We carried out an announced comprehensive inspection at Abbey Wood Surgery on 25 October 2017 and rated the practice as good overall and requires improvement in the caring key question.

The reports of all the previous inspections can be found by selecting the ‘all reports’ link for Abbey Wood Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection which we undertook on 13 March 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the issues identified in our previous inspection on 25 October 2017. This report covers our findings in relation to those requirements.

We found that the practice had made improvements and is rated as good overall.

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

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The provider routinely reviewed the effectiveness and appropriateness of the care provided.
• Care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated people with compassion, kindness, dignity and respect. The service was acutely aware of the sensitivities around patient confidentiality, and this was taken seriously, with associated policies in place.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Results from the national GP patient survey showed that the practice was above the local average for patients who felt listened to or involved in decisions about their care.
• Information about services and how to complain was available.
• The practice’s uptake for cervical screening was below the coverage target for the national screening programme.

There were areas where the practice could make improvements and should:

• Continue to take steps to increase cervical cancer screening uptake rates.
• Review process of read coding patients to ensure registers are maintained and monitored effectively.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Abbey Wood Surgery on 2 December 2014. The overall rating for the practice was good. The full report of this inspection can be found by selecting the ‘all reports’ link for Abbey Wood Surgery on our website at www.cqc.org.uk.

On 25 October 2017 a second announced comprehensive inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was still meeting the legal requirements of the regulations. Overall the practice is still rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. However, the system in place for monitoring uncollected prescriptions did not ensure that all prescriptions were reviewed prior to destruction to ensure follow-up was carried out where appropriate.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed that some patients did not feel listened to or involved in decisions about their care.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• An interpreting service was available for patients who required it, however, there were no signs in the reception area informing patients this service was available.
• Patients we spoke with said they were usually able to make an appointment with a named GP and there were urgent appointments available the same day. However, results from the GP Patient Survey, and feedback from patients we spoke to, suggested that patients often had to wait more than 20 minutes after their appointment time to be seen.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had identified only 61 patients as carers (0.8% of the practice list).
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• Patient Group Directions had been adopted by the practice to allow nurses to administer medicines in line with legislation. However, some PGDs required updating and signing by relevant staff.

There were areas where the provider should make improvements.

• The provider should ensure all Patient Group Directions are in date and signed by all relevant staff.
• The provider should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to all carers registered with the practice.
• The provider should review the results of patient surveys in order to identify and implement the necessary action required to improve patient satisfaction.
• The provider should display a sign in the reception area informing patients that interpreting services are available.
• The provider should review the repeat prescribing procedure to ensure that all uncollected prescriptions are reviewed prior to destruction to ensure follow-up is carried out where appropriate.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Abbey Wood Surgery, located in the London Borough of Greenwich in south-east London, provides a general practice service to around 8,000 patients.

We carried out an announced comprehensive inspection on 2 December 2014. The inspection took place over one day and was undertaken by a lead inspector, along with a GP specialist advisor, a specialist advisor with a background in practice management and an Expert by Experience. We looked at care records, and spoke with patients and staff including the management team.

Overall the practice is rated as Good.

Our key findings were as follows:

• The service is safe. There were systems in place for reporting, recording and monitoring significant events to help provide improved care. Staff were clear of their roles in regards to monitoring and reporting of incidents, safeguarding vulnerable people and children, and following infection prevention and control guidelines.

• The service is effective. The GPs shared good practice through internal arrangements and meetings and also by sharing knowledge and expertise with others. There was a multidisciplinary input in the service delivery to improve patient outcomes.

• The service is caring. Feedback from patients about their care and treatment via the national and practice-run surveys was positive. Patients were treated with kindness and respect and felt involved in their care decisions. Almost all the comment cards completed by patients who used the service in the two weeks prior to our inspection visit had positive comments about the care and service provided by the surgery.

• The service is responsive to people’s needs. The practice worked as far as possible with the patients and the Patient Participation Group (PPG) to improve the service. The practice was responsive to the needs of vulnerable patients and there was a focus on caring and on the provision of patient-centred care. Information on health promotion and prevention, on the services provided by the practice and on the support existing in the community was available for patients.

• The service is well-led. The practice had a clear strategic direction and was well-led by the GPs. Staff were suitably supported and patient care and safety was a high priority.

All the population groups including older people; people with long term conditions; mothers, babies, children and young people; the working age populations and those recently retired; people in vulnerable circumstances and people experiencing poor mental health received care that was safe, effective, caring, responsive and well-led.

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

The provider should:

• Ensure the governance arrangements and responsibilities are more equitably shared amongst clinical and managerial staff.
• Ensure the practice website and leaflets in the reception area provide better information around mental health issues and emotional support.
• Ensure the automated check-in machine in the reception area provides options in multiple languages to better support the diverse community of the area.
• Ensure the online appointment system works more effectively and efficiently.
• Ensure the current system of recording referrals is standardised across the practice and provides a clear audit trail of actions taken and follow up.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice