We carried out an announced comprehensive inspection at Wallington Medical Centre on 18 December 2018 as part of our inspection programme.

At the last inspection in November 2017 we rated the practice as requires improvement for providing safe services and for providing effective services because:

• Safety systems and processes had deteriorated since the last inspection in January 2015. Some risk assessments were not being used effectively to manage risk, and there were gaps in staff training.
• There were some areas (such as cervical screening, NHS health checks, and care of patients with some long-term conditions, as measured by QOF) where the practice performance was below average.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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.

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.

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

• Continue to implement and monitor action plans to reduce exception reporting and prescribing of hypnotics, and increase take up of screening and childhood immunisations.
• Continue to review policies to ensure they are in line with latest guidance.

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

This practice is rated as Requires improvement overall. (Previous inspection – January 2015 - Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Requires improvement

Families, children and young people – Good

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Wallington Medical Centre on 7 November 2017, as part of our scheduled inspection programme.

At this inspection we found:

• Some safety systems and processes had deteriorated since the last inspection. Some risk assessments were not being used effectively to manage risk, and there were gaps in staff training.
• There were some areas (such as cervical screening, NHS health checks, and care of patients with some long-term conditions, as measured by QOF) where the practice performance was below average.
• The practice had clear systems to manage safety incidents. When incidents did happen, the practice learned from them and improved their processes.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (See requirement notices section at the end of the report for more detail.)

The areas where the provider should make improvements are:

• Assess whether the practice is compliant with the NHS Accessible Information standard, and take action on any areas identified for improvement (For example, by developing easy read materials).

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 Wallington Medical Centre on 16 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned through annual appraisal.
• Patients said they were treated with kindness, compassion, and respect and that they were involved in decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand.
• Patients were generally satisfied with the appointment system and found it easy to make a convenient appointment.
• 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.

We saw one area of outstanding practice:

• The practice had arranged an independent clinical risk self-assessment in April 2013 to identify potential risks that could impact on patient and staff safety. All clinical and non-clinical staff had actively engaged in the process and participated in identifying risks and actions required to mitigate risks. As a result improvements to practice were made, including changes to administration processes, roles and responsibilities.

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

The provider should:

• Undertake a risk assessment to assess the different responsibilities and activities of administration staff to determine if they are eligible for a Disclosure and Barring Service (DBS) check.
• Ensure that staff receive training in the use of the automated external defibrillator (AED) purchased by the practice (in accordance with the Resuscitation Council (UK) recommendations for primary care).
• Ensure that all practice policies are dated and include dates of review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice