Slade Green Medical Centre

Updated 16 August 2017

Slade Green Medical Practice is located in the London Borough of Bexley. The practice has a branch surgery, Colyers Lane Medical Centre, which we also visited as part of this inspection. The practice provides a general practice service to around 8,000 patients.

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

The practice has a Personal Medical Services (PMS) contract and provides a full range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning, sexual health services and minor surgery.

The practice has two male GP partners. They employ two long term locum GPs, one male and the other female. There is also a female practice nurse and a male healthcare assistant completing the clinical team. The practice has a full time practice manager and nine administrative staff consisting of medical secretaries, reception staff, clerks and typist. The practice provides 25 GP sessions per week.

The Slade Green Medical Practice is currently open Monday, Tuesday, Wednesday and Friday from 8am to 7pm; on Thursdays they are open 8am to 6.30pm. Colyers Lane Medical Centre is open from 8am to 6pm, with the exception of Thursdays when they are open 8am to 12noon. Consultation times are from 8am to 12.30pm and from 15:30 in the afternoon. The practice is not open at weekends. When the practice sites are closed, the telephone answering service directs patients to contact the out of hours provider.

Updated 16 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Slade Green Medical Centre on 24 September 2015. The practice was rated as good for providing caring and responsive services, and rated requires improvement for providing safe, effective and well led services. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2015 inspection can be found by selecting the ‘all reports’ link for Slade Green Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken as an announced comprehensive inspection on 19 June 2017. Overall the practice is now rated as Good.

Our key findings were as follows:

• The areas we identified at our last inspection as in need of improvement have now all been addressed
• 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 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 were satisfied with the care and treatment received at the practice, but some patients commented that they found it difficult to get an appointment to see a GP within a reasonable time.
• 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.

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

The provider should ensure:

• arrangements are put in place to ensure electrical safety tests are carried out at recommended intervals

• arrangements are put in place to support improvements to clinical outcomes for patients with diabetes and chronic obstructive pulmonary disease

• improvements are made to the identification of, and provision of appropriate support to, carers in the patient population

• arrangements are made to improve patient access to appointments

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 16 August 2017

The practice is rated as good 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.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• 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.

• The practice maintained clinical registers of our patients with long term conditions including diabetes, chronic obstructive pulmonary disease (COPD), asthma, heart problems, thyroid disorders, hypertension, cancer, arthritis and stroke.All patients within these groups were routinely invited to the practice for appropriate consultations, including treatment by intervention or education.

• The practice’s performance for diabetes and COPD related indicators was lower than the local area and national averages, therefore the practice is rated as requires improvement for providing effective services to people with long term conditions

Updated 16 August 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 comparable to national averages for some standard childhood immunisations, but were lower than national averages for some immunisations recommended for children up to two years of age

• 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 practice worked with midwives and health visitors to support this population group, such as in the provision of ante-natal, post-natal and child health surveillance clinics.

• For women aged between 24 and 65, the practice offered the cervical screening programme, in line with national guidance, which included providing advice on sexual health and contraception.

• The practice had a female long term locum GP who was responsible for women’s health.

• The practice targeted their younger population, aged between 15 to 24, to provide sexual health education. This has included free contraception and the option for Chlamydia testing. Both surgeries were equipped with forms and testing kits to accommodate opportunistic requests.

• The practice had recently started monitoring children who are aged seven years at risk of obesity for weight management.

Updated 16 August 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 offered proactive, personalised care to meet the needs of the older patients in its population. Patients older than 88 were included in the practice’s Avoiding Unplanned Admissions register and each patient had a personalised care plan.This care group were regularly discussed at clinical meetings to ensure their needs were met.

• 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.

• Elderly patients were able to request to have their flu vaccinations at home.

Updated 16 August 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, by the provision of extended opening hours and telephone consultations.

• 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.

• As part of our seasonal flu vaccination programme, the practice provided additional clinics on a Saturday morning.

Updated 16 August 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.

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

• 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.

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

Updated 16 August 2017

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

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

• 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.

• The practice included carers in this group, as they considered them at risk of neglect due to the focus is on the person that they are caring for. The practice established links with local community groups and encouraged discussion about support for carers within their patient participation group.