Brunswick Park Family Practice Also known as Dr Patel practice at St gilesSsurgery

Updated 4 November 2016

St Giles Surgery (Dr J Rosemen) is located at 40 St Giles Road, Camberwell, London SE5 7RF. The practice was previously known as St Giles Surgery (Dr A Patel). Dr Patel retired from the practice in April 2015. At the time of our inspection the practice had submitted notification to CQC of the change in partnership.

The practice provides NHS primary care services to approximately 6,500 patients living in the Camberwell and Peckham area through a Personal Medical Services (PMS) contract (a locally agreed 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 Southwark Clinical Commissioning Group (CCG) which consists of 45 GP practices.

The practice operates from a two-storey purpose-built property which it shares with a separate GP partnership. All patient services are on the ground floor. The first floor is accessed via stairs. The practice has access to four GP consulting room and two treatment rooms. There is a shared reception, waiting room and multi-purpose clinical room. In addition to signage to assist patients in identifying their correct GP, both practices are colour-coded. Dr Roseman’s practice is the red practice.

The practice population is in the third least deprived decile in England. 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 20 to 24, 25 to 29 and 30 to 34 was higher than the national averages.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures and treatment of disease; disorder or injury. The practice had not registered for the regulated activity maternity and midwifery. However, the practice carried out post-natal care which fell into the scope of this regulation. The practice has submitted an application to CQC to add this regulated activity.

The practice staff comprises of one female and two male GP partners (totalling 24 clinical sessions per week), one female salaried GP (5 clinical sessions per week) and one female GP registrar. The clinical team is supported by a practice nurse, a healthcare assistant, a practice manager and seven administration/receptionist staff. The practice shares all its support team with the GP practice in the same premises. All staff are contracted to work 37.5 hours per week and their time is split based on practice population. The practice told us staff work approximately 60% of the whole time equivalent with the practice.

The practice is a training practice and at the time of our inspection had one GP registrar attached to the practice.

The practice premises are open from 8am to 6.30pm Monday to Friday. Extended hours are provided on Wednesday from 6.40am to 8am and from 6.30pm to 8pm. GP and healthcare assistant appointments are available at these clinics.

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

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111. Patients also have access to an extended access centre open 8am to 8pm, seven days per week which were created through funding from the Prime Minister’s Challenge Fund (the Challenge Fund was set up nationally in 2013 to stimulate innovative ways to improve access to primary care services).

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Giles Surgery (Dr J Rosemen) on 18 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 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:

• Ensure the practice is registered for the regulated activity maternity and midwifery services to cover the post-natal care provided by the practice.
• Ensure the guidelines for the correct segregation and disposal of sharps waste is followed to ensure compliance with legislation.
• Ensure blank prescriptions are tracked through the practice in line with national guidance.
• Ensure all staff know how to access clinical protocols relevant to their role.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Formulate a written strategy to deliver the practice’s vision.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 November 2016

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

• The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice hosted ‘virtual diabetes clinics’ provided by the local diabetes community team which involved diabetes consultants and specialists visiting the practice to undertake case review of complex patients.
• 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.
• Performance for diabetes related indicators was below the local and national average for some indictors and comparable for others. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 66% (CCG average 73%; national average 78%) and the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 90% (CCG average 85%; national average 88%).
• 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 4 November 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 relatively high for all standard childhood immunisations.
• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the three RCP questions was 83% (CCG average 75%; national average 75%).
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 80% and the national average of 82%.
• The practice promoted and offered chlamydia screening for the under 25s.
• 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 4 November 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. There was an alert system on the clinical system for elderly patients at risk and patients on a case management register receive same day telephone consultations.
• The practice referred its patients into the local Age UK’s Safe and Independent Living (SAIL) project aimed to support older people stay healthy and independent in their home for as long as possible by helping them navigate and access the full range of services available, including leisure and social services.

Updated 4 November 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 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.
• The practice offered a ‘Commuter’s Clinic’ on Wednesday from 6.40am to 8am and from 6.30pm to 8pm for working patients who could not attend during normal opening hours. Both GP and healthcare assistant appointments were available at these clinics.

Updated 4 November 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 comparable to the local and national averages. 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 76% (CCG average 85%; national average 88%) and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 84% (CCG average 86%; national average 90%).
• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 73% (CCG average 80%; 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.

Updated 4 November 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 and those with a learning disability.
• 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 and signposted vulnerable patients to 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 GPs and practice nurse had undertaken Female Genital Mutilation (FGM) training.