Archived: Dr Marilyn Graham Also known as Fairview Medical Centre

Updated 30 August 2016

Dr Marilyn Graham (Fairview Medical Centre) is located at 69 Fairview Road, Norbury, London, SW16 5PX. The practice provides NHS primary care services to approximately 7,200 patients living in the Norbury area through a Personal Medical Services (PMS) contract (an alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract).

The practice is part of Croydon Clinical Commissioning Group (CCG) which consists of 61 GP practices.

The practice population is in the fifth most deprived decile in England (one being most deprived and 10 being least deprived). People living in more deprived areas tend to have a greater need for health services. The practice population of male and female patients between the age brackets 25 to 44 is higher than the national averages.

The practice is registered as an individual with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services; and family planning.

The practice staff comprises of a female principal GP (seven clinical sessions per week), one male salaried GPs (six clinical sessions per week), two female salaried GPs (totalling five sessions per week), two regular locum GPs (totalling 3 clinical sessions per week) and two registrars (totalling 10 clinical sessions per week) and one male GP returner (four clinical sessions per week). The clinical team is supported by a full-time practice nurse, a part-time healthcare assistant, a practice manager and deputy practice manager, two administrators and six receptionists.

The practice is a GP registrar training practice and teaching practice for 1st, 2nd and 3rd year medical students. There are currently two GP registrars and one medical student attached to the practice. The practice also had one GP on the returner scheme, designed to support GPs who have previously been in practice back into the workforce.

The practice provides a range of services including childhood immunisations, chronic disease management, smoking cessation, sexual health, cervical smears and travel advice and immunisations.

The practice is open from 8am to 6.30pm Monday, Tuesday, Thursday and Friday and from 8am to 2.30pm on Wednesday. Extended hours appointments with both a doctor and a practice nurse are available on Monday from 6.30pm to 8.30pm.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111.

Updated 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Marilyn Graham (Fairview Medical Centre) on 28 June 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:

• Review the cleaning arrangements for the practice.
• Ensure there is an effective system to track blank printer prescriptions through the practice in line with national guidance.
• Consider improving communication with patients who have a hearing impairment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 2016

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

• The practice’s principal GP was lead on education issues around end of life care (EoLC) in Croydon and had participated in the development of the EoLC training module ‘Difficult Conversations’ which trained healthcare professionals how to have compassionate conversations with patients and their families/carers through serious illness and EoLC.
• The practice utilised the Coordinate My Care (CMC) personalised urgent care plan developed to give people an opportunity to express their wishes and preferences on how and there they are treated and cared for.
• The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for asthma and chronic pulmonary obstruction disease (COPD) was above national average. For example, the percentage of patients with asthma, on the register, who have had a asthma review in the preceding 12 months that includes an assessment of asthma control using the three RCP questions was 95% (national average 75%) and the percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in preceding 12 months was 93% (national average 90%).
• The practice hosted a community-led respiratory clinic.
• 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.
• Nutritional and dietary advice was available with an in-house nutritionist which included patients with diabetes and for weight management.
• Influenza vaccine clinics were offered on Saturday during Influenza vaccine season.
• The practice had installed a ‘Surgery Pod’ in the waiting room. The Surgery Pod enabled patients to measure their own vital signs, including weight and blood pressure, and to answer lifestyle questions. The information gathered was integrated into the practice’s clinical system.

Updated 30 August 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, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were comparable to CCG and national averages for all standard childhood immunisations. The practice had invited, in conjunction with its PPG, an educational talk on the measles mumps and rubella (MMR) vaccine and invited parents to the surgery who were concerned about the MMR vaccine for their children.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average of 82% and the national average of 82%.
• The practice provided a family planning, long-acting reversible contraceptive and sexual advice clinic for its patients, which included Chlamydia screening.
• 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 30 August 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.
• All patients over 75 had a named GP and were reviewed every three months and home visits offered to those who were housebound.
• The practice offered weekly ‘ward rounds’ at a nursing home and residential home in their catchment.
• Patients who were on the avoidable admissions register were offered urgent appointment with extended appointments available.
• Available data showed the practice had low levels of accident and emergency and hospital emergency admissions. For example, the number of emergency admissions for 19 ambulatory care sensitive conditions per 1,000 population was 11% (CCG average 13%; national average 15%).

Updated 30 August 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 offered a ‘Commuter’s Clinic’ on Monday from 6.30pm to 8.30pm for working patients who could not attend during normal opening hours which included doctor and healthcare assistant appointments. The practice also offered an early morning phlebotomy clinic.
• The practice offered daily telephone consultations for working patients with any doctor of their choice to provide minor ailment advice and medication reviews.
• The practice was proactive in offering online services and patients could book and cancel appointments, request repeat prescriptions and update personal information through the practice website. The practice operated an automated text reminder system for appointments.

Updated 30 August 2016

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

• Performance for mental health related indicators was above national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95% (national average 88%).
• The percentage of patients diagnosed with dementia who had had their care reviewed in a face-to-face meeting in the last 12 months was 88% (national average 84%).
• 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. Some of the non-clinical staff had undertaken dementia awareness training.

Updated 30 August 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 refugees and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and undertook visits to a learning disability home in their catchment area when requested. The practice had recorded 43 patients on its learning disability register and had undertaken annual review on 42 patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and 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.
• GPs had undertaken Female Genital Mutilation awareness training.