Archived: Clover Health Centre Also known as Greenwich Primary Care Collaborative CIC

Updated 5 February 2018

Clover Health Centre began operating in 2011 delivering GP services under an Alternative Provider Medical Services (APMS) contract. (APMS contracts allow NHS England to contract with a provider under local commissioning arrangements specific to that service). Until October 2016 the service was also providing a GP Walk-in service.

The service is registered with the CQC as an Organisation under the parent company Greenwich Primary Care Collaborative which is a Community Interest Company (CIC). (A CIC is a type of company designed for social enterprises. In line with the organisational requirements of a CIC the profits are reinvested in the company for the good of the community.) The service is registered with the CQC to provide the regulated activities of maternity and midwifery services; diagnostic and screening procedures and treatment of disease, disorder and injury.

Clover Health Centre is based in Equitable House, 10 Woolwich New Road SE18, a building shared with several other businesses, located in the centre of Woolwich opposite Woolwich Arsenal station. The practice is based on the first floor of the building (served by a lift) with all areas occupied by the practice being on one level. The service is located in the Royal Borough of Greenwich. Greenwich Clinical Commissioning Group (CCG) is responsible for commissioning health services for the locality.

The accommodation includes five consulting/treatment rooms and an isolation room and four further consulting/treatment rooms which are used to host other community services, such as diabetic eye screening and physiotherapy. There is a reception desk with administration area and practice manager's office behind and two separate waiting areas. Staff amenities, including kitchen and rest area, are also on the same floor.

The practice has a steadily increasing patient population of 5,800 registered patients. The practice age distribution differs from the national average with a much higher than average number of patients in the 20 to 39 year age group and a much lower number of patients aged over 50 years (96% of the patient population are under 65 years). The surgery is based in an area with a deprivation score of 3 out of 10 (with 1 being the most deprived and 10 being the least deprived).

GP services are provided by one full-time male lead GP (salaried), providing six clinical sessions a week and one male long-term locum GP providing seven clinical sessions a week.

Clinical services are also provided by four practice nurses (3.34 wte) and a part-time health care assistant.

Administrative services are provided by the Practice Manager (1 wte) and six administration/reception staff (4.63 wte).

The service is open from 8am to 6.30pm Monday to Friday and from 9am to 1.30pm on Saturday.

Updated 5 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. The practice was previously inspected on 10 December 2014 when the service was rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

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

People whose circumstances may make them vulnerable – Requires improvement

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

We carried out this announced comprehensive inspection at Clover Health Centre on 22 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had 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. However, minutes of meetings where incidents were discussed, were not sufficiently detailed to ensure learning was shared effectively with all staff.
• Staff we spoke to knew how to identify and report safeguarding concerns. However, not all staff had received up-to-date safeguarding training appropriate to their role, including the safeguarding lead who did not have training in adult safeguarding.
• The practice did not keep records of essential training for all staff, such as training in fire safety, infection control and safeguarding.
• There were procedures in place to manage infection prevention and control; however, there was no cleaning schedule in place against which cleaning standards were monitored.
• There was a system for receiving and acting on safety alerts, such as those provided by MHRA (Medicines and Healthcare products Regulatory Agency). However, the system in place was not sufficient to guarantee appropriate action was always taken when required.
• Patient Group Directions (PGDs) had been adopted by the practice to allow nurses to administer medicines in line with legislation. However, some PGDs had not been signed by all relevant staff.
• The most recent published Quality and Outcomes Framework (QOF) results (2016/17) showed the practice performance rates for a number of indicators were below the local clinical commissioning group (CCG) and national average.
• The practice’s uptake rate for cervical screening was 62%, which was below the CCG average of 79% and national average of 81%.
• The results from the annual national GP patient survey published in July 2017 showed that patients did not feel they were always treated with care and concern. Practice satisfaction scores were below average for most indicators regarding consultations with GPs and nurses.
• The practice had identified only 10 patients as carers (0.16% of the practice list).
• Results from the annual national GP patient survey published in July 2017 showed that patients’ satisfaction with how they could access care and treatment was below the local clinical commissioning group (CCG) and national averages. This was supported by comments from patients on the day of the inspection.
• Structures, processes and systems to support the management of good governance were in place and generally understood but procedures were not always formalised.
• The practice did not have an active patient participation group.

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

• The provider must ensure that persons employed in the provision of regulated activities receive the appropriate training to enable them to carry out their duties.
• The provider must improve patient outcomes by implementing a clinical quality improvement programme which includes monitoring performance against the Quality and Outcomes Framework.
• The provider must review the results of patient surveys in order to identify and implement the necessary action required to improve patient satisfaction.
• The provider must ensure that there is an effective procedure in place for the processing of patient safety alerts, such as those produced by the Medicines and Healthcare products Regulatory Agency (MHRA).
• The provider must ensure Patient Group Directions (PGDs) are signed by all relevant personnel.

The areas where the provider should make improvements are:

• The provider should revise their process for recording minutes for significant event analysis meetings to include all relevant details to ensure learning and necessary improvements are identified and shared with all staff.
• The provider should monitor cleaning standards on a regular basis.
• The provider should continue to monitor the practice uptake rate for cervical screening to make improvements as appropriate.
• The provider should review the effectiveness of policies and procedures and monitor adherence to systems and processes.
• The provider should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to all carers registered with the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 February 2018

Updated 5 February 2018

Updated 5 February 2018

Updated 5 February 2018

Updated 5 February 2018

Updated 5 February 2018