We carried out an announced comprehensive inspection at Paxton Green Group Practice on 31 January 2019 as part of our inspection programme. The practice had been previously rated as good when we carried out the first inspection in November 2015. Our inspection team was led by a Care Quality Commission (CQC) Inspector and included a GP specialist advisor.

Our judgement of the quality of care at this service is based 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 overall.

This means that:

• Patients were protected from avoidable harm and abuse and that legal requirements were met.

• Patients had good outcomes because they received effective care and treatment that met their needs.

• Patients were supported, treated with dignity and respect and were involved as partners in their care.

• People’s needs were met by the way in which services were organised and delivered.

• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.

We rated the practice as outstanding for providing responsive services because there were innovative approaches to providing integrated person-centred care including:

• Time bank offered at the practice for patients to drop in and socialise or learn new skills. This offered older patients an opportunity to avoid social isolation.
• Significant attention to patient feedback and thriving PPG. The PPG was instrumental in developing the ask the GP facility on the practice website. This reduced the need for appointments by providing patients with a 48 hour response to their health questions. It also enabled GPs to arrange prompt appointments if the question asked required a consultation.
• A daily telephone advice line overseen by the doctors. This focussed on advice for older patients, their relatives and/or carers.
• A prostate cancer screening service including ultrasound and urine flow tests at the practice. Providing opportunity for early diagnosis without the need to travel to hospital and onward referral for prompt treatment.
• A dedicated medicine query telephone line run by a practice pharmacist where queries were responded to the same day.
• Prompt referral to community and voluntary groups with evidence of older patients receiving quick support from such groups to reduce the risk of hospital admission. The practice had the highest referral rate to support groups for the elderly within the clinical commissioning group (CCG) area. CCG benchmarking data showed the practice as one of the lowest for hospital admissions and accident and emergency attendance.
• On site pilot clinics with psychiatric nurses for patients with long term mental health problems and for early screening for dementia, leading to earlier diagnosis and support.
• There was access to a mental health specialist at the practice every day.
• Patients with long term mental health needs had a named nurse for continuity of care.

We rated the population groups as good with the exceptions of both Older People and People experiencing poor mental health (including those with dementia) which were rated outstanding. This is because the practice had introduced additional services, as described above, which focused on ensuring appropriate and timely support for these groups of patients. The practice also made additional efforts to provide continuity of care for these groups.

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

We carried out an announced comprehensive inspection at Paxton Green Group Practice on 30 November 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:

• 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 but not always well managed with regards to recruitment procedures and the management of medicines in the doctor’s bags; however we saw that the practice was pro-active in addressing these issues shortly after our inspection.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The system for ensuring updates were read and actioned was not clear but the practice took action to make improvements.

• 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 was available and easy to understand, with the exception of translation services.

• Most patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• There was a clear leadership structure and staff felt supported by management. The practice pro-actively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice:

• The practice set up a drop-in service for older patients who wanted to socialise with and engage in a range of activities with their peers. The drop-in was started after staff identified that isolated older patients attended the practice solely seeking social interaction.

• The practice provided food vouchers to patients facing serious financial difficulties, which allowed them access to a hot meal on the day, temporary food and sanitary supplies and access to local support groups to help them improve their circumstances.

• The practice set up a local time bank in 2011 for isolated patients and those living with depression to encourage social interaction. The practice had received very positive feedback from patients including comments that the time bank had had a positive impact on their feeling of purpose.

However, there are areas where the provider should make improvements.

The provider should:

• Ensure staff follow the protocol for reading and actioning alerts received.

• Ensure there is a system in place to record that medicines in the doctor’s bags have been checked.

• Ensure the recruitment process includes two references for all staff, in accordance with the recruitment policy, and an assessment of the immunisation status of all newly-recruited non-clinical staff.

• Ensure outcomes relating to the care of patients with poor mental health and diabetes are continually monitored and areas for improvement are identified and actioned.

• Ensure translation services are clearly advertised in the waiting areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice