St Stephens House Surgery

Updated 22 February 2018

St Stephens House Surgery is a practice offering general medical services to the population of Ashtead in Surrey. There are approximately 5,700 registered patients. The practice population has a higher number of patients between 0-4 and 65+ years of age than the national and local clinical commissioning group (CCG) average. The number of patients with a longstanding health condition is 48% compared to the CCG average of 52% and national average of 54%. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for both the CCG area and England.

St Stephens House Surgery is run by three partner GPs (female). The practice is also supported by a salaried GP (Female), three practice nurses, a healthcare assistant, a team of administrative and reception staff, and a practice manager.

The practice runs a number of services for its patients including asthma clinics, diabetes clinics, coronary heart disease clinics, minor surgery, child immunisation clinics, new patient checks and travel vaccines and advice.

Opening hours are 8am to 6.15pm Monday to Friday.

Extended hours are:

Tuesday 7.40am to 8am

Wednesday 6.30pm to 7pm

Friday 7.30am to 8am

And one day per month on a Saturday 9am to11am

During the times when the practice is closed arrangements are in place for patients to access care from Care UK which is an Out of Hours provider.

The practice is part of a hub of GP practices that offer evening appointments until 9pm and weekend appointments 9am until 1pm. These appointments are not run from the practice but from separate locations in Leatherhead, Epsom and on the Downs.

St Stephens House Surgery is registered to provide services from the following location:

St Stephens House, 102 Woodfield Lane, Ashtead, Surrey, KT21 2DP.

Updated 22 February 2018

We carried out an announced comprehensive inspection at the St Stephens House Surgery on 6 September 2016 and a focused follow up inspection on 17 August 2017. The practice was rated good overall. However, we found that the practice required improvement for the provision of safe services because breaches of regulation were identified. The full comprehensive report on the 6 September 2016 inspection can be found by selecting the ‘all reports’ link for St Stephens House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused follow up inspection carried out on 6 February 2018. This was 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 August 2017. This report covers our findings in relation to those issues identified only.

Overall the practice is still rated as good and is now good in the safe domain.

Our key findings were as follows:

• The practice had incorporated a new on line training system that all staff had access to.

• Staff had received the appropriate training for their role.

• The practice manager had access to a training matrix and certificates of training were held in staff files.

• The GPs had quarterly training from the local clinical commissioning group.

• The practice was identifying potential areas of additional training support for non clinical staff in their everyday roles.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 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 was comparable to the national average in some areas and higher in others. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 71% compared to the CCG average of 74% and national average of 78%. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 94 % compared to the CCG average of 81% and the national average of 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 18 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 practice’s uptake for the cervical screening programme was 86%, which was comparable to the CCG average of 81%, the same as the 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 and health visitors.

Updated 18 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.
• The practice has regular meetings with the Proactive Care Team to help avoid admissions. The practice provides an enhanced service for unplanned admissions – a register of the most vulnerable patients - with care plans and reviews following any unplanned hospital admissions.

Updated 18 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.

Updated 18 January 2017

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

• 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
• Performance for mental health related indicators was better than the CCG and national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 98% compared to the CCG average of 89% and national average of 88%.
• 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 18 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 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.