Little Park Surgery in Hanworth, Feltham is a Doctors/GP specialising in the provision of services relating to diagnostic and screening procedures, family planning services, maternity and midwifery services, services for everyone and treatment of disease, disorder or injury. The last inspection date here was 13th November 2019
Little Park Surgery is managed by Little Park Surgery.
Contact Details:
Address:
Little Park Surgery 281 Hounslow Road Hanworth Feltham TW13 5JG United Kingdom
This practice is rated as Good overall. (Previous rating October 2017 – Inadequate)
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
We carried out an announced comprehensive inspection at Little Park Surgery on 12 September 2018.This was a comprehensive inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The practice had been placed in special measures following an inspection on 19 October 2017. Following the inspection, the practice was served with a warning notice for Regulation 17. A further follow up inspection to the warning notice was carried out on 9 May 2018 to check that the practice was meeting the requirements of the warning notice. That inspection found that the practice had met all the requirements of the warning notice. The full comprehensive report of the October 2017 and May 2018 inspections can be found by selecting the ‘all reports’ link for Little Park Surgery on our website at www.cqc.org.uk.
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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
Staff involved and treated patients with compassion, kindness, dignity and respect.
Most patients found the appointment system easy to use and reported that they could access care when they needed it.
However, some patients reported a less positive experience when attempting to access the practice by telephone. The practice were aware of this and were working to make improvements.
There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider should make improvements are:
Continue action to promote the benefits of the childhood immunisation programme to increase patient uptake.
Continue improvements to ensure all patients can access the practice by telephone easily.
I am taking this service out of special measures. This recognizes the significant improvements made to the quality of care provided by this service.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.
We did not review the ratings awarded to this practice at this inspection.
We carried out an announced comprehensive follow up inspection of Little Park Surgery on 19 October 2017. We rated the practice as inadequate for safe and well-led services, requires improvement for effective, and responsive and good for caring. In line with our enforcement procedures we issued a warning notice in relation to regulation 17: Good Governance of the Health and Social Care Act 2008.The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Little Park Surgery on our website at .
This inspection was an announced focused inspection carried out on 11 May 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 19 October 2017. This report covers our findings in relation to those requirements made since our last inspection.
At this inspection on 11 May 2018 we found that actions had been taken to improve the provision of well-led services in relation to the warning notice.
Specifically:
The practice had ensured that all staff were aware of the safeguarding leads in the practice and the processes they would follow if they had safeguarding concerns.
All policies and procedures were updated and staff were aware of how to access them.
The practice had ensured relevant staff were trained on using the practices computer system effectively.
The practice were able to demonstrate their monitoring of medicines reviews for patients with long term conditions was effective.
The practice were able to demonstrate that confidential patient information was stored securely.
The practice had reviewed a system for monitoring equipment expiry dates and stock control and this was being followed.
The practice had systems to respond to negative feedback relating to access to the service.
The practice had reviewed its systems to assess, monitor and mitigate fire safety risks.
The practice had carried out the outstanding staff appraisals and a system had been introduced of ensuring the were not missed.
The practice were able to demonstrate they had a system in place for recording, handling and responding to complaints.
Our inspection on 11 May 2018 focussed on the concerns giving rise to a warning notice being issued on 15 December 2017. We found that the provider had taken action to address the breaches of regulation set out in the warning notice. However, the current rating will remain until the provider receives a further comprehensive inspection to assess the improvements achieved against all breaches of regulation identified at the previous inspection.
The comprehensive report of the 19 October 2017 inspection which was published on1 February 2018 should be read in conjunction with this report.
Letter from the Chief Inspector of General Practice
We carried out an announced follow up focussed inspection on 14 September 2017. During this inspection we found a number of concerns and decided to carry out a further visit to look at the full range of services at the practice. All previous reports can be found by selecting the ‘all reports’ link for Little Park Surgery on our website at www.cqc.org.uk.
We revisited the practice on 19 October 2017 to carry out an announced comprehensive inspection. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
There was a lack of good governance and the practice had not addressed all the concerns raised at the previous inspection.
Monitoring procedures were in place but were not always carried out consistently and effectively and there were inconsistent arrangements in how risks were assessed and managed.
The practice was unable to demonstrate they followed national guidance on infection prevention and control.
The practice was unable to demonstrate that all appropriate recruitment checks had been undertaken prior to employment.
The practice was unable to demonstrate that their systems for handling complaints, responding to safety alerts and the management of patients confidentiality were operated effectively.
Staff appraisals had not always been completed in a timely manner. Staff were up to date with training relevant to their role.
Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
There was some evidence of quality improvement activity including clinical audit.
Staff we spoke with informed us the management was approachable and always took time to listen to all members of staff.
The areas where the provider must make improvements are:
Ensure care and treatment is provided in a safe way to patients.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
In addition the practice should:
Improve how best to record significant events including identification of trends or themes.
Introduce quality improvement initiatives which may include audit.
Take action to promote the benefits of the childhood immunisation and bowel cancer national screening in order to increase patient uptake.
Take action to address the concerns raised by nursing staff regarding lack of time to complete administrative tasks.
Improve access to patients with hearing difficulties.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Letter from the Chief Inspector of General Practice
Our previous comprehensive inspection in October 2016 found breaches of regulations relating to the safe, effective and well-led delivery of services.
Following the October 2016 inspection Little Park Surgery was rated requires improvement for the provision of safe, effective and well-led services. The practice was rated good for providing caring and responsive services. Consequently we rated all population groups as requires improvement. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Little Park Surgery on our website at www.cqc.org.uk.
We carried out an announced follow up focussed inspection on 14 September 2017. This inspection was undertaken to ensure improvements had been implemented and that the service was meeting regulations. During this inspection we found a number of concerns and decided to carry out a further visit to look at the full range of services at the practice. The practice was not rated during this focussed inspection.
Our key findings across all the areas we inspected were as follows:
There was a lack of good governance and the practice had not dealt with some of the issues in a timely manner.
We found additional breaches of regulation that had not been identified by the practice prior to inspection, which demonstrated that governance monitoring procedures were not always carried out consistently and effectively.
There were inconsistent arrangements in how risks were assessed and managed. For example we found risks relating to the monitoring of fridge temperatures, safeguarding vulnerable adults and children training and management of health and safety related risk assessments.
Staff we spoke with on the day of inspection was not aware who the safeguarding lead in the practice was.
The practice was unable to demonstrate they always followed national guidance on infection prevention and control.
The practice was unable to demonstrate that all appropriate recruitment checks had been undertaken prior to employment.
Staff appraisals had not always been completed in a timely manner. However, the practice informed us after the inspection that dates were planned to complete all appraisals by October 2017. Not all staff were up to date with training relevant to their role.
One clinical audit cycle had been completed in the last 12 months, which demonstrated quality improvement. The practice did not have a rolling programme of audits to drive and monitor improvement in patient outcomes.
We saw evidence that the practice was encouraging patients to register for online services. For example, 12% (735) patients were registered to use online Patient Access compared to 10% (615) we found during the previous inspection in October 2016.
The practice had reviewed the appointment booking system and increased online GPs appointments to reduce the pressure on the telephone system.
Staff we spoke with informed us the management was approachable and always took time to listen to all members of staff.
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.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
In addition the practice should:
Implement systems to carry out a thorough periodic analysis of the significant events to identify any themes and take appropriate action.
Develop a rolling programme of audits to ensure continuous monitoring.
Ensure the most recent CQC rating is clearly displayed.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Little Park Surgery on 12 October 2016. Overall the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
The system for reporting and recording significant events was not clear to all staff.
Risks to patients were assessed and well managed.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received some training to provide them with the skills and knowledge, however we found this was limited and they had not received any training in infection control.
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 difficult to get through to the practice by phone to make appointments.
There was a leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
There were some governance arrangements in place, however there was no clear vision for the practice that staff were aware of.
The provider was aware of and complied with the requirements of the duty of candour.
The areas where the provider must make improvement are:
Ensure systems and process are in place to assess the risks to the health and safety of patients and do all that is reasonably practicable to mitigate risks. Such as:
Implement systems to carry out a thorough analysis of the significant events to identify any themes and take appropriate action.
Ensure all staff receive infection control training and there is a cleaning schedule for all parts of the premises.
Ensure electrical equipment testing is carried out to ensure the equipment is safe to use. Implement systems to ensure emergency equipment is fit for use and keep a record of such checks.
Implement risk assessment processes to monitor safety of the premises such as control of substances hazardous to health and legionella.
Ensure appropriate emergency medication is available in line with guidance such as Benzyl penicillin or Hydrocortisone or undertake a risk assessment to support the decision not to.
Carry out quality improvement activity such as clinical audits including re-audits to ensure improvements have been achieved.
Develop a clear vision for the practice and a strategy to deliver it. Ensure it is shared with staff and ensure all staff know their responsibilities in relation to it.
The areas where the provider should make improvement are:
Identify a lead member of staff for safeguarding and ensure all staff know who it is.
Continue to address issues identified in the infection control report such as replacing the taps and carpets in the consulting rooms.
Review the phone system to ensure patients are able to contact the practice to make appointments and improve patient satisfaction.
©2019 Care Services, all rights reserved. No part of this website may be reproduced without permission of the copyright holders.
