zachariah, Lee, Acheson & Sinha on 11 November 2016. The practice was rated good for being effective and caring and requires improvement for being safe, responsive and well led. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Drs. Zachariah, Lee, Acheson & Sinha on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 21 August 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 11 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice remains rated requires improvement.
Our key findings were as follows:
Whilst some improvement had been made we found a number of issues identified at the inspection of 11 November 2016 remained unaddressed at the inspection of 21 August 2017. Also, the provider had failed to submitted an action plan detailing what steps they would take to address the concerns identified during the inspection of 11 November 2016.
Data showed patient outcomes in respect of mental health indicators and childhood immunisations remained below average.
There was limited evidence of continuous clinical and internal audits used to monitor quality and to make improvements.
Patients said they did not find it easy to make an appointment with a named GP. Urgent appointments were available the same day.
Patients remained unsatisfied with the practice opening hours. Forty-five percent of respondents said they were satisfied with the practice’s opening hours compared to the CCG average of 70% and the national average of 76%. The practice was reviewing options to try and improve this.
Some issues identified during the most recent infection control audit had been addressed; however, those requiring refurbishment of the premises remained outstanding.
Some risks to patients were assessed and well managed. However, some issues which related to infection control remained unaddressed.
The practice had a governance framework however this was not always put into practice to ensure the delivery of the strategy and good quality care was maintained.
The practice aimed to deliver high quality care and promote good outcomes for patients, however this was not always achieved in practice.
We saw evidence of the regular review of and the sharing of learning from complaints.
There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
Lessons were learnt from individual concerns and complaints and also from analysis of trends.
At the previous inspection of 11 November 2016 we said the provider should:
Take action to ensure patient outcomes were in line with national and local averages including people with mental health conditions and childhood immunisations.
Review systems to identify carers in the practice to ensure they received appropriate care and support.
At this inspection we found:
The practice’s performance in relation to mental health remained below average for the period April 2015 to March 2016 (practice 59%, CCG 92%, national 93%). The provider reiterated that this had been due to the illness and then passing away of the partner who led on mental health. They told us they had already taken action to address performance in this area, including nominating a new lead GP for mental health. They expected improvement for the current year.
Childhood immunisation rates for the vaccinations given had improved. There are four areas where childhood immunisations are measured; each has a target of 90%. The practice achieved the target in four out of four areas.
Processes to identify patients who were carers had not improved. They had identified 19 patients as carers, less than one per cent of the patient list. Carers were identified opportunistically. There was no process in place to support the identification of carers by the practice. During the inspection the new patient registration form was updated to include a question about caring responsibilities.
There remained areas of practice where the provider needed to make improvements.
Importantly, the provider must:
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular, the provider must ensure staff receive necessary training in infection control and being fire wardens.
Review processes and procedures to support a set programme of continuous clinical and internal audit.
Improve systems or processes in order to seek and act on feedback from relevant persons and other persons on the services provided in the carrying on of the regulated activity. In particular, patients’ views about how they could access care and treatment.
In addition the provider should:
Continue to review and pursue options to ensure the outstanding actions identified during the infection control audit and fire risk assessment are addressed.
Continue to review the practice’s performance in relation to patients suffering poor mental health and take appropriate steps to address below average performance.
Continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Drs. Zachariah, Lee, Acheson & Sinha on 11 November 2016. Overall, the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
The areas where the provider must make improvements are:
In addition the provider should:
Chief Inspector of General Practice