Norheads Lane Surgery

Updated 13 September 2017

Norheads Lane Surgery is located in Biggin Hill, Kent, in the London Borough of Bromley. The area is predominantly residential. Local rail services are five miles from the surgery and there are limited local bus routes. Unrestricted on-road parking is available close to the surgery.

The practice is located in a residential property which has been converted for the sole use as a surgery. The accommodation is based over two floors with patient facilities based on the ground floor. The two consultation rooms, one treatment room, reception area and waiting room are based on the ground floor with three administration offices and staff kitchen on the first floor.

A GP practice has operated from the current address for more than 40 years. The service operates under a General Medical Services contract providing services to 3098 registered patients. Bromley Clinical Commissioning Group (CCG) is responsible for commissioning health services for the locality. This is one of only two GP surgeries in the Biggin Hill area.

The surgery is based in an area with a deprivation score of 9 out of 10 with 1 being the most deprived and 10 being the least deprived.

The provider is registered with the CQC to provide the regulated activities of family planning; maternity and midwifery services; treatment of disease, disorder and injury and diagnostic and screening procedures.

The provider is currently registered with the CQC as an Individual, which it has been since 2007, following the retirement of one of the previous partners. Since then, until the month preceding the inspection, a salaried GP had been employed to provide five sessions per week in addition to the four weekly sessions provided by the lead GP.

Clinical services are usually provided by two GPs (providing a total of 9 sessions per week) and one full-time Practice Nurse.

At the time of the inspection there was no salaried GP in post and the lead GP was on long-term sickness absence. GP services were therefore provided by locum GPs (9 sessions per week). The lead GP is planning to return to work in September 2017 and the new GP partner is due to join the practice on 1 October 2017.

Administrative services are provided by four part-time members of staff including a Practice Manager (24 hours), Medical Secretary (27 hours) and two reception staff (29 hours).

The practice reception is open from 9am to 1.30pm and 5pm to 7.30pm on Monday; from 9am to 1.30pm and 4.30pm to 6.30pm on Tuesday; from 9am to 1.30pm and 5pm to 7pm on Wednesday and Friday and from 9am to 1.30pm on Thursday.

Telephone lines are open from 8.30am to 3pm and 5pm to 7.30pm on Monday; from 8.30am to 3pm and 4.30pm to 6.30pm on Tuesday; from 8.30am to 3pm and 5pm to 7pm on Wednesday and Friday and from 8.30am to 3pm on Thursday.

On Thursday the practice reception is open between 9am and 1.30pm with telephone lines open until 3pm. Between 3pm and 6.30pm the answerphone message instructs patients that the surgery is closed and provides a mobile number to call if the matter is urgent. The mobile phone is held by the duty doctor.

Appointments are available with a GP from 9am to 11.50am and 5pm to 6.50pm on Monday, Wednesday and Friday; from 9am to 11.50am and 4.30pm to 6.20pm on Tuesday and from 9am to 11.50am on Thursday.

In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are available on the same day through the walk-in clinic for patients that need them.

Telephone consultations are available daily.

The practice can also access appointments with the local Primary Care Access Hub (The Bromley GP Alliance). The service is available between 4pm and 8pm Monday to Friday and between 8am and 8pm Saturday and Sunday. Appointments must be booked through the surgery. The service is staffed by GPs from the practices who are members of the alliance and full access to GP electronic records is available for all consultations. The nearest location is approximately nine miles from the surgery.

Appointments are available with the Practice Nurse from 9am to midday and 5pm to 6.30pm on Monday, Tuesday, Wednesday and Friday and from 9am to midday on Thursday.

When the surgery is closed at weekends and between 6.30pm and 8.30am weekdays, urgent GP services are available via NHS 111.

Updated 13 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Norheads Lane Surgery on 2 August 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Clinical staff were aware of current evidence based guidance and had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and felt involved in their care and decisions about their treatment. The practice was rated above average for consultations with the nurse but comparable to or below the national average in some areas for consultations with a GP.
• Information about services and how to complain was available. Improvements were made as a result of learning from complaints and concerns.
• A patient participation group (PPG) had been in operation in the practice since 2011. However, there were now only six members of the group and as they no longer held meetings, communication was carried out by email only.
• Most patients we spoke with said they were usually able to make an appointment with a GP when they wanted one and urgent appointments were usually available the same day through the practice walk-in service.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• The provider should continue to monitor patient satisfaction rates regarding consultations with GPs and implement improvements as appropriate.
• The provider should consider strategies to encourage patients to join the patient participation group (PPG) and establish regular communication with group members.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 13 September 2017

The practice is rated as good for the care of people with long-term conditions.

• The Practice Nurse and GP worked collaboratively in the management of patients with long-term conditions.
• The practice performance rates for the Quality and Outcomes Framework (QOF)diabetes related indicators were above the local and national average.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were processes in place for patients with long-term conditions who experienced a sudden deterioration in health.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 13 September 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of records we reviewed we found there were systems to identify and follow up children who were at risk, for example, children and young people who had a high number of accident and emergency attendances.
• Immunisation rates were below the national target for some standard childhood immunisations but the practice were aware of this and continued to work towards improving uptake rates.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group in the provision of ante-natal, post-natal and child health surveillance clinics. Quarterly meetings were held with the health visitor to discuss children and families of concern.
• The practice had processes in place for managing appointments for acutely ill children and for acute pregnancy complications.

Updated 13 September 2017

The practice is rated as good for the care of older people.

• Staff had received training to enable them to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients and offered home visits and urgent appointments for those with enhanced needs.
• Patients were involved in planning and making decisions about their care, including their end of life care.
• The practice followed up older vulnerable patients when discharged from hospital to ensure care plans were updated to reflect any additional needs.
• Where older patients had complex needs, the practice shared summary care records with local care services following consent from patients.
• Older patients were provided with health promotional advice and support to help them maintain their health and independence for as long as possible.

Updated 13 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible.
• The practice was proactive in offering online services.
• A full range of health promotion and screening services were provided that reflects the needs for this age group.

Updated 13 September 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was above the local average of 82% and national average of 84%.
• The practice monitored the physical health needs of patients with poor mental health and dementia.
• The practice monitored repeat prescribing for patients receiving medicines for mental health needs.
• 100% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was above the local average of 83% and national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health regarding how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff we interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 13 September 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 patients with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.