Madeira Medical

Updated 6 June 2016

Madeira Medical Practice is located in West Byfleet Health Centre, a purpose built centre which houses two other general practices, a pharmacy and other health services. The practice shares some facilities with the other practices in the health centre such as some waiting areas, the minor operations suite and the IT/building manager. District nurses, health visitors and midwives are based in the health centre which aids communication.

The practice is in a central location in West Byfleet near the railway station.

The practice operates from:

West Byfleet Health Centre

Madeira Road

West Byfleet

Surrey

KT14 6DH

There are approximately 8,400 patients registered at the practice. Statistics show very little income deprivation among the registered population. The registered population is lower than average for 15-34 year olds, and slightly higher than average for those aged 40 and above .

The practice has four partners and one salaried GP (three male and two female). Two of the doctors work full time and the other three work part time. There are two practice nurses.

The practice is a training practice and there are regularly GP trainees working in the practice.

The practice is open from 8.00am to 6.30pm from Monday to Friday. Appointments are from 8.30am to 12pm and 2pm to 6.20pm. In addition the practice offers extended hours opening with appointments from 7am on Monday, Wednesday and Friday. Patients can book appointments in person, by phone or on line.

Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hours service on telephone number 111.

The practice has a General Medical Services (GMS) contract. GMS contracts are nationally agreed between the General Medical Council and NHS England.

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Madeira Medical on 19 April 2016. Overall the practice is rated as good.

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

• The practice provided safe and effective clinical care.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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 a very thorough and systematic approach to reviewing patients with long term conditions, and this was reflected in the high level of achievement in Quality and Outcomes (QOF) clinical targets.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice worked closely with the other two practices in the health centre to make best use of the facilities. It worked with the local community and hospitals to provide extended health services at a convenient location for patients.
• 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 practice was very well organised with clear roles and responsibilities, good communication and cohesive team working.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 6 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• All these patients had a named GP and 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.
• 95% of patients on the diabetes register had a record of a foot examination and classification which was better than the national average of 88%.
• Longer appointments and home visits were available when needed.
• The practice had achieved 100% of target in the Quality and Outcomes framework (QOF) for the management of long term conditions.

Updated 6 June 2016

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

• There were systems in place 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 A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• The practice held a weekly child health surveillance clinic for babies aged 6-8 weeks.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• 82% of eligible female patients had a cervical screening test which was the same as the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors. The health visitors were based in the health centre alongside the practice which aided communication.

Updated 6 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• Many older people were on the admissions avoidance register with associated care plans in place. Any concerns relating to these patients were discussed at weekly practice meetings.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was actively identifying older people to refer to the new locality hub providing integrated care and a swift assessment by a multidisciplinary team.
• The practice carried out polypharmacy medication reviews with the local medicines optimisation team to minimise potential adverse drug interactions and ensure appropriate monitoring was set up.

Updated 6 June 2016

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• 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.
• Electronic prescribing allowed prescriptions to be sent to a pharmacy near to the workplace. 
• The practice offered early morning appointments from 7am for appointments with GPs.
• Many outpatient clinics were held in the health centre offering patients a local alternative to travelling to hospital.

Updated 6 June 2016

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

• 91% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• 94% of patients experiencing poor mental health had an agreed care plan, which was better than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• A local consultant psychiatrist ran a weekly community mental health outpatient clinic in the health centre.

Updated 6 June 2016

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 those with a learning disability.
• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.