Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 30 July 2015. Breaches of legal requirements were found such that the practice was rated as RI in the safe and well-led domains. 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 12 (2) (f) (h)) and regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 8 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 Bexley Medical Centre 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 and well led services. As the practice was now found to be providing good services for safe and well led, this effected the ratings for the population groups we inspect against. Therefore, it was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

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, infection control, the management of emergency medicines, and dealing with medical emergencies.

• The practice had installed an additional software programme to facilitate staff access to policies and procedures, meeting minutes, staff feedback and the outcomes and learning from clinical audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bexley Medical Group, consisting of three sites, on 30 July 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Data showed patient outcomes were above average for the locality
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a PPG that met regularly and was involved in recommending service improvements.
• Information about services and how to complain was available and easy to understand.

• The practice had a number of policies and procedures to govern activity, but not all staff were clear that these were available and how to locate them.
• The practice held regular staff meetings but these were not attended by staff across the practice’s branch sites.

We saw one area of outstanding practice:

The practice had recently started piloting an outreach programme, to reach isolated patients through a befriending service, the Home Alone project. The project was being implemented with the support of the PPG. So far two members of the PPG had been recruited to support the project

However there were areas of practice where the provider should make improvements:

Importantly the provider must:

The areas where the provider must make improvements are:

• Ensure risks to patients are assessed and well managed, specifically in relation to staff recruitment, infection control, the management of emergency medicines, and dealing with medical emergencies.
• Ensure recruitment arrangements include all necessary employment checks for all staff.

In addition, the provider should:

• Ensure the outcomes and learning from clinical audits are clearly presented and shared with the practice team
• Ensure clear lines of communication are maintained with the entire staff team, and that their feedback is sought by holding regular staff meetings attended by staff from all its sites.
• Ensure information about how to make complaints to is readily available in the practice
• Ensure there are formal governance arrangements in place and staff are aware how these operate.
• Ensure all staff have appropriate assess to policies, procedures and guidance to carry out their role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We did not speak with patients during this inspection. We carried out this inspection to determine if the provider had taken action to address the areas where we found non-compliance during our last inspection in September 2013.

Our last inspection of 12 September 2013 found that there were improvements required in the arrangements for staff recruitment and in record keeping. During this inspection we found that the provider had taken action to address these issues. The provider had updated their recruitment policy and new recruitment procedures were being implemented. The provider had reviewed and updated staff records, ensuring missing items of information were now in place.

We found that records were kept securely.

We visited the King Harolds Way and Hurst Place surgeries as part of this inspection and spoke to people and staff at both locations. Most people we spoke with were very happy with the treatment they received at the practice. One person told us that staff were "really friendly" and that they were usually able to get an appointment on the day that they called. Another person told us that the staff were "lovely" but that clinical staff "sometimes use too much medical terminology". However, they told us that they were able to ask questions so that they understood the treatment they were receiving.

We found that people were treated with dignity and respect when visiting the practice and that they were given suitable information and support regarding their care or treatment. People's treatment was planned and delivered in such a way as to ensure their safety and welfare. The provider had taken appropriate steps to protect people from the risk of abuse and monitored the quality of the service people received. However we also found that appropriate checks were not always carried out on staff prior to their employment at the practice. Records had not always been written up appropriately at the time of people's appointments and were not always stored securely.

Bexley Medical Group is a provider registered with CQC.

We carried out an inspection of the provider on 24 April 2019 as part of our inspection programme.

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 and good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• The practice had systems in place for the safe management of patient’s medicines. However prescription stationary usage was not being tracked and IT systems were not being updated with patients’ review dates.
• Risk management systems for premises were lacking. For example at one branch site the premises were managed by a third party and the practice had limited oversight or awareness of risk management activities at this site. Action had not been taken to mitigate risks associated with legionella. Infection control risks had not been assessed within the last 12 months and not all staff had completed fire safety training.
• Comprehensive recruitment checks were in place for staff including locum staff. However not all staff whose files we reviewed had records of immunisations against common communicable dieases.
• Safeguarding systems and processes were clear and effective.
• Staff were not all aware of the systems and process for reporting signficant events although we saw good examples of action and learning stemming from events that had been reported.

We rated the practice as good for providing effective services because:

• There was evidence of quality improvement activity.
• Staff were receiving regular appraisals.
• Effective joint working was in place. The practice held monthly multidisciplinary meetings and detailed records of discussions and action points were retained.
• Patients were receiving regular reviews and the treatment provided was in line with current guidelines this was reflected in high levels of achievement against local and national targets. Although there were instances of above average exception reporting; the sample of records we reviewed showed that the exception reporting was appropriate.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care. Some patient feedback was below local and national averages. Staff attributed this to problems with the practice’s IT system.
• The practice had a carers register and staff were actively trying to increase the identification of patients with caring responsibilities and improve the support offered to these patients.

We rated the practice as good for responsive services because:

• The practice had worked to accommodate an influx of patients from a nearby surgery which had recently closed. Care had been taken to optimise the care and treatment of these patients.
• Complaints were managed in a timely fashion and detailed responses were provided.
• Feedback from both the patient survey and comment cards received by CQC indicated that it was easy to access care and treatment at the practice. The practice was continually reviewing and adjusting the appointment system to cater to the needs of patients.

We rated the practice as good for providing well-led services because:

• There were effective governance arrangements in most areas.
• The provider had adequate systems in place to assess, monitor and address most risks.
• The provider had an active patient participation group and there were structured feedback and engagement mechanisms for patients.
• There was evidence of continuous improvement or innovation.
• Staff provided positive feedback about working at the service which indicated a good working culture.
• The practice had taken action to ensure the sustainability of the service and responded well to challenges associated with the dispersal of the patient list from a nearby service which closed and problems associated with migration to a new IT system.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review areas of high QOF exception reporting to ensure that exception reporting is appropriate.
• Update the practice’s locum pack.
• Review areas of the national patient survey which are below local and national averages and act to improve patient satisfaction in these areas.
• Continue with planned work to improve the service offered to patients with learning disabilities.
• Continue to review the system for coding patient who act as carers.
• Review physical access arrangements at the King Harold’s Way location.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.