We carried out an announced focused inspection at The Practice Beacon on 5 February 2019. The inspection was triggered by concerns received by the Care Quality Commission. The concerns suggested that the practice was not appropriately prepared for medical emergencies and that staff did not have access to sufficient training opportunities.

We previously published a comprehensive inspection of The Practice Beacon on March 2017. At that time the service was rated as good overall, for all key questions, and all population groups.

We focused our inspection on 5 February 2019 on the concerns raised; areas we had identified for improvement at the last inspection and areas where the practice’s published performance had changed since our previous inspection. We have rated the key questions we focused on as follows:

Are services safe? – Good

Are services effective? – Good

The practice remains rated as good overall. It remains rated as outstanding for providing responsive care and good for providing safe, effective, caring and well-led care. It remains rated as good for all population groups.

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 and other organisations.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.

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

Dr Rosie Benneyworth

BM BS BMedSci MRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Practice Beacon on 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 in place for reporting and recording significant events.
• 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 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.

We saw one area of outstanding practice:

The practice had a particular interest in the improvement of palliative and cancer care. As a result of learning from its own challenging cases,it had designed templates to improve quality of end of life care which were being adopted by all practices within the CCG. The template included links to out of hours services, the Gold Standards Framework and a number of hospices. The practice presented case examples of quality palliative care, demonstrating the importance of pre planning and working closely with other organisations. The cases included a letter from a family thanking the practice for the quality of care provided and reflection of the treatment of a patient presented at a network learning forum. The practice had also acknowledged the importance of recognising patients early and secured funding from a national cancer charity to sponsor palliative care facilitators for two years in the CCG. This benefitted both patients at the practice and more widely in the locality.

The areas where the provider should make improvement are:

• Ensure records are kept of the regular fire drills completed at the practice.
• Arrange for checks of anaphylaxis medicine to be recorded.
• Complete and document a risk assessment of the decision for not stocking medicine for severe pain in the emergency medicines kit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The Practice Beacon is a GP surgery providing weekday primary care services to patients in West London. It provides primary care services from its site in Ladbroke Grove.

The surgery had approximately 1,800 registered patients at the time of our inspection. The surgery was located at street level and is accessible to people who require wheelchair access. The Practice Beacon is registered with the Care Quality Commission to carry on the regulated activities of Diagnostic and screening procedures, Maternity and midwifery services, Surgical procedures, and Treatment of disease, disorder or injury.

The Practice Beacon staff team is made up of two GPs, a practice nurse, healthcare assistant, a practice manager and two reception staff. In addition to GP appointments, clinics are led by the practice nurse for services including wound care, chronic disease management, child immunisations and cervical smears. Clinics led by the healthcare assistant include new patient health checks and blood pressure monitoring.

All the patients we spoke with were complimentary about the service they had received. The results of the most recent patient survey showed that patients were satisfied with the care and treatment they received. However we found that the practice did not have an active patient participation group. The practice took action in response to improvements suggested by patients.

The provider responded promptly and effectively to incidents and complaints, made improvements and learned from these events.

The leadership team was visible and staff and patients found them approachable and supportive.

We found good examples of how The Practice Beacon was meeting the needs of each of the population groups we report on. Older people and people who were physically frail received additional support through on-going reviews and, if required, had home visits. People with long term conditions were also encouraged to have additional monitoring and reviews, and the practice had good working relationships with other providers such as hospitals and community health teams to ensure people received ongoing care. The practice carried post natal checks for new mothers and child immunisations.

Particular good practice we found during this inspection was that the practice was implementing a new appointments system in July 2014, partly in response to patient feedback that would offer greater accessibility and flexibility to patients by allowing them to book appointments and request repeat prescriptions online. The new system will also have text enablement to confirm and remind patients about their appointments.

There were also a number of areas we found that the practice could make improvements in. The practice could provide clearer information about the opening hours and appointment hours on their website and within the practice, so that people had a clear understanding of the accessibility of the practice. Staff should be clear on circumstances when children may be seen without being accompanied by a parent and / or without parental consent. Staff should also have a better understanding in the assessment of mental capacity. The practice could ensure annual staff appraisals are completed for the 2013 / 14 year, and new staff objectives are set for the current year 2014 / 15. The practice could ensure that a functioning and effective patient participation group (PPG) was set up.