We carried out an announced comprehensive inspection at Plumstead Health Centre PMS on 10 November 2016. The overall rating for the practice was good. The rating for the effective key question was requires improvement and for the safe, caring, responsive and well-led key questions the rating was good. The full comprehensive report, published on 11 January 2017, can be found by selecting the ‘all reports’ link for Plumstead Health Centre PMS on the CQC website at .

An announced follow up focused inspection was carried out on 24 May 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 10 November 2016. At that inspection the rating for the effective key question remained requires improvement.

This inspection was an announced focused inspection carried out on 22 August 2018 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 24 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good but continues to be rated as requires improvement for providing effective services as the practice did not make the necessary improvements to patient outcomes. However, we saw evidence that the practice had made significant improvements in a few areas.

Our key findings were as follows:

• Unverified QOF 2017/18 data showed that the practice had improved on their 2016/17 overall QOF score which awarded them 425 points out of 559. At the time of the inspection the practice had achieved 525 points out of the available 559.
• The Quality and Outcomes Framework (QOF) data from 2016/17, showed that the practice performance was below the local and national average for several clinical indicators.
• Unverified results for 2017/18 provided by the practice showed an improvement in some QOF indicators.
• The practice worked closely with other organisations within the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice is part of the Live Well Centre which provides services, under the Royal Borough of Greenwich’s public health and wellbeing services, to the local population.
• Information about services and how to complain was available and easy to understand.
• Patients were treated with compassion, dignity and respect and generally felt listened to during their appointment.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Continue to work towards improving outcomes for patients by implementing a comprehensive and effective clinical quality improvement programme.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice was previously inspected as part of the new comprehensive inspection programme. We carried out an announced comprehensive inspection at Plumstead Health Centre PMS on 10 November 2016. The overall rating for the practice was good. The rating for the effective key question was requires improvement and for the safe, caring, responsive and well-led key questions the rating was good. The full comprehensive report, published on 11 January 2017, can be found by selecting the ‘all reports’ link for Plumstead Health Centre PMS on the CQC website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 May 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 10 November 2016. This report covers our findings in relation to those requirements and any improvements made since our last inspection.

Overall the practice is rated as good but continues to be rated as requires improvement for providing effective services as the practice failed to make the necessary improvements to patient outcomes. However, we saw evidence that the practice had made the necessary improvements in all other areas. At this inspection we found that:

• Risks to patients were assessed and well managed. We saw evidence that there was a failsafe procedure in place to ensure that results were received for all specimens sent for cervical screening.
• The practice had good facilities and was well equipped to treat patients and meet their needs. There was a comprehensive business continuity plan in place and the provider had evidence to confirm that Legionella checks had been carried out at both the main and branch surgeries.
• We saw evidence that the provider had established protocols with the premises owners of both sites for sharing information about the maintenance of the premises and cleaning schedules.
• A comprehensive programme of quality improvement and performance monitoring had been developed by the practice but there had been insufficient time for this to have a positive impact on patient outcomes. Unpublished Quality and Outcomes Framework performance rates for 2016/17 showed that the practice remained below the local and national average for a number of indicators.
• In the previous 12 months there had been no audits undertaken that demonstrated improvements to patient outcomes. However, the provider informed us that a programme of clinical audit had been developed as part of the newly implemented programme of quality improvement.

There were areas where the provider must continue to make improvements:

• The provider must continue to work towards improving outcomes for patients by implementing an effective clinical quality improvement programme to include clinical audit and monitoring of performance against the Quality and Outcomes Framework.

At our previous inspection on 10 November 2016, we rated the practice as requires improvement for providing effective services as the performance rates for the Quality and Outcomes Framework for a number of indicators were below the local and national average and there was no evidence of clinical audits carried out in the previous 12 months to show improvements in patient outcomes. As there had been no improvement in this area the practice continues to be rated as requires improvement for providing effective services.

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 Plumstead Health Centre PMS on Thursday 10 November 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 for reporting and recording significant events.
• Risks to patients were assessed and well managed. However, there was no failsafe procedure in place to ensure that results were received for all specimens sent for cervical screening.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. However, the performance rates for the Quality and Outcomes Framework for a number of indicators were below the local and national average. Only two audits had been undertaken in the previous 12 months neither of which showed an improvement to patient outcomes.
• 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 were able to make an appointment with a named GP and 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. However, a business continuity plan was not available and the practice were unsure if Legionella checks had been carried out and did not monitor cleaning schedules.
• 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.

There were areas where the provider must make improvements:

• The provider must improve patient outcomes by implementing a clinical quality improvement programme and monitoring performance against the Quality and Outcomes Framework and clinical audit.

There were areas where the provider should make improvements:

• The provider should implement a failsafe procedure to ensure that results are received for all specimens sent for cervical screening.
• The provider should produce a business continuity plan for major incidents such as power failure or building damage and ensure this is made available to staff.
• The provider should ensure that they establish protocols with the premises owners of both sites for sharing information about the maintenance of the premises, such as cleaning schedules and various risk assessments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice