Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Deptford Surgery on 29 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, responsive, caring and well-led services. We found the practice to be requiring improvement in effective; this is because non clinical staff were not aware of the practices protocol for dealing with clinical documentation.

It was good at providing services for 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. It was good for providing safe and caring services.

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.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

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

Action the provider SHOULD take to improve:

• Take account of results of audits and take action immediately.

• Ensure that non clinical staff are aware and follow the practice`s protocols relating to patients clinical documentation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection June 2015 rated – Good overall, Requires Improvement for Effective)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Deptford Surgery on 13 April 2018, as part of our inspection programme.

At this inspection, we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had implemented defined and embedded systems to minimise risks to patient safety.
• Staff knew about current evidence based guidance. The practice ensured that staff received training to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Staff delivered care and treatment according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Patients told us that they were always able to make appointments at the practice. The 2017 national patient survey also showed that patients found it easy to make appointments.
• Information about services and how to complain, was available.
• There was good evaluation of the service provided to patients.
• There was clear leadership and leaders encouraged practice staff to be accountable.

We saw one area of outstanding practice:

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• The practice had identified an area of need for transgender patients requesting hormones from their GP for gender transition. The GPs worked with the CCG to develop a South East London guideline and liaised with local community services in order to educate patients on what their GP can provide outside of gender services. The practice had developed a patient agreement to safeguard patients with gender transition and set out best practice for prescribing bridging prescriptions and Gender Identity clinic referrals.

The areas where the provider should make improvements are:

• The practice should make improvements in relation to patient involvement in decisions about their nursing care.
• The practice should be able to provide evidence that they have considered where new Disclosure and Barring (DBS) checks are needed for clinical staff, to renew their DBS professional registration.
• The practice should have a protocol for taking consent from patients undergoing joint and soft tissue injections.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice