Archived: Streatham Place Surgery

Updated 1 September 2017

The practice operates 28 Streatham Place, Streatham, London, SW2 4QY. The practice is based across two floors of a purpose built building. It is part of the Lambeth clinical commissioning group area. Services are delivered under a Personal Medical Services (PMS) contract. (PMS contracts are locally agreed agreements between NHS England and a GP practice).

The practice is managed by AT Medics Limited. This provider manages 50 services across London. The service manages three services in the Streatham area, and patients have the opportunity to utilise additional services at the other two sites which are respectively a quarter of a mile and a mile away from the site. The provider has managed this site since September2015.

The practice has approximately 4,800 patients. The surgery is based in an area with a deprivation score of 3 out of 10 (10 being the least deprived). The area served by the practice has a mixed population with some areas of high and some areas of low deprivation. The practice population’s age demographic is broadly in line with the national average, although there are slightly higher numbers of patients aged between the ages of 10 to 54, and slightly fewer patients over the age of 55 than the national average.

The GP team includes two GPs (both female) who work solely at the site. However, two GP locums (one male and one female) work at this site as does one male GP who is a manager at AT Medics. In total this equates to 2.05 full time GPs at the practice. At the time of the inspection the practice list was increasing (from 4,200 when AT Medics took over management of the site) and the number of GPs required at the site was being reviewed. The nursing team includes one nurse (0.54 WTE) and two healthcare assistants (0.71 WTE). The practice also employs a prescribing practice pharmacist (0.72 WTE), and another pharmacist employed by AT Medics is available on an ad-hoc basis as required. The clinical team is supported by a senior manager, a practice manager and five other administrative and reception staff.

The practice is open from 8.00am to 6:30pm Monday to Friday. There are also extended hours available at a site approximately a quarter of mile from the surgery which is owned by the same provider from 9am until noon on Saturdays and Sundays. All patients have access to these appointments. The practice offers appointments throughout the day when the practice is open. When the surgery is closed urgent GP services are available via NHS 111.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice had not previously been inspected by the CQC.

Updated 1 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Streatham Place Surgery on 7 June 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• 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.
• Results from the national GP patient survey showed that in most areas patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw several areas of outstanding practice:

• The practice had invested in a business intelligence tool which provided ready access to searches relevant to medicines management and effective care outside of those provided through the patient record system. This provided ready access to information relating to when follow up tests for patients on medicines used to manage long term condition and patients with poor mental health. All staff were involved in the monitoring and improvement of outcomes, and there were both clinical and administrative leads in place to ensure that follow ups were scheduled. The practice had evidence to show that the system had improved compliance of tests in the eighteen months that they had managed the practice.

• The provider had arranged relevant in house training for all staff in the practice for the next year. Training was determined on the basis of role, and training was delivered in person, by Webex and where necessary 1:1. For clinical staff this focussed on the management of long term conditions and mental health. All staff at the practice undertook training on the Mental Capacity Act and Deprivation of Liberty Safeguards.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 September 2017

The practice is rated as outstanding for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average. The practice had scored 95.6% for diabetes related indicators in the last QOF slightly higher than the national average of 89%. The exception reporting rate for diabetes related indicators was 3.3%, lower than the national average of 11.6%.

• The practice had invested in a business intelligence tool which provided ready access to searches relevant to medicines management and effective care outside of those provided through the EMIS system. This provided ready access to information relating to when follow up tests were required for patients on medicines used to manage long term conditions. The practice had evidence to show that the system had improved compliance of tests in the eighteen months that they had managed the practice.

• The practice had improved the way in which diabetes was monitored such that performance against eight forms of monitoring had improved from 21% when they first took over the practice in September 2015 to 88% at the time of the inspection. This was the highest level within the CCG area.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

Updated 1 September 2017

The practice is rated as good for the care of families, children and young people:

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The service offered out of hours appointments on both Saturday and Sunday at a practice owned by the same provider 400 yards away.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 1 September 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice had undertaken a project with Age UK to ensure that blankets were available free of charge at the surgery for the benefit of elderly patients. This was not specifically in response to local needs, but there had been uptake from the practice population.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

Updated 1 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The service offered out of hours appointments on both Saturday and Sunday at a practice owned by the same provider 400 yards away.

Updated 1 September 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.

• All of the patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• QOF performance for mental health related indicators was similar to the national average. The practice had scored 88.5% for mental health related indicators in the last QOF, which was similar to the national average of 93%. The exception reporting rate for mental health related indicators was 5.7%, lower than the national average of 12%.

• The practice had invested in a business intelligence tool which provided ready access to searches relevant to medicines management and effective care outside of those provided through the EMIS system. This provided ready access to information relating to when follow up tests were required for patients on medicines used to manage poor mental health. The practice had evidence to show that the system had improved compliance of tests in the eighteen months that they had managed the practice.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. The practice also worked to prevent the need for this with written guidance for patients in the event that they became unwell.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 1 September 2017

The practice is rated as good for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice had specific searches and monitoring in its business intelligence tool to ensure that patients with learning disabilities and other vulnerable groups could better have their care and treatment monitored, and where necessary changed.

• The practice had put in place systems such that patients could be registered by their preferred gender.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. All staff at the practice undertook training on the Mental Capacity Act and Deprivation of Liberty Safeguards.

• The practice had significantly increased the number of patients identified as carers in the past year. They had developed a carers network at the practice which included regular carers coffee mornings where all patients are invited to meet with the practice’s dedicated” Carers Navigator” and with the local Carers Hub.