This practice is rated as Requires Improvement overall.

The practice consists of what was two former practices which merged in July 2018. Both practices had previously been inspected by CQC. The main site which has always been known as Clapham Family Practice was inspected in October 2016 and was rated as good in all areas. The site at 86 Clapham Manor Street was inspected in April 2018 and was rated as requires improvement overall. It was rated as inadequate for safe, requires improvement for effective and well led and as good for caring and responsive. All population groups were rated as requires improvement.

The report stated where the practice must make improvements:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that systems and processes are established and operated effectively to ensure compliance with the requirements of good governance.

In addition, the provider should:

• Review the arrangements for identification of patients with caring responsibilities so they can provide and signpost them to the appropriate support.

We carried out an announced comprehensive inspection at The Clapham Family Practice on 6 November 2018. The inspection was a comprehensive inspection of the newly merged organisation, but also a follow up of the inspection at the Clapham Manor Street site.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

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.
• The practice had some implemented defined and embedded systems to minimise risks to patient safety, although the management of sharps was not in line with national guidance.
• The practice did not have systems in place to ensure the safe management of high risk medicines and the security of prescriptions.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, some members of staff had not been appraised.
• 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.
• Information about services and how to complain was available.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Governance systems were in place in most areas, but clinical meetings were not documented.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that systems and processes are in place to ensure compliance with the requirements of good staffing.

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 on 29 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.
• There was a system in place for reporting and recording significant events.
• Risks to patients were assessed and generally well managed but the practice was not effectively managing its patient group directions.
• 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 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Review and monitor the management of patient group directions to ensure they cover all relevant medicines and they are all signed and up to date.

• Ensure health and safety risks in the premises are assessed, and mitigating action is taken in respect of these risks.

• Keep adequate records of safeguarding meetings with health visitors and social workers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

People who used the service told us, “The service is fantastic,” and there are “good doctors.” Another person told us it’s an “excellent practice.” Some people were unable to speak to us during the inspection day but had left comments on the NHS choices website. The comments included, “Doctor is fantastic - very understanding, friendly and never condescending or patronising. Can't speak highly enough.” Another person stated, “My GP is exceptional and extremely helpful, the staff when you walk in are friendly and cheerful.” Another person stated, “The doctor was unrushed, made a thorough examination and gave full immediate care and a referral to the hospital of my choice.” Many of the comments on NHS choices from people over the last month were about difficulties they had experienced in getting an appointment. One person stated, “The issue with this practice is that it's impossible to call in and many times I had to give up.” Another person stated, “Trying to get an appointment with this surgery is almost impossible,” and a person reported “being on hold for 20 minutes.”

The practice was improving the system. In response to feedback from people who used the service, the appointment schedule had been reviewed and the number of appointments that were available to be booked 48 hours in advance and a week in advance had increased. In addition, the practice had introduced daily appointments for emergencies.

The practice had systems in place to maintain the safety and welfare of people using the service.

There were processes in place to protect people using the service from abuse. Staff were knowledgeable in recognising signs of potential abuse and the relevant reporting processes.

There were appropriate recruitment and selection processes in place. The records we saw showed that staff had the appropriate skills, knowledge and experience to support people using the service.

There were processes in place to monitor the quality of the service. Learning from complaints and significant events was shared amongst the staff team.