Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Downham Family Medical Practice on 1 March 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events; however, some significant events had not been recorded appropriately and learning was not always thorough enough.
• Risks to patients were assessed and well managed with the exception of the absence of oxygen for use in medical emergencies. After the inspection, the provider told us they would purchase oxygen.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Improvements had been made following a clinical audit; however, there was no evidence of a programme of continuous audits.
• 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 did not always find it easy to make an appointment with a named GP, but urgent appointments were available the same day.
• The practice had good facilities and was mostly well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

The area where the provider must make improvement is:

• Ensure oxygen is available and all staff know how to use it.

The areas where the provider should make improvements are:

• Review the system for recording and learning from significant events so it is robust.

• Consider ensuring all clinical staff receive mental capacity training, and that any training received is documented.

• Ensure patient feedback is continually reviewed and areas for improvement actioned where possible, particularly in relation to the availability of appointments and waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Downham Family Medical Practice is situated in a Health and Leisure Centre in a residential area of Bromley and is a practice within Lewisham CCG. 

The practice is registered by the Care Quality Commission to provide the regulated activities of Diagnostic and screening procedures, Family Planning, Surgical Procedures and Treatment of disease disorder or injury.

During our inspection we spoke with seven patients, and received twenty three comments cards which had been provided by the Care Quality Commission.  Patients were positive about the service. They said they received effective treatment by caring staff.

We spoke with six staff from a clinical and non clinical background who were able to demonstrate knowledge and competence for their area of professional responsibility at the practice.

We found that some improvements could be made to improve the safe delivery of the service. The staff team could do more to learn from incidents and events. Improvements were also needed to plan and monitor training for staff and ensure the recruitment procedure was robust.

The practice asked patients for their views and a Patient Participation Group (PPG) represented patients.  Efforts had clearly been made to build an effective PPG.     

Letter from the Chief Inspector of General Practice

We undertook an announced focused inspection of Downham Family Medical Practice on 16 September 2016. We found the practice to be good for providing safe care, and it is rated as good overall.

We had previously conducted an announced comprehensive inspection of Downham Family Medical Practice on 1 March 2016. As a result of our findings during that visit, the practice was rated as good for being effective, caring, responsive and well-led, and requires improvement for being safe. We found that the provider had breached Regulation 12 (1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; safe care and treatment.

The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements. We undertook this focused inspection to check that the practice had followed their plan, and to confirm that they had met the legal requirements.

This report only covers our findings in relation to those areas where requirements had not been met. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Downham Family Medical Practice on our website at http://www.cqc.org.uk/provider/1-199742664.

Our key findings across all the areas we inspected were that the practice had met the legal requirements by having:

• Purchased and installed oxygen to ensure that they were suitably equipped to manage medical emergencies. In addition the practice had added oxygen to the emergency medicines audit log to monitor the oxygen, created an oxygen management protocol, and staff had received training to ensure that they were familiar with the correct and safe use of the oxygen.

The practice had made additional improvements as follows:

• They had improved their processes to ensure that significant events were recorded appropriately and that learning from these events was thorough.

• GPs had received training to keep them updated on their responsibilities in relation to the Mental Capacity Act.
• The practice had conducted audits of waiting times for two GPs. The audits identified reasons for any late running of appointments, wherever this had occurred, and they created an action plan to make appropriate improvements. They planned further audits of the waiting times of all GPs, to be completed by the end of December 2016.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice