Carshalton Fields Surgery

Updated 12 January 2017

Carshalton Fields Surgery is based in a converted house located in a residential street in Carshalton Beeches, which is in the London Borough of Sutton.

There is limited parking available on site. Further parking is generally available on the street, which is free of charge and with no restrictions. The Surgery is within walking distance from Carshalton Beeches train station and the area is served by local bus routes.

The premises comprises three consulting rooms, one treatment room, reception and waiting areas, and administrative offices. There is step-free access from the street to the surgery and through to the reception and waiting areas, as well as to two consulting rooms and the treatment room. There is a lavatory for patient use on the ground floor, which is accessible to wheelchair patients. The upper level is accessed via a flight of stairs and has one consulting room, offices and a lavatory for staff use.

The practice team usually consists of one principal doctor and two salaried doctors. At the time of the inspection the role of the salaried GPs was being covered by two locum GPs as one GP had left and the other was on maternity leave. There are two female practice nurses, who both work part-time. Non-clinical management was led by a practice manager, and there were two medical secretaries, and four receptionists.

There are approximately 3600 patients registered at the practice. Compared to the England average, the practice has fewer young children as patients (age up to four) and more aged between five and nine, fewer young adults (aged 15 to 24). The surgery is based in an area with a deprivation score of 10 out of 10 (one being the most deprived), and has a lower levels of income deprivation affecting older people and children. Compared to the English average, fewer patients are unemployed. Life expectancy of the patients at the practice is in line with CCG and national averages.

The practice is open 8am to 8pm on Monday and 8am to 6.30pm Tuesday to Friday. Appointments with GPs are available from 9am to 2.30pm and 4pm to 8pm on Monday and 9am to 1.10pm and 2pm to 6pm Tuesday to Friday. When the practice is closed cover is provided by a local service that provides out-of-hours care.

The practice offers GP services under a Personal Medical Services contract in the Sutton Clinical Commissioning Group area. The practice is registered with the CQC to provide family planning, diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.

This is the first time that the CQC has inspected the practice since the new provider took over in February 2014.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carshalton Fields Surgery on 2 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.
• 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.
• 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 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Strengthen infection control arrangements (ensure the lead person has appropriate regular training and that all actions are followed up) and the checks of emergency equipment (to include defibrillator pads).

• Review the procedure for maintaining staff files and training records to ensure that they are complete.

• Continue to improve care for patients with long term conditions, particularly patients with diabetes and high cholesterol.

• Develop a system to monitor prescription form usage.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 12 January 2017

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.
• Performance for most diabetes related indicators were comparable to the national average.
• 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.
• The practice was reviewing all of its systems, both in terms of practice processes and patient pathways, to improve patient care. Staff told us that the care of patients with cancer had been chosen for review – to check the practice was providing patents with good care at all stages. The practice invited a facilitator from Cancer Research to the practice to check the practice’s process for identifying and recording patients with cancer, and to provide advice on how to improve screening rates, and had a programme in place to ensure best practice care.

Updated 12 January 2017

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 relatively high for all standard childhood immunisations.
• 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.
• The practice acknowledged all births by sending a congratulatory card to the parents, including a registration pack for baby and information on the postnatal and first baby appointments.
• The practice’s uptake for the cervical screening programme was 86%, which was comparable to the CCG and 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, health visitors and school nurses.

Updated 12 January 2017

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.
• Older patients had a named GP to support their care.
• To help tackle social isolation amongst older people, the practice took a leading role in developing (with other local organisations) a calendar of events aimed at older people. GPs planned to discuss activities on the calendar with patients during consultations, including chair-based exercise sessions to ensure they were aware.
• The practice hosted weekly sessions run by the Alzheimer’s Society to provide support to those worried about their own, or someone else’s, memory.

Updated 12 January 2017

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. The practice invited a local healthy living service into the practice to perform health checks. This meant that patients received their health check in a single visit, without the need to arrange a separate blood test.

Updated 12 January 2017

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

• 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is above the national average.
• Performance for other mental health related indicators was comparable to the 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 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• A local ‘well-being’ service, provided by the mental health trust, held monthly clinics at the practice, this allowed patients to receive support quickly and in a familiar environment.

Updated 12 January 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, travellers and 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.