Archived: The Park Group Practice

Updated 29 December 2016

The Park Group practice provides services to approximately 7800 patients in the Penge area of south east London under a Personal Medical Services contract (a locally agreed contract between NHS England and a GP practice. The contract offers variation in the range of services which may be provided by the practice). It sits within the Bromley clinical commissioning group (CCG) which has 45 member practices serving a registered patient population of more than 340,000. The Park Group practice provides a number of enhanced services including Meningitis Provision; Childhood Vaccination and Immunisation Scheme; Facilitating Timely Diagnosis and Support for People with Dementia; Influenza and Pneumococcal Immunisations and Learning Disabilities.

The staff team at the practice consists of three GP partners, two female and one male; and three female salaried GPs. There is also a practice manager, an assistant practice manager, two practice nurses and administrators/ receptionists. The practice provides 27 GP sessions per week, eight fewer than they would like. The service is provided from this location only.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.50am to 12.30pm every morning and 3.20pm to 5.40pm every afternoon except for Wednesday afternoons when appointments are available between 2.30pm and 5.30pm. Every Wednesday the practice offers an open access clinic based on a first come first served basis, although patients do have to book in before 9.15am.The practice is a member of the Bromley GP Alliance and can utilise its HUB services to provide patients with additional appointments in the evenings up to 8pm and between 9am and 1pm at weekends. Outside of these hours, patients are advised to contact the NHS 111 service. The practice provides an online appointment booking system and an electronic repeat prescription service. Patients were sent text messages to remind them of appointments. The premises are not purpose built; however, the practice provides a removable ramp to facilitate wheelchair access and had a ground floor consulting room for patients who cannot climb the steps to the regular consulting rooms. The practice is due to move to a purpose built centre, currently under construction, in the summer of 2017. There is a hearing loop, and accessible toilet facilities which include a baby changing facility. We noted the accessible toilet did not have an emergency cord; however, staff felt that as it is situated next to reception this is unnecessary.

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

The practice has a slightly lower percentage than the national average of people with a long standing health condition (52% compared to a national average of 54%).The average male life expectancy for the practice is 78 years, and for females 82 years. These compare to the CCG averages of 81 years and 84 years; and the national averages of 79 years and 83 years.

The population in this CCG area is predominantly white British. The second highest ethnic group is black or black British. The practice sits in an area which rates within the third most deprived decile in the country, with a value of 30.1 compared to the CCG average of 15.2 and England average of 21.8 (the lower the number the less deprived the area).

The patient population is characterised by an above England age average for patients, male and female, under the age of nine and between the ages of 30 and 49; and for female patients aged 25 - 29. It has fewer patients, male and female, aged 15 – 24 and above 55 than the England average.

Updated 29 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Park Group Practice on 9 November 2016. 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 an effective system in place for reporting and recording significant events.
• Most risks to patients were assessed and well managed; however, we found fire alarms were not being tested and some staff had not undergone training in in fire safety, health and safety, infection prevention and control, basic life support or information governance.
• Not all clinical staff had appropriate medical indemnity insurance in place at the time of the inspection.
• Patient Group Directions (PGDs) relating to travel vaccinations were out of date although the practice had put additional measures in place until this could be resolved.
• An induction checklist was in place for newly recruited staff; however, these were not always being completed.

• The partners acknowledged that they struggled to offer a sufficient number of appointments to meet the demands of their patient population, and were trying to address this through the introduction of, for example, the walk in clinic and the services accessible though the Hub. They were also trying to recruit additional GPs.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their 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 sometimes found it difficult to get an 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had identified 132 patients as carers, but this represented just 1.7% of the practice list.

The areas where the provider must make improvements are:

• Ensure staff undergo training appropriate to their role, including fire safety, basic life support and infection prevention and control.

• Regularly test fire alarms to ensure they are in working order.

• Ensure all clinical staff have appropriate medical indemnity insurance in place, and if they do not they should not be permitted to work until it is in place.

The areas where the provider should make improvements are:

• Complete induction checklists for all new staff.

• Review the risk assessment in relation to chaperones and Disclosure and Barring checks, and explicitly consider and record reasonable risks and scenarios within the risk assessment.

• Continue efforts to obtain up to date PGDs.

• Take appropriate steps to identify patients who are also carers to allow the practice to provide support and suitable signposting.

• Continue to seek ways to increase the number of available appointments for patients, including the recruitment of an additional GP.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 December 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. Annual reviews of these patients were carried out by the practice nurses.
• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was 95% compared to the CCG average of 75% and England average of 78%.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2014 to 31/03/2015) was 78% compared to the CCG average of 74% and England average of 78%.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 83% compared to the CCG average of 87% and England average of 88%.
• Longer appointments and home visits were available when needed.
• 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.
• Patients with long term conditions were referred to community services, the COPD (chronic obstructive pulmonary disease) clinic and to the Community Matron.

Updated 29 December 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.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Breast and bowel cancer screening was below CCG and England averages: females aged 50 – 70 screened for breast cancer in the last 36 months was 61%,compared to the CCG average of 73% and England average of 72%. Persons aged 60 – 69 screened for bowel cancer in the last 30 months was 49% compared to the CCG average of 58% and England average of 58%.
• Cervical screening rates were comparable - 89%compared to the CCG average of 84% and England average of 82%.
• Child immunisation was comparable to the CCG.
• 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, health visitors and school nurses. Weekly clinics were held at the practice by the health visitors and midwives.
• The practice offered postnatal checks and eight- week baby checks. We saw a copy of the letter sent to new mothers that included a new birth registration form and an invitation to visit the practice for the child health clinic.

Updated 29 December 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Flu vaccinations were offered on home visits.
• The practice participated in the Avoiding Unplanned Admissions Enhanced Service. The practice contacted patients shortly after discharge and after attendance at an emergency department. We reviewed the care plan of a patient in this category and found it was well written. All patients over 75 had a named, accountable GP.
• All eligible patients were offered the shingles vaccination.
• Regular meetings were held with the palliative care nurses, district nurses and community matron.
• The practice organised delivery of medicines to elderly patients with the local pharmacy.

Updated 29 December 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 including appointments, prescriptions and summary care records.
• The practice offered a full range of health promotion and screening that reflects the needs for this age group.
• The practice registered students as temporary patients.
• The practice offered appointments at weekends and in the evenings through the HUB (The Hubs are run by the Bromley GP Alliance. This service allows Bromley patients access to a general practitioner 7 days per week, where the clinician has, with the patients' consent, full access to their GP records).

Updated 29 December 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 76% compared to the CCG average of 84% and England average of 88%. Data for 2015 – 16 showed this had risen to 92.5%, above the CCG average and comparable to the England average.
• However, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) was 59% compared to the CCG average of 84% and England average of 88%. %. Data for 2015 – 2016 showed this had risen to 91%, comparable to both the CCG and England average.
• 87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (01/04/2014 to 31/03/2015), which was comparable to the CCG average of 83% and the national average of 84%. However, data for 2015 – 16 showed this had dropped to 71%, below the CCG and national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Information leaflets were available in the waiting area.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 29 December 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 homeless people, travellers and those with a learning disability. There were 36 patients on the learning disability register of whom 22 had had an annual review so far this year. We reviewed a care plan for one of these patients and found it was well written.
• 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.
• The practice had a child protection register and a register for children in need and vulnerable families. It held a meeting every other month with the health visitor to discuss these patients and their care.
• Staff had received training in identifying domestic abuse and how to refer patients to appropriate support services.