Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 10 June 2015. Breaches of legal requirements were found such that the safe domain was rated as Requires Improvement. 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 (1) (2) (a) (b) (g) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 30 March 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. 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 Rushey Green Group Practice on our website at www.cqc.org.uk.

Overall the practice is now rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

Care and treatment for service users was being provided in a safe way as the practice had taken steps to make suitable arrangements for emergency equipment and infection control and prevention.

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 Rushey Green Group Practice on 10 June 2015. Overall the practice is rated as good.

Specifically, we found the practice was good for providing an effective, caring, responsive and well-led service. The practice was rated requires improvement for providing safe services.

The practice was good for providing services for the six population groups we report on: older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), and people experiencing poor mental health (including people with dementia), and people whose circumstances may make them vulnerable

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, with the exception of those relating to infection control, and medicines management.
• Data showed patient outcomes were mostly above average for the locality.
• Audits had been carried out and were driving improvement in performance to improve patient outcomes.
• 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.
• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments.
• The practice had a number of policies and procedures to govern activity
• The practice had proactively sought feedback from staff or patients.

We found the following areas of outstanding practice at Rushey Green Group Practice:

• The practice has supported, from its infancy, the Rushey Green Time Bank, which is a community development time-exchange charity, based at the practice. Older, isolated people particularly find the time bank a useful resource, and participated in various events and activities such as monthly meetings, chair-based exercise sessions, walking group, befriending service and telephone after discharge service.
• The practice was open 8am – 8pm Monday to Friday and Saturday morning 9am – 12 noon. They told us this equated to one of the longest surgery opening hours in Lewisham. The practice offered long opening hours in response to patient demand.
• The practice was particularly focussed on the provision of care to meet the needs of patients in vulnerable circumstances. One of the GP partners is the named GP for Lewisham for safeguarding children, and one of the practice GPs is the Substance misuse Lead for the CCG. The practice had registered patients at a male homeless unit, several mental health and neurodisability units, a probation home with patients with significant forensic histories and a home for looked after young people. Two of the practice GPs ran a locality-wide drug and alcohol community detoxification service together with a specialist nurse and a key worker.

The areas where the provider must make improvements are:

• Ensure infection prevention and control arrangements are in place.
• Ensure an automated external defibrillator (AED) is in place, or a risk assessment in place outling the justification for not having the equipment in place

In addition the provider should:

• Ensure there is proper management of prescription pads in the practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Rushey Green Group Practice provides GP primary care services to people living in the borough of Lewisham and  is a GP training practice. It has just over 12000 patients registered.

During our visit , we spoke with the GPs, the deputy practice manager, nurses, health care assistant (HCA) and administrative staff. We spoke with eight patients and a representative of the practice’s patient participation group (PPG). Sixteen patients completed comments cards telling us what they thought of the care they had received from the service. 

All the patients were satisfied with the quality of care and support offered by the surgery. The practice had an active patient participation group (PPG) that met bi-monthly and contributed to the annual patient surveys which were carried out.

The practice had a clear vision statement and an accessible leadership team. Staff told us the practice had a supportive open culture and were fully aware of the governance arrangements in place. Staff were well supported in their work and were given protected time for mandatory training each year.

There were processes in place to report significant events and any incidents that occurred at the practice. We saw evidence of learning from incidents and appropriate safeguarding policies and procedures were in place.

Treatment was delivered in line with recognised national guidance including the National Institute for Health and Care Excellence (NICE) and they participated in clinical audits and peer reviews.

The practice demonstrated an understanding of the needs of the local population. However, we found improvements were required to ensure the practice is more responsive to people’s needs, as patients told us they found it extremely difficult to get an appointment at the surgery.