This practice is rated as Requires Improvement overall. (Previous rating 5 June 2017 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at East Croydon Medical Centre on 5 September 2018 as part our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen; however, we found that the provider had not considered some incidents as significant events. When incidents did happen, the practice learned from them and improved their processes.
• We found that some staff had not received training relevant to their role.
• The practice reviewed the effectiveness and appropriateness of the care it provided. However, the outcomes for patients with long-term conditions including asthma and mental health were below average and clinical exception reporting for patients with long-term conditions were significantly above average.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on learning and improvement.

The areas where the provider must make improvements are:

• Ensure care and treatment of the service users met their needs.
• Ensure staff receive appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvements are:

• Improve identification of significant events.
• Review procedures in place to ensure equipment’s are tested and calibrated appropriately; risk assessments are carried out; there is a system in place to monitor the implementation of medicines and safety alerts.
• Improve uptake for childhood immunisations and cervical screening.

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.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of East Croydon Medical Centre on 8 June 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 a system in place for reporting and recording significant events, however there was no policy and not all significant events were recorded.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice was not ideally suited to patients with mobility problems or parents with pushchairs, as patients had to use steps to make their way up to the first floor and there was no lift to help facilitate this.
• 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.

The areas where the provider must make improvement are:

• Ensure that governance arrangements are robust, and that policies and procedures meet the requirements of the practice and managing risk.

• Ensure that the infection control policy is adhered to.

In addition the provider should:

• Ensure services provided on site are available and accessible to all patients, including those with mobility problems and those with young children.

• The practice should consider reviewing the level of exception reporting, which was higher than the national average.

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 of East Croydon Medical Centre on 8 June 2016. The overall rating for the practice was Good. However breaches of legal requirements were found relating to the Well Led domain. The provider failed to maintain systems and processes to assess, monitor and improve the quality and safety of the services provided. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report can be found by selecting the ‘all reports’ link for East Croydon Medical Centre on our website at www.cqc.org.uk.

This inspection was a focused desk-based review carried out on 19 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Following the focussed inspection, we found the practice to be good for providing well led services.

Our key findings were as follows:

• The practice had effective governance arrangements in place; they had policies and procedures that met the requirements to manage risk. We saw evidence of new and updated policies regarding infection control, safeguarding children and adults, significant events, chaperone policy and a smartcard policy. We saw a comprehensive policy index spread sheet detailing all practice policies. We also saw a range of detailed practice minutes with action points and learning outcomes.

• The practice had an effective infection control policy in place. We saw evidence of monthly meeting minutes where infection control was discussed. We also saw a checklist the practice used on a daily/monthly basis to ensure infection control was addressed regularly.

• Since the initial inspection the practice had reviewed their accessibility to patients including those with mobility problems and those with young children. We saw, minutes confirming planning permission had been granted for a first floor extension which would incorporate a lift and a pram park. We saw architect plans for a lift extension which was commencing in April 2017. We saw photographs of a lowered reception counter, and new hand rails on the fire exit/disabled ramp.

We also reviewed the areas we identified where the provider should make improvement:

• The practice confirmed they discussed their exception reporting rate; however, had no formal minutes.

Importantly, the provider should:

Ensure minutes are kept of discussions in relation to the level of exception reporting, which was higher than the national average.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice