Broad Lane Surgery

Updated 24 October 2016

The Surgery is based in Richmond, a residential area on the south west of London. The practice is based in a converted premises. There is a consultation room on the ground floor, and a stairlift to allow patients with restricted mobility to access the consultation rooms on the first floor.

Three doctors work at the practice: one male and two female. One of the doctors is in partnership with a (non-clinical) management partner. Some of the GPs work part-time. Full time doctors work 8 sessions per week. The practice provides 18 GP sessions per week. The (all female) nursing team is made up of a practice nurse and a Health Care Assistant. They both work part-time, with all of the nursing hours adding up to just under one full-time role.

The practice is open from 8.30am to 1.30pm and 2.30pm to 6.30pm Monday to Friday. GP appointments are available from 8.30am to 12.30pm and 4pm to 6pm Monday to Friday. On Wednesday appointments are available until 7.50pm.

When the practice is closed, patients are directed to Richmond GP out of hours service.

There are approximately 4700 patients at the practice. Compared to the England average, the practice has more older working age patients (over 35) and older people and fewer children and young people (under 35). The surgery is based in an area with a deprivation score of nine out of 10 (1 being the most deprived), and has a lower levels of income deprivation affecting older people and children. Compared to the average English GP practice, fewer patients are unemployed. Most of the patients are White British/Mixed British

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

The GP partner was previously registered with the CQC to provide GP services from the same address as Dr Parvin Bhatia. An inspection took place on 11 June 2013. The inspection team found that the practice was meeting the regulations in place at that time.

Updated 24 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery on 13 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. We identified some areas that needed strengthening, and the practice took swift action to keep patients safe (for example ordering a particular emergency medicine).
• 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:

• Consider how to make details of the cold chain policy easily accessible to staff checking the vaccine fridges.

• Consider providing accessible information for patients with learning difficulties.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 October 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. The practice provided tests to help diagnose patients or assess the management of long-term conditions, such as INR (blood clotting) testing.
• Performance for diabetes related indicators was comparable to or above the national average. For example, 83% of patients with diabetes, had their HbA1c (blood sugar over time) last measured at 64 mmol/mol or less, compared to the national average of 78%, and 92% of patients with diabetes had a foot examination and risk classification, compared to the national 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.

Updated 24 October 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.
• 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.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 84% and 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, health visitors and school nurses.

Updated 24 October 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. Particularly vulnerable patients (for example those who were housebound) were able to request repeat prescriptions by telephone.
• The practice was part of a scheme to identify patients at most risk of a deterioration in health and completed care plans. GPs and nurses had agreed individual care plans with more than 3% of patients, compared to 2% nationally.
• Immunisation rates for flu were relatively high. In 2013/2014: 81% of patients aged 65 and older received the vaccination (73% nationally). The practice showed us that 81% of eligible patients (over 65 and other at risk groups) received the vaccination in 2015/2016.
• 73% of patients over 75 years old received an annual health check in 2015/16.

Updated 24 October 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.

Updated 24 October 2016

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

• 81% 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 in 2014/15. Other mental health indicators were in line with the 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 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.

Updated 24 October 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.
• The practice offered longer appointments for patients with a learning disability. The practice provided home visits for patients with learning disabilities who found it difficult to attend the practice.
• 85% of patients with learning difficulties received an annual health check in 2015/2016.
• 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.