We carried out an announced focused inspection at New Addington Group Practice on 19 December 2018 to follow up on breaches of regulations.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 8 November 2017.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good for providing well-led services.

We found that:

• 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 acted on and learned from medicines and safety alerts.
• The practice had a system in place to check emergency medicines.
• The practice had a system in place to follow up patients who had been referred for suspected cancer. The provider used an electronic referral system to refer patients and referral letters contained all the necessary information.
• We found that patient consultations were appropriately coded; the provider undertook regular coding audits to ensure consultations were appropriately coded.
• All staff received regular appraisals.
• All staff received training appropriate to their role and up to date records of training were maintained.
• Exceptions for patients with long-term conditions were appropriately reported.
• The national GP patient survey results for 2018 indicated that patients were satisfied with waiting times for appointments.
• 83% (85 patients) of 102 patients with learning disability had their health checks in 2017-18. The practice had looked at the reasons for patients with learning disability not attending appointments to improve uptake of health checks.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection May 2015 rated overall as Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive inspection at Parkway Health Centre on 8 November 2017 as part of our regular inspection programme.

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. However some the staff we spoke to were not aware of these incidents.
• 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

• The practice worked with the local community development project and referred patients who were isolated, vulnerable patients, carers and single parent families to a health connector to join local groups. Health connectors were employed by the local council who coordinated care between social services, health charities and carer organisations. The practice had referred over 150 patients who were isolated or stressed and we saw case studies and statements from four patients who had indicated an improvement in their general well-being.

The areas where the practice must make improvements are:

• Assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity. Ensure that an effective system in place to share learning from incidents and patient safety alerts; ensure an effective system in place to monitor stock of medicines and to follow-up patients referred for suspected cancer (two week wait referrals); ensure staff supervision, appraisal and training was appropriate and up to date.
• Maintain accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and decisions taken in relation to the care and treatment provided. Ensure exceptions for patients with long term conditions are appropriately reported and clinical procedures and consultations are appropriately coded.

The areas where the provider should make improvements are:

• Take action to improve patient satisfaction with waiting times for appointments.
• Undertake health checks for all patients with a learning disability.

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 the AT Medics GP practice at Parkway Health Centre on 13 May 2015. Overall the practice is rated as good.

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.

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
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 easy to make an appointment, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw a number of areas of outstanding practice:

• There were excellent examples of how the practice’s vision and ethos was implemented by the staff team working together to maintain high standards, deliver positive health outcomes for patients and foster a supportive work environment. The practice had achieved the Royal College of General Practitioners (RCGP) Quality Practice Award (QPA), ISO 9001:2008 certification for its quality management system, and an Investor in People (IIP) award. QOF data for this practice showed the practice was performing exceptionally high, achieving an overall score of 100% in the 2014 /15 year.
• The practice had completed a smoking cessation audit within the last year which had led to increases in the numbers of people completing the course and remaining as non-smokers.

• We found the practice outstanding in its care of People experiencing poor mental health (including people with dementia) because they had recognised the stigma surrounding poor mental health and had worked with local enterprises to work to ensure people were better informed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice