Archived: The Molebridge Practice

Updated 20 January 2017

The Molebridge Practice is situated in Fetcham, Surrey and provides general medical services to approximately 6,340 registered patients. The Molebridge Practice has two locations which services are provided from (Fetcham and Leatherhead). Patients registering with the practice can access care and services at either practice location. GPs, nursing staff and some reception and administrative staff work within both locations. This inspection report relates to the Fetcham location.

Services are provided from:-

The Molebridge Practice, 3 Cannonside, Fetcham, Leatherhead, Surrey, KT22 9LE

Opening Times

Monday, Tuesday and Friday 1pm to 6.30pm

Wednesday 7.30am to 1pm

Thursday 8.30am to 1pm

And

North Leatherhead Medical Centre, 148 - 152 Kingston Road, Leatherhead, Surrey, KT22 7PZ.

Opening Times

Monday and Tuesday 8am to 1pm

Wednesday 1pm to 7pm

Thursday 1pm to 6.30pm

Friday 7.30am to 1pm

North Leatherhead Medical Centre has already been inspected on 22 March 2016.

The ground floor has disabled access with a seated waiting area. However, we noted the practice did not have automatic opening doors and no bell where staff could be summoned if patients had problems opening the doors. All of the GP consulting rooms and treatment rooms are located on the ground floor. Staff offices and facilities are located on the first floor. There is an accessible toilet for patients on the ground floor and there are baby changing facilities.

Care and treatment is delivered by two GP partners and locum GPs. The two GP partners are male. The practice employs a team of clinical staff including a nurse practitioner, two practice nurses and a healthcare assistant who is also the phlebotomist. GPs and nurses are supported by the practice manager and a team of reception and administration staff.

The practice runs a number of services for its patients including asthma reviews, child immunisation, diabetes reviews, new patient checks and holiday vaccines and advice.

During the times when the Fetcham practice is closed, patients are able to access appointments from the North Leatherhead practice and evening appointments from the locality hub providing extended hours from 6.30pm to 9.30pm and weekend appointments 9.30am to 1.30pm.

From the hours of 9.30pm to 8am the practice has arrangements for patients to access care from an Out of Hours provider accessed via NHS 111. This was advertised through the website, on display at the practice and when calling the practice a phone message re-directed to you to call the 111 number.

The practice population has a higher number of patients aged between 40-54, 65-69 and 70+ years of age than the national and local clinical commissioning group (CCG) average. The practice population shows a lower number of patients aged from birth to 4 and 20-34 years of age than the national and local CCG average. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for England. Less than 10% of patients do not have English as their first language.

The following regulated activities are carried out at the practice: Treatment of disease, disorder or injury; Surgical procedures; Diagnostic and screening procedures; Maternity and midwifery services.

Updated 20 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Molebridge Practice on 30 November 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 we spoke with told us 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 were able to access appointments at both of the practices’ locations and there were extended hours appointments on Wednesday and Friday Mornings from 7.30-8am and Thursday evenings until 7pm.
• The practice participated in a locality initiative which enabled patients to access appointments from 6.30pm to 9.30pm Monday to Friday and from 9.30am to 1.30pm on Saturdays and Sundays at three different locations (Epsom, Leatherhead and from Tadworth Medical Centre).
• Patients were able to access urgent appointments on the same day. However, patients rated the practice below average for several aspects of their ability to access services.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice website held a wealth of information in supporting patients with long term conditions and had links to various support groups. The website also had video links including ‘how to take a blood glucose test’ and ‘what is chronic obstructive pulmonary disease'.
• The practice reviewed the healthcare of patients in three local learning disability homes and made weekly visits to one residential facility which cared for patients with physical and learning disabilities and acquired brain injuries.
• 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.
• All staff were trained in the Mental Capacity Act 2005.

The areas where the provider must make improvement are:

• Continue to monitor the national patient survey results and ensure that where possible measures are put in place to secure improvements where scores are below average.

The areas where the provider should make improvement are:

• Review access for those patients who use wheelchairs and patients who have a hearing impairment.
• Review risk assessments for clinical staff starting before a Disclosure and Barring Service check has been completed.
• Continue to record / monitor dates for nurses registration with the NMC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 January 2017

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.
• Performance for diabetes related indicators were higher than the local clinical commissioning group (CCG) and national averages. For example, 86% of patients with diabetes, whose last measured total cholesterol was in the target range(within the last 12 months) which was the higher than the clinical commissioning group (CCG) and national average of 80%.
• Patients were supported to self manage their long-term conditions by using agreed plans of care and were encouraged to attend self-help groups
• The practice website held a wealth of information in supporting patients with long term conditions and had links to various support groups. The website also had video links including ‘how to take a blood glucose test’ and ‘what is chronic obstructive pulmonary disease'.
• 94% of patients with chronic obstructive pulmonary disease(COPD) had a review undertaken including an assessment of breathlessness, which was higher than the national average of 90%
• 74% of patients with asthma had an asthma review performed in the previous 12 months. This was comparable with the national average of 75%
• 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 20 January 2017

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 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, and we saw evidence to confirm this.
• The number of women aged between 25 and 64 who attended cervical screening in 2015/2016 was 74% which was below the clinical commissioning group (CCG) and 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.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff.
• Appointments were available at the practice with the GP until 6.30pm and one afternoon a week until 7pm.

Updated 20 January 2017

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.
• GPs and nurse practitioners utilised dementia testing tools and maintained a register of patients living with dementia.
• The practice monitored the healthcare of patients who lived in nursing and residential homes by undertaking home visits when needed and providing advice over the telephone.
• The practice offered influenza, pneumonia and shingles vaccination programmes.

Updated 20 January 2017

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.
• The practice was part of a group of GP practices offering evening appointments until 9.30pm as well as weekend appointments, from three locations in Epsom, Leatherhead and Tadworth.
• The practice offered extended hours appointments on two mornings each week and one evening each week for working patients who could not attend during normal opening hours.
• Telephone consultations were available during working hours.
• Electronic Prescription Services (EPS) and a repeat dispensing service helped patients to get their prescriptions easily.
• Travel health and vaccination appointments were available.

Updated 20 January 2017

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

• 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, with the national average being 84%
• 100% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented, in the last 12 months, with the national average being 88%. The percentage of those patients who had a record of their alcohol consumption in the preceding 12 months was 92% compared with a national 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.
• All staff were trained in the Mental Capacity Act 2005.

Updated 20 January 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 homeless people, travellers and those with a learning disability.
• The practice made weekly visits to one residential facility which cared for patients with physical and learning disabilities and acquired brain injuries.
• 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 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.
• The practice could accommodate those patients with limited mobility or who used wheelchairs.
• Carers and those patients, who had carers, were highlighted on the practice computer system and were signposted to the local carers support team.