Archived: South Lewisham Group Practice

We carried out an announced inspection at South Lewisham Group Practice on 10 December 2021. Overall, the practice is rated as Good.

Set out the ratings for each key question

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following a new provider registration in April 2019, this was the first inspection of the location under the new provider. Following this inspection on 10 December 2021, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for South Lewisham Group Practice on our website at www.cqc.org.uk.

Why we carried out this inspection

This inspection was a comprehensive inspection and included the key questions: safe, effective, caring, responsive and well-led.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short site visit

Our findings

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 and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall;

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice monitored their performance and had plans in place to deal with any backlogs the COVID-19 pandemic had caused.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Although the lead GP had reviewed systems and processes, Childhood immunisation uptake rates were below the World Health Organisation (WHO) targets. Uptake rates for the vaccines given were below the target of 95% in five areas where childhood immunisations are measured.
• The practice had not demonstrated it had an effective strategy to improve its performance for cervical screening which was lower than CCG and England averages.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. We found the practice had taken appropriate action to improve access to care and treatment.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.

Whilst we found no breaches of regulations, the provider should:

• Continue to explore alternative methods to engage the community and improve the uptake of cervical cancer screening and childhood immunisations.
• Continue to prioritise recruitment of a practice nurse, to better support patients diagnosed with prediabetes.

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 and Integrated Care