Archived: South Lewisham Group Practice

Updated 29 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 5 June 2015. Breaches of legal requirements were found. 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 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 9 March 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This inspection did not include a visit to the practice. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for South Lewisham Group Practice on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

• Systems and processes were in place to keep people safe. The practice had taken steps to ensure risks to patients were assessed and well managed, specifically in relation to staff recruitment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 September 2015

The practice is rated good for the care of patients with long term conditions.

There was a named clinical lead for each long term condition. One of the GPs oversaw end of life care, working with the local palliative care team. One of the nurses carried out the annual diabetes checks and two weeks later the patient saw the GP for the results and the opportunity to ask questions. Staff said this gave patients ownership of their treatment. All patients with chronic obstructive pulmonary disease were offered care plans and referred to pulmonary rehabilitation when appropriate. They targeted patients with long term conditions to have the flu vaccine. The practice provided a range of urgent on the day and book in advance appointments and longer appointments were provided for patients with a number of long term conditions. The practice worked with other health and social care providers to ensure patients with complex health needs received joined up care and treatment.

Updated 3 September 2015

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

The practice had above the national average number of patients under 18. They provided urgent on the day appointments and appointments outside of school hours to help families with children. Systems were in place to identify children in disadvantaged circumstances and those at risk, which was clearly recorded so all staff were aware. Baby and childhood immunisation rates for the practice were above the CCG average and the practice had improved the uptake of the MMR following close working with health visitors. Failure to attend appointments for immunisations was followed up. The practice was accessible for families with pushchairs. The practice worked with midwives, who attended the practice once a week, to provide shared antenatal care and with health visitors to deliver the Healthy Child Programme. Staff told us that they treated children and young people in age-appropriate ways and we saw evidence to confirm this.

Updated 3 September 2015

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

The practice had above the national and local average number of patients aged over 75. They provided a named GP for all patients aged over 75. The practice provided a range of book in advance and on the day urgent appointments and home visits were provided when required. Systems were in place to invite patients to attend regular medication reviews. They used co-ordinate your care for patients receiving end of life care and these were shared with the out of hours provider to ensure they were aware of patient’s needs and wishes. Seventy seven per cent of patients over 65 received their flu vaccination in 2014 which was above the national average of 73%. The practice took part in a frail elderly assessment during 2014 to identify those at risk and identify social isolation and worked with other health and social care providers to help reduce this.

Updated 3 September 2015

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

To meet the needs of working age people, the practice provided extended opening hours from 6.30pm-8.00pm on a Monday and Thursday evening and from 9.00am-12noon every fourth Saturday. Patients could book non-urgent appointments and order repeat prescriptions on-line. The practice provided the NHS Health Check for those over 40 and opportunistic screening for blood pressure, cholesterol and diabetes at routine appointments. Seventy eight per cent of women had attended for a cervical smear test which was an improvement from 76% the previous year but was still below the national average of 82%.

Updated 3 September 2015

The practice is rated as good for the care of patients experiencing poor mental health.

The practice held a register of patients experiencing poor mental health, 72% had a care plan that was reviewed annually, and this was below the national average of 86%. The practice did not provide named GP for patients experiencing poor mental health; however they said they aimed to provide continuity of GP. The practice worked with multidisciplinary teams to provide joined up care to people experiencing poor mental health, making appropriate referrals to community mental health teams and holding three monthly meetings with relevant health professionals. Patients were signposted to local services and the practice had a community drugs project worker on site once a week. Data showed patients were routinely asked about their alcohol consumption and smoking status which was recorded in the electronic patient record.

The practice had a register of patients with dementia, all of whom were offered an annual health check and review. The practice had increased the number of patients diagnosed with dementia in the last year due to changes in the way they recorded this on the electronic patient record. Advanced care planning was in place for patients with dementia.

Updated 3 September 2015

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 learning disabilities. It had carried out annual health checks for people with a learning disability and offered longer appointments for these checks. The practice worked with multi-disciplinary teams to provide joined up care for vulnerable patients. Staff were aware of their responsibilities regarding sharing safeguarding information, they knew how to contact the relevant agencies and how to recognise signs of abuse in vulnerable adults. Staff at the practice had access to translation services to help them meet the needs of patients whose first language was not English and appointments for these patients were longer to allow extra time for translation. Suitable arrangements were in place for the practice to register patients who were homeless.