We carried out an announced comprehensive inspection at The Sandmere Road Practice on 12 December 2018 as part of our inspection programme.

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 overall and good for all population groups, except for older patients and people whose circumstances may make them vulnerable which are rated as outstanding. The responsive key question is also rated as outstanding.

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.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw five areas of outstanding practice:

• The practice provided patients with organically grown apples to encourage them to live healthier lives. The practice had also arranged for patient walks of the orchard where apples were grown. The practice gave away 100kg of apples per year.
• The practice had arranged for a film detailing self-harm to be shown at two local cinemas and had arranged for patient groups to attend so that issues of this kind might be better identified and managed.
• The practice had dedicated administrative safeguarding leads to protect confidentiality for these patients and to ensure that they were followed up by the practice in a timely way, particularly if appointments were missed.
• The practice referred patient to the Age UK Safe and Independent Living (SAIL) programme so that they could receive multi-disciplinary support for health and other social issues. The practice had a dedicated co-ordinator who reviewed patients who may benefit from such referrals, and 88 patients had been referred. This had optimised care for these patients.
• The practice had entered a partnership with a local coffee shop where hundreds of self-care leaflets were handed out, including details of medicines that could be bought over the counter rather than on prescription. They had also arranged for discounted coffee on Wednesdays for older patients, carers and vulnerable patients with a view to encouraging more lonely patients to leave the house. The practice had a plan to promote talking therapies in the next year.

Whilst we found no breaches of regulations, the provider should:

• Review the way in which vaccine refrigerators are stocked to prevent damage to the vaccines.

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 The Sandmere Road Practice on 25 February 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 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.
• 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.
• 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 two areas of outstanding practice:

• The practice had undertaken an audit with a view to improving its uptake of breast screening as only 30% of eligible women in the practice population had regular screening; one of the lowest uptakes among practices in Lambeth. The initial audit was undertaken in 2012 and was repeated every twelve months thereafter. The practice held an educational session for all staff on the procedure; invited women who were eligible by telephone to come in for screening and promoted the service in the practice waiting area. The practice also ensured that locums were aware of the service and were actively encouraging patients to attend. As a result uptake within the practice has gradually increased year on year and was 59.3% in 2014/15 comparative to the CCG average of 60.1%. Although the practice were still below the CCG average; this demonstrated an effective use of a rolling audit programme which significantly improved uptake of screening; potentially resulting in significantly improved outcomes for the patients involved.

• The practice told us of an incident where an elderly frail patient attended the practice for an appointment and did not have transport home. On the basis of this incident a taxi fund was established to ensure that frail patients were able to be taken home safely.

The areas where the provider should make improvement are:

• Review the arrangements for clinical waste storage.

• Provide online facilities enabling patients to book appointments and order repeat prescriptions.

• Review their practice around coding to ensure that patients with long term conditions and carers are being identified.

• Undertake analysis of the appointment system reviewing waiting times and patient perceptions of waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with six people who used the service and they were mostly positive about the care and treatment they received. We also spoke with representatives of the practice’s patient participation group and they too were complimentary about the service provided to patients. One person we spoke with said, “The staff are very helpful, polite and considerate. The doctors listen to me when discussing my health problems.” Another person told us, “I am 110% happy with the service. The doctor is really thorough and I feel very confident in the treatment and care I receive.” People told us they felt involved in decisions about their care, were provided with clear information and understood the treatment and choices available.

Care was planned and delivered in way to ensure people’s safety and welfare. We saw up to date plans that set out people’s care and treatment needs, identified potential risks to their health and showed their agreement was sought in the care and treatment provided.

There were appropriate procedures in place to protect people from abuse and staff knew how to identify and report signs of abuse.

There were effective recruitment and selection processes in place and people were supported by, suitably qualified, skilled and experienced staff.

There were systems in place to monitor the quality of service provided. People who used the service gave feedback through patient surveys on service quality and delivery. The service had a patient participation group which provided support and advice to the practice on behalf of patients. The service had systems to manage and review incidents and complaints.