Archived: Brunswick Surgery

Updated 5 November 2015

The practice operates from Surbiton Health Centre. They have national average numbers of children under 18 years of age and lower than national averages of people aged over 65 and 75 years. They have above the Clinical Commissioning Group (CCG) average of patients aged over 85 years although in line with national average. Fifty five per cent of patients have long standing health conditions, above the CCG and national averages of 46% and 54%. Just over 12% of patients have caring responsibilities which is below the CCG average of 14.6% and the national average of 18.2%. Sixty one per cent of patients are in paid work or full time education, below the CCG average of 68% and in line with the national average of 61%. It is in the second least deprived area of England. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of: diagnostic and screening procedures, treatment disease, disorder or injury, maternity and midwifery services and family planning.

The practice provides primary medical services through a General Medical Services (GMS) contract. A GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice provides a range of services including long term condition management, smoking cessation, family planning and contraceptive services, maternity services, child health surveillance and immunisations to just over 7,200 patients in the Surbiton and Berrylands areas of Kingston.

The practice is a member of Kingston CCG and is one of 27 practices. It comprises of four partner GPs (two male and two female), two part time practice nurses and a part time phlebotomist. There is a full time practice manager and five administrative and reception staff. The practice is a teaching practice for third year medical students.

The practice is open from 8.00am to 6.30pm Monday to Friday. Appointments are available from 7.30am-1.00pm Monday, Tuesday, Thursday and Friday and from 2.00pm-6.00pm Monday to Friday. Extended hours surgeries are provided between 6.30pm and 7.30pm on Wednesdays and 7.30-8.00am Monday, Tuesday, Thursday and Friday and from 8.00am-9.50am on Saturday.

The practice has opted out of providing out-of-hours services to their own patients and these services are provided by the locally agreed out-of-hours provider for the CCG.

The practice has applied to get a new partner registered with CQC and for the practice address to be updated.

Updated 5 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brunswick Surgery on 30 June 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Information about safety was recorded and monitored with actions taken to make improvements when required;
• Risks to patients were assessed and well managed;
• Patients’ needs were assessed and care and treatment was planned and delivered following best practice guidance. Staff received training to help them carry out their roles and further training needs were identified and planned;
• Patients told us they were treated with respect and their privacy and dignity were maintained and they were involved in decisions about their care and treatment;
• Information about the services provided and how to make a complaint were accessible to patients and easy to understand;
• Patients told us they found it easy to make an appointment with their preferred GP and that they received continuity of care;
• Appointments were available outside of working and school hours and urgent appointments available on 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 the partners and
• The practice sought feedback from patients and staff and acted upon it.

We saw several areas of outstanding practice including:

• The Practice Nurse holds an angina clinic with a training and education programme, which gave patients the opportunity to understand their condition and learn how to manage and take control of their condition. (This is a service commissioned by Kingston CCG at the Health Centre, and is open to all patients registered in Kingston CCG).

However there were areas where the provider should make improvements:

• Ensure the Patient Participation Group has the opportunity to meet with practice staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 November 2015

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

Nursing staff had lead roles in chronic disease management, they worked with the GPs to provide regular treatment and medicine reviews. The practice offered an angina clinic which included patients attending a 90 minute interview appointment and then four classes to give them information about their condition and education about how to manage it and prevent further deterioration. Feedback from patients about this had been very positive. Systems were in place to call patients with long-term conditions for regular reviews. Longer appointments and home visits were provided when required. The practice worked with other health and social care providers to ensure patients with long-term conditions received joined up care. Clinical staff had lead responsibility for different long-term conditions and used National Institute for Health and Care Excellence and local guidelines to provide most appropriate care and treatment to these patients.

Updated 5 November 2015

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

The number of patients under 18 was in line with local and national averages. Systems were in place to follow up children living in disadvantaged circumstances and those at risk and the practice met with other health and social care providers to identify and discuss children at risk. They provided urgent on the day appointments and appointments outside of school hours. Rates for childhood immunisations were in line or above the local averages. Patients told us that children and young people were treated in age appropriate ways. The practice was accessible for families with pushchairs and had baby changing facilities. There was a selection of toys available in the waiting area.

Updated 5 November 2015

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

Nationally reported data showed outcomes for patients were good for conditions commonly found in older people. The practice provided a named GP for patients over 75 years. They offered a range of book in advance and on the urgent on the day appointments and home visits were provided when required. They worked with other health and social care providers to ensure patients received joined up care and to avoid unplanned admissions for those at risk. The practice had arrangements with local pharmacies to deliver repeat prescriptions.

Updated 5 November 2015

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

The needs of working age patients were identified and extended hours appointments were provided four mornings and four evenings a week and every other Saturday morning. A range of electronic services were provided to enable patients to book appointments and repeat prescriptions without having to telephone the practice. GPs provided telephone consultations and call backs. A range of sexual health and family planning services were provided. Eighty five per cent of women had attended for their cervical smear test, in line with the national average of 82%. Clinical staff offered opportunistic health advice during appointments.

Updated 5 November 2015

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

The practice had a register of patients experiencing poor mental health; 98% had a care plan that was reviewed annually which was above the national average. The practice worked with other health and social care services to refer patients when required and enable patients to receive joined up care. They held three monthly meetings with community mental health teams. Data confirmed patients were asked about their alcohol consumption and smoking status. They held a register of patients with dementia and provided annual health reviews. Advanced care planning was used for patients with dementia.

Updated 5 November 2015

The practice is rated good for the care of people whose circumstances may make them vulnerable.

The practice had registers of patients in vulnerable circumstances including those who were homeless and people with learning disabilities. They provided longer appointments and annual health checks for patients with learning disabilities. They worked with local health and social care services to ensure patients received joined up appropriate care and treatment. Information about local voluntary organisations was available at the practice. Staff completed training in safeguarding and were clear about their responsibilities to record and report concerns.