Archived: Surrey Docks Health Centre

Updated 12 January 2017

Surrey Docks Health Centre is based in the Southwark Clinical Commissioning Group and serves approximately 10,600 patients. The practice is registered with the Care Quality Commission for the following regulated activities Family Planning; Maternity and Midwifery Services; Treatment of Disease, Disorder or Injury; Diagnostic and Screening Procedures and Surgical Procedures.

The practice population has a larger proportion of working age people compared with the national average and lower proportion of those aged 45 and over. Unemployment is double the national rate. The practice is comparable to national averages in respects of the levels of deprivation.

The practice is run by a male and female GP partner who employ four salaried GPs of mixed gender. There is one female nurse and a female and male healthcare assistant. The practice is a training practice and currently has one registrar. The practice has 4.4 whole time equivalent GPs and one whole time equivalent GP registrar.

The practice had undergone a series of staffing changes; including the departure of a three partners during 2015/16. The two remaining partners told us that there were both nearing retirement and as a result had taken the decision to merge with a neighbouring practice to ensure that the practice could continue.

The practice was open between 8 am till 6.30 pm Monday to Friday except Tuesdays and Thursdays when the practice opens at 7 am. Extended hours appointments were offered from 7 am to 8 am on Tuesdays and Thursdays. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were also available for people that needed them.

The Surrey Docks Health Centre operates from a purpose built location which is leased. The service is accessible to those in wheelchairs and all treatment and consulting rooms are located on the ground.

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

The practice operates under a General Medical Service (GMS) 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, rota virus and shingles immunisations, extended hours access, learning disabilities health check scheme, avoiding unplanned admissions and drug misuse.

The practice is a member of GP Federation Quay Health Solutions.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Surrey Docks Health Centre on 18 August 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 and most significant events reviewed showed clear analysis and action points. However some staff were unaware of how to access the significant event reporting form and learning from actions was not always documented.
• Most risks to patients were assessed and well managed though the practice had yet to address some of the actions outlined in their fire risk assessment and records of staff immunity to common communicable diseases were incomplete.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. However the practice did not have valid PGDs in place to enable the practice nurse to administer medicines. Patients were not proactively followed up after unplanned secondary care attendances.
• 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.
• Most 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, though some patients said that waiting times were lengthy and telephone access to book an appointment was poor.
• 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 patients and allowed staff to voice concerns and suggestions, which it would act on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Work to improve processes around the management of medicines including systems for securing prescriptions and ensure that nursing staff are always administering medicines in line with valid patient group directions.

• Ensure that processes are in place to mitigate against risks associated with fire and the spread of common communicable diseases.

The areas where the provider should make improvement are:

• Continue to review the practice’s telephone access and appointment times with a view to improving patient access and reduce waiting times and continue to host regular Patient Participation Group (PPG) meetings.

• Assess effectiveness of current system for reviewing test results to ensure that all results are actioned in a timely manner.

• Ensure that all staff are clear around the process for assessing capacity and consent of minors and the process for reporting and managing significant events.

• Ensure that all emergency equipment is within its expiry date and fit for use.

• Ensure that all staff complete training appropriate to their roles regularly.

• Continue to undertake comprehensive recruitment checks for all members of staff and undertake annual appraisals for salaried GPs and continue to document the induction process of all new staff members.

• Continue with the planned work to increase the identification of carers and support provided to them.

• Ensure that the practice complaints procedure is in line with legislation and guidance.

• Put systems in place to ensure that vulnerable patients are proactively followed up after unplanned admissions to secondary care.

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.

• All clinical staff were involved in chronic disease management and patients at risk of hospital admission were identified as a priority but not actively followed up after unplanned hospital admissions. The practice health care assistants referred patients to local educational support services.

• Performance in respect of diabetic indicators were 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 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 healthcare assistant ran a smoking cessation programme.

• The practice participated in virtual clinics for patients with chronic conditions who were deemed high risk. This involved reviews on an annual or six monthly basis with the support of consultants from the local hospitals.

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 Accident & Emergency attendances. However the practice did not have systems in place to follow up patients who attended accident and emergency. Immunisation rates were relatively high for all standard childhood immunisations.

• The percentage of women who had attended for cervical screening was comparable to 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.

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. Care plans were drafted with a view to preventing unnecessary admissions to secondary care and those who had these care plans were provided with a bypass number to facilitate easy access to a GP.

• The practice healthcare assistant undertook Holistic Health Assessments which aimed to address both the social as well as health needs of those patients over 80 or over the age of 65 and housebound.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

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 offered commuter clinics so that patients could access a GP services outside of working hours.

• The practice was a yellow fever centre.

• The practice had protocols for contraception and hypertension which allowed them to access care in a way that was convenient to them.

• 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.

Updated 12 January 2017

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

• 94% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average. No dementia patients were exception reported.

• Mental health indicators were comparable to 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 did not have a system in place to ensure that all patients who had attended accident and emergency where they may have been experiencing poor mental health were followed up.

• The practice hosted a counsellor from a local mental health service. Staff had a good understanding of how to support patients with mental health needs and dementia.

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 those with a learning disability.

• The practice ran a substance misuse clinic with the assistance of a local drug and alcohol support service.

• 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.