Archived: The Melbourne Grove and Hambleden Practice

Updated 12 January 2017

Melbourne Grove Medical Practice is based in the Southwark CCG and serves approximately 7154 patients. The practice is part of Concordia Health Limited and is registered with the CQC for the following regulated: Surgical Procedures, Diagnostic and Screening Procedures and Treatment of Disease, Disorder or Injury. The practice is providing Maternity and Midwifery Services and Family Planning but is not yet registered for these services. The practice has been asked to take steps to ensure their registration is up to date and correct.

The practice has average levels of deprivation compared to other areas nationally. The practice has a larger than average working age population and lower proportion of patients over the age of 65. The practice has a slightly lower proportion of patients with a long term health condition compared to the local and national average.

Clinical care is provided by three GPs of mixed gender, two female practice nurses and a healthcare assistant. The practice had recently become a training practice and we were told that they were due to receive their first GP in training in August 2016.

The practice is open between 8 am to 6.30 pm Monday to Friday and 9 am to 1 pm on Saturdays. The practice offers 87.9 GP hours per week with booked and emergency appointments five days per week. The practice had recently recruited another GP due to start in September 2016 who would work 39 hours per week. However we were told on the day of the inspection that one of the GPs who worked 27 hours would shortly be leaving the practice. The practice told us that they were looking to recruit an additional 24 GP hours, 32 nurse practitioner hours and 10 practice nurse hours. Locum staff are currently being used to ensure that there was adequate cover.

Melbourne Grove Medical Practice operates from purpose built premises at Melbourne Grove, London, Southwark SE22 8QN. The practice is based over two floors. The service is accessible for patients with mobility problems and those who cannot climb stairs could be seen in a surgery on the ground floor.

Patients are directed to contact the local out of hours provider when the surgery is closed.

The practice operates under a Alternative Provider Medical Services (APMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These are: Childhood Vaccination and Immunisation Scheme, Facilitating Timely Diagnosis and Support for People with Dementia, Improving Patient Online Access, Influenza and Pneumococcal Immunisations, Learning Disabilities, Minor Surgery, Patient Participation, Rotavirus and Shingles Immunisation and Unplanned Admissions

The practice is a member of GP federation Improving Health Limited.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Melbourne Grove Medical Practice on 8 September 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 though the practice had not implemented the recommendation from their Legionella risk assessment.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Not all patients felt they were treated with compassion, dignity and respect or 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. However we saw that the practice did not provide complaint responses in two out of the three complaints reviewed for over four months.
• Some patients said they had difficulty accessing appointments over the telephone and there was a lack of continuity of care as a result of staff turnover and reliance on locum GPs. Urgent appointments were available the same day.
• 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:

• Review and update the practice’s safeguarding policies with details of all relevant contacts to enable staff to effectively report safeguarding concerns.

• Consider providing customer service training for all staff.

• Comply with the recommendations in the practice’s legionella risk assessment.

• Continue to work on recruiting additional staff to improve continuity of patient care.

• Arrange additional training for practice nurses with higher than average inadequate cervical screening sample rates.

• Continue to work on improving patient satisfaction scores around access; particularly in respect of their ability to contact the practice over the telephone.

• Ensure that the practice's stock of emergency medicines are appropriate to meet the needs of patients requiring emergency treatment.

• Take action to respond to low national patient survey scores and monitor progress.

• Respond to complaints in a timely fashion in accordance with the practice’s complaints policy

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.

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for the management of diabetic patients was in line with local and national averages.

• 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 medicine 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 ran a monthly diabetes patient’s support group which was delivered by the practice clinical lead. This provided education and information to patients as well as allowed them to talk through their experiences with other patients. We were told that there were 18 patients participating in this group. The practice had held a diabetes awareness week from 13 to 17 June 2016 which included a fruit and vegetable bring and buy where money was donated to a diabetes charity and educational talks on diabetes were provided for both staff and patients.

• The practice had undertaken a review of all patients referred to secondary care. Learning points from this review included improving the practice’s urgent referral process; ensuring those patients urgently referred had attended secondary care appointments and the importance of educating locum staff on how to complete urgent referral forms.

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

• The number of women who had undergone cervical screening was in line with local and national averages.

• 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 practice undertook a research project between September and November 2015 which aimed to identify the needs to young patients. All patients aged 13 – 18 were written to with a questionnaire asking them to provide feedback on their experience of using GP services. As a result the practice held a youth PPG and discussions were held about topics relevant to the practice’s youth population including exam stress and substance misuse.

• The practice had a twitter account which it was hoped would allow young patients to engage more effectively and provide feedback.

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.

• The practice participated in the CCG’s Holistic health assessments service whereby patients over 65 years who were housebound or had chronic diseases or were aged over 80 had comprehensive health assessments with a view to using this information to address their health and social care needs.

• The practice aimed to engage with the local community and turn the practice into a community hub which would combat social isolation. The practice had partnered with a local charity in January 2016 and had started a weekly arts and crafts group for patients over 65.

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 offered a ‘Commuter’s Clinic’ on Saturdays between 9 am and 1 pm for working patients who could not attend during normal opening hours.

Updated 12 January 2017

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

• 77% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• The practice performance for the management of patients with mental health conditions was in line with local and national averages.

• 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.

• The practice held a drug counselling service every week where the clinical lead reviewed patients attending with a drug counsellor.

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 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.

• Staff at the practice had received domestic violence training.

• The practice had developed a vulnerable adult’s protocol that provided staff with a list of patients who would be classified as vulnerable. The protocol outlined the requirement for all of these patients to be correctly coded on the patient record system and that those patients coded were prioritised and accommodated when booking appointments, proactively followed up and flagged to clinicians in the event that they did not attend their appointments.