We spoke with carers of people receiving treatment at the surgery. They told us that they were very happy and satisfied with the service provided by the surgery. They said they always found the surgery to be clean whenever they visited. One person we spoke with said, “the service is excellent.” All the people we spoke with said they they were given appropriate information and the procedures were always explained.

We found that there were suitable procedures for the planning and delivery of care and safeguarding of vulnerable adults and children. Staff were well supported, guidance on cleanliness and infection control was followed appropriately and records were up to date and stored securely.

Overall people were happy using the services provided by Beckenham Beacon.

People using the service told us that nurses were “very good” and that “staff were very courteous.”

People told us that they were treated with respect and felt included in their care and treatment.

People thought that the Beckenham Beacon provided “a prompt good service” and that appointments generally ran to time.

Patient Experience Tracker System data between April 2011 and December 2011 showed that on average of 92% were satisfied with the service provided.

Bromley Healthcare Limited’s 2011 satisfaction survey showed that 96% of people felt that services provided were very good compared to 91% in 2010.

Overall, we rated community services at Beckenham Beacon as good because:

• Staff knew how to report incidents and the senior team disseminated learning from incident investigations to their teams. There were effective arrangements for safeguarding vulnerable people and staff demonstrated how they fulfilled their responsibilities regarding this.

• There were effective systems in place to protect patients from harm. The incidence of pressure ulcers was low. 

• Clinical effectiveness service goals were used in each service to support quality improvement. All services met or exceeded their goals in at least two months of the most recent programme.

• Patient records were comprehensive with appropriate risk assessments completed. Each service had adapted the electronic patient records template to ensure patient notes were individualised and could meet their needs. An annual quality audit was used to identify areas of improvement in documentation.

• Staff routinely assessed and monitored risks to patients. Services consistently exceeded their monthly safety targets in relation to patient risk assessments and documentation.

• Audits were embedded in the service and staff used the results to establish practice in line with national guidance from accredited organisations. The services monitored patient outcomes to improve care.

• Effective medicines management processes were in place and monitoring of safety systems included learning from errors and regular training for independent prescribers.

• Infection prevention and control standards and practice were benchmarked against national best practice guidance. An infection control lead was in post and each service had hand hygiene champions to support compliance with cleanliness and hygiene standards.

• Patients were cared for by appropriately qualified staff. Staff received an induction to the unit and achieved specific competencies before being able to care for patients on their own. Service teams were positive about the quality of training offered to them and staff had undertaken specialist training to ensure they continued to meet demand on the service.

• There was effective internal and external multidisciplinary team working and staff worked with staff in other agencies to ensure patients received co-ordinated, specialist care. This included working with psychologists, sexual health services, care homes and social workers. The quality and therapies teams worked together to establish and improve clinical effectiveness. The health visiting team was involved in the development of a new perinatal mental health service at a local trust.

• Staff provided a caring, kind, and compassionate service and we received positive comments from patients. We observed the way patients were treated in their homes, in clinic settings and at a school. Patients reported they were involved in their care.

• Staff continually sought to exceed the expectations of patients and their relatives by providing individualised care that improved their social wellbeing as well as meeting their physical needs. For example, the integrated care team provided patients with ‘social prescriptions’ that provided access to day centres to help them make new friends. Staff in the HIV service facilitated patients' access to a peer support group.

• Services were planned and delivered in line with local needs. Community clinics for children and families were available in different locations across the borough making it easy for children and their families to access the nearest location to them. There were systems and procedures in place to ensure that people in vulnerable circumstances were able to access the services they needed promptly.

• Waiting times for podiatry and speech and language therapy appointments reduced significantly in the 12 months prior to our inspection as a result of improved communication and access. In addition, the HIV and diabetes teams both consistently met their target for referral to assessment times and the integrated care nursing team offered weekend drop-in clinics.

• The health visiting team carried out five mandated checks in line with the healthy child programme. Performance against these checks was better than the London average but sometimes lower than the provider’s own target.

• We saw positive local leadership within the service and staff reflected this in their conversations with us. Staff were supported in their role and had opportunities for training and development. There was a positive culture in the service and members of staff said they could raise concerns with the leadership team.

• There was a robust governance system in place, which included a range of committees attended by service leads and members of the executive team. Staff had regular team meetings and received regular communication from the executive team. The management team had oversight of the risks within the services and mitigation plans were in place.

• A patient experience group led patient engagement and there was evidence this group was able to influence executive decisions to adapt and improve services. Each clinical service had developed patient engagement strategies based on their knowledge of their own patients. This included surveys, peer support groups and social clubs.

• Staff valued opportunities to take part in pilot schemes and competitive applications for programme funding that enabled them to expand local services. There was a commitment to drive innovative practice within the teams.

However,

• Although there had been an improvement in staffing levels within the health visiting team, the caseload still exceeded recommended levels.

• Although the quality of patient records was consistent within the integrated care community nursing team, there were some consultations with no electronic documented notes. However, t

  here were paper records left in the patients' homes, and the provider took action to address the backlog of uncompleted electronic records.  

• Staff turnover within the adult community services was significantly higher than the organisational average and there was a vacancy rate of 17%.