At the previous inspection, in January 2016, we had rated the Archway Medical Centre as Good. We carried out this further comprehensive inspection on 22 February 2018, in accordance with our published process to re-inspect a proportion of practices previously rated as good or outstanding. We have again rated the practice as Good overall and in relation to the five key questions:

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, which we have rated as follows:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Good

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

At this inspection we found:

• The practice learned from incidents and took action to improve its processes.
• Published data showed the practice performance was comparable with local and national averages.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found it easy to use the appointment system and told us they could access care when they needed it. However, waiting times with appointments running late, were above average.
• Data from the GP patient survey showed that patient satisfaction was generally above local and national averages. Where a need for improvement had been noted, the practice had drawn up action plans.

The areas where the practice should make improvements are:

• Continue to monitor appointments running late and identify how delays can be reduced.
• Continue with efforts to improve the uptake rates of childhood immunisations.
• Continue with efforts to identify and support patients who are carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

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.

We carried out an announced comprehensive inspection on the 11 January 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.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• 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.

• 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.

• The provider was aware of and complied with the requirements of the Duty of Candour.

However, there are areas where improvement can be made.

The provider should -

• Continue to monitor the appointment system to identify where improvements in patient access can be made.

• Continue to regularly review and assess the risks associated with not having a defibrillator on the premises.

• Work with the PPG to increase its activity, allowing patients to be more involved in making recommendations and decisions regarding service delivery.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

This visit was a follow up to our inspection of the 19 December 2013, when we found that the provider was failing to comply with regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The regulation requires that providers ensure people who use services are protected against the risks associated unsafe or unsuitable premises. We noted a number of concerning issues, such as the premises fire alarm not having worked for some time and that staff had not been given recent fire safety training.

Following our inspection in December 2013, the provider sent us a plan of the actions intended to meet the requirements of the regulation. At this inspection, we checked that the actions had been implemented. We spoke with the practice manager and clinical and administrative staff and inspected documents and records relating to fire safety management at the practice.

We found that the practice had installed a new fire alarm system, weekly checks had been implemented and relevant training for staff had been arranged. The action taken by the provider was appropriate and sufficient to comply with the regulations.

Archway Medical Centre was well regarded by the patients we spoke with. One person described the care as 'exceptional' and another said, 'All the doctors are good. All the nurses are good'. A staff member told us, 'Whoever comes is welcome', and we saw arrangements were in place to meet the needs of some of the most vulnerable patients.

The premises were kept clean and the eight staff members were spoke with were well informed about child protection and adult safeguarding. There were arrangements in place for staff to keep up to date with new developments and to monitor their own performance.

However we were concerned about the lack of access for people with disabilities affecting their mobility and the poor fire safety arrangements.