Elborough Street Surgery

Updated 5 July 2017

Elborough Street Surgery provides primary medical services in Wandsworth to approximately 6,150 patients and is one of 44 member practices in the NHS Wandsworth Clinical Commissioning Group (CCG). The practice operates under a Personal Medical Services (PMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

The practice operates from converted residential premises with patient facilities on the ground floor, which is wheelchair accessible throughout, and the first floor which is not wheelchair accessible. There are six consultation and treatment rooms, two administration rooms, a meeting room, and a reception and waiting area. There are staff facilities and accessible facilities for patients with baby changing and breast feeding areas available.

The practice team at the surgery is made up of two full time female GP partners with one part time and one full time female salaried GPs. Together the GPs provide 31 clinical sessions per week. The practice employs two part time female practice nurses and two part time female health care assistants. The practice also has a part time phlebotomist. The non-clinical team consists of one practice manager and six administrative and clerical staff. The practice is a training and teaching practice for medical students and GP registrars.

The practice opens between 8.00am and 6.30pm Monday to Friday. Appointments are available in two sessions daily, one morning and one afternoon. Extended hours appointments are offered from 6.30pm until 8.00pm on a Monday and Thursday evening. The practice is also open every Saturday between 9.00am and 12.00am.

The provider has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8.00am when the practice directs patients to seek assistance from the locally agreed out of hours provider.

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

Updated 5 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elborough Street Surgery on 17 November 2016. The overall rating for the practice was good; however the safe domain was rated as requires improvement as:

• The practice did not have an automatic external defibrillator (AED) available on the premises for use in medical emergencies and no formal risk assessment in place to mitigate the risk to patients of not having one.

We also asked the practice to:

• Review how patients with caring responsibilities were identified and recorded on the clinical system to ensure information, advice and support was made available to them.
• Review the requirements for, and stocks of, emergency medicines in the practice to ensure these were in line with guidance and meeting the needs of patients.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Elborough Street Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 23 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 November 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had installed an AED in the practice and all staff had been trained to use it.
• The practice had reviewed and had put in place systems to improve how carers were identified. For example, the practice spoke to patient opportunistically, including those on the practice register of patients at risk of admission to hospital, to ask them if they had caring responsibilities. The practice also reviewed their computer system to make sure that patients were correctly ‘coded’ after being identified as having caring responsibilities (coding allows the computer system to be searched to find groups of patients with common interests or conditions or patients with specific needs such as carers). Carers are now included in the practice quarterly care planning process, where patient needs are reviewed and staff updated on information and support available. However the practice were unable to demonstrate the impact of the work or the increase in the numbers of carers identified.
• The practice had reviewed their emergency medicines and had updated stocks to include recommended medicines that were not present at our last inspection; Aspirin (used in the treatment of suspected myocardial infarction, a heart attack) and Diazepam (used in the treatment of epileptic seizures).

The areas where the provider should make improvement are:

• Review how patients with caring responsibilities were identified and recorded on the clinical system to ensure information, advice and support was made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 17 February 2017

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

• Nursing staff had lead roles in management of long term conditions and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was above the local and national average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered 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 17 February 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 practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 79% and the national average of 81%.

• 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 and health visitors.

Updated 17 February 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.

• All older people had a named GP responsible for their care.

Updated 17 February 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, telephone appointment booking, and telephone consultations as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 17 February 2017

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 local and national averages.

• 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 17 February 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 offered longer appointments for vulnerable patients.

• 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.