Archived: Dr Neville Fernandes Also known as The Norwood Surgery

Updated 3 October 2016

Dr Neville Fernandes’ practice provided services to approximately 3100 patients in the Norwood area of south east London under a Personal Medical Services contract (an agreement between NHS England and general practices for delivering personal medical services). It sits within the Lambeth clinical commissioning group (CCG) which has 48 member practices serving a registered patient population of more than 380,000. Dr Fernandes’ practice provides a number of enhanced services including timely diagnosis and support for people with dementia; support for patients with a learning disability; minor surgery and remote care monitoring.

The staff team at the practice consists of one full time male GP, a female practice manager, two part time female practice nurses and five administrators/receptionists. The practice provides 13 GP sessions per week. Three of these are provided by a locum GP. The practice told us that wherever possible they try to ensure the locum is female so as to provide patients with a choice. The service is provided from this location only.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 9am to 12pm every morning and 3pm to 6pm every afternoon daily. Extended hours appointments are offered on Thursdays until 7.50pm. Outside of these hours, patients are advised to contact the practices out of hours provider, whose number is displayed on the practice noticeboard. The practice provides an online appointment booking system and an electronic repeat prescription service. Patients can also view test results online. The premises are not purpose built but a ramp has been fitted to enable ease of access for patients with mobility difficulties and a hearing loop has recently been ordered. There is a lift to provide access to consulting rooms on the first floor.

If no appointments are available, patients can be referred to the Lambeth GP access hub (which provides additional GP and nurse appointment at four specific GP practices spread across the borough). The closest of these to this practice is just over half a mile away at the West Norwood Leisure Centre.

The practice is registered with the Care Quality Commission to carry on the regulated activities of maternity and midwifery services, treatment of disease, disorder or injury, family planning, surgical procedures, and diagnostic and screening procedures.

The practice has a higher percentage than the national average of people with a long standing health condition (59% compared to a national average of 54%).The average male and female life expectancy for the CCG area and the practice is in line with the national average for both males and females.

The population in this CCG area is predominantly white British. The second highest ethnic group is black or black British. The practice sits in an area which rates within the fourth most deprived decile in the country, with a value of 29.1 compared to the CCG average of 28.9 and England average of 21.8 (the lower the number the less deprived the area).

The patient population is characterised by an above England average proportion of patients, male and female, between the ages of 25 and 54; and a below England average proportion of patients, male and female, over the age of 60.

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Neville Fernandes on 23 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.
• Risks to patients were assessed and generally well managed. We found two areas of the premises that required minor repair. We also found the practice needed to take action to address the issues raised in the gas safety check and to ensure the lift was maintained at appropriate intervals.
• 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 although they had not had training in the Mental Capacity Act (MCA) 2005 or the Duty of Candour. With the exception of the GP, staff had a limited knowledge of the MCA 2005, and no knowledge of the Duty of Candour.
• 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 we saw complaints were dealt with promptly. 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 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 had an active patient participation group and acted on its suggestions.
• We found the fire evacuation records; children’s safeguarding policy, complaints policy, recruitment files and infection control audit needed updating.

The areas where the provider should make improvement are:

• Keep recruitment files up to date and ensure they contain the information required in the regulations.

• Keep a record of fire evacuation drills.

• Introduce a quality improvement programme which includes re-auditing to complete the audit cycle.

• Keep under review how best to address (some) patients’ preference for a female GP.

• Ensure staff have and maintain an understanding of MCA and Duty of Candour appropriate to their roles.

• Add contact details for external authorities to the safeguarding children policy and review the complaints procedure to make it practice specific.

• Keep records suitable for review and auditing purposes of actions taken in response to audits, risk assessments and safety checks.

• Carry out repairs to the premises.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 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 percentage of patients with diabetes, on the register, who had had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) was 96% compared to the CCG average of 90% and England average of 94%. The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2014 to 31/03/2015) was 90% compared to the CCG average of 74% and England average of 78%.
• 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.

• Patients were referred to a wide range of services to assist them to maintain good health, for example exercise and healthy eating programmes.
• Patient information was regularly updated so that patients were kept informed.
• Virtual clinics with consultants were held regularly to discuss complex patients. In the last year this had included clinics for hypertension, diabetes and atrial fibrillation.
• Clinicians kept abreast of NICE and local CCG guidelines on the management and prescribing of long term conditions. They attended Lambeth CCG training as well as peer group learning, for example joining the Practice Nurse Forum.

Updated 3 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, for example, children and young people who had a high number of A&E attendances.
• Young children were given priority in the walk in clinics and also seen urgently when required.
• 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.
• The practice was proactive in promoting and providing contraception including coil fitting. This service was also provided to non-registered patients.
• The practice offered sexual health testing.
• The practice promoted preventative immunisation, such as MMR catch-up immunisation for young adults who had not previously been immunised.
• The practice worked with the wider primary health care team and allied health professionals such as the health visitors and social services.
• Cancer screening data was mixed compared to CCG and England averages. For example, the number of females, aged 50 -70, screened for breast cancer in last 36 months was 58% compared to the CCG average of 60% and England average of 72%. The number of females aged 25-64, who whose notes recorded that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 81% compared to the CCG average of 80% and England average of 82%.
• Child immunisation rates were comparable to or above the CCG averages in all but two areas. The percentage of children aged 24 months who received the Infant Men C immunisation was 67% (CCG average 81%) and those aged 5 years who received the Dtap.IPV Booster was 74% (CCG average 83%).

Updated 3 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, including phlebotomy, and urgent appointments for those with enhanced needs.
• Patients over the age of 75 years had a named GP.
• Holistic health assessments were offered for patients aged over 65. The practice had carried out 61 assessments this year of which 41 had been for housebound patients.
• Housebound patients were discussed at regular meeting with District Nurse.
• Palliative care patients were discussed at regular meeting with the local hospice.
• The practice participated in monthly MDT meetings with the local hospital geriatrician to discuss management of complex patients requiring multidisciplinary service input.
• The practice took part in geriatrician virtual clinics.

Updated 3 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.

• Extended hours clinics were available including a late night family planning clinic.
• Online booking, electronic prescribing and travel immunisation was offered.
• Sexual health screening was provided and free condoms were available.
• NHS health checks for 40-74 year olds were offered.
• The practice worked with the local GP federation hub which provided 8am-8pm weekday and weekend appointments for patients when the practice had no availability.

Updated 3 October 2016

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

• The practice had nine patients on its dementia register. One hundred percent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (01/04/2014 to 31/03/2015), which was above the CCG average of 88% and national average of 84%.
• The practice had 69 patients on its mental health register. 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 (01/04/2014 to 31/03/2015) was 97% compared to the CCG average of 85% and England average of 89%.
• 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. For example, patients were offered appointments at times to suit them as for some, due to their medication, morning appointments were not practical.

• Dementia assessments were part of the holistic health assessment offered to the over 65 year olds.
• The practice had engaged in the GP+ scheme which enabled patients with mental ill health to be discharged into primary care.

Updated 3 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. There were 20 patients on the learning disability register. The practice told us they had all had an annual review in the preceding year, and they were currently working through the list for the current year.
• The practice offered longer appointments for patients with a learning disability which were compatible with their carer’s availability.
• 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.

• Vulnerable patients were added to the practice’s admissions avoidance register and regularly reviewed.
• The GP had undergone training in alcohol and drug misuse, and the practice hosted a fortnightly clinic with a counsellor.
• Homeless and refugee patients could register with the practice.
• Non-English speakers were offered double appointments with an interpreter.
• The practice works closely with a local food bank and provided food vouchers to vulnerable patients.