St Giles - Dr M Pandey and Partner

Updated 4 November 2016

St Giles Surgery (Dr E Begley) is located at 40 St Giles Road, Camberwell, London SE5 7RF. The practice was previously known as Dr A A N Virji’s Practice. Dr Virji retired from the practice in March 2016. 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 5,400 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 three 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 Begley’s practice is the blue 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 ages 20 to 39 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; treatment of disease; disorder or injury; maternity and midwifery services; and family planning. Prior to our inspection the practice told us they were undertaking minor surgical procedures. However, they were not registered for the regulated activity of surgical procedures. The practice told us they would stop all minor surgery until they had updated their registration.

The practice staff comprises of two female GP partners (totalling 16 clinical sessions per week) and one female salaried GP (eight clinical sessions per week). 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 40% of the whole time equivalent with Dr Begley’s practice.

The practice premises are open from 8am to 6.30pm Monday to Friday. Extended hours are provided on Wednesday from 7am to 8am and 6.30pm to 7.30pm.

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 was 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 E Begley) on 23 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 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 with CQC for the regulated activity surgical procedures before minor surgical procedures are resumed at the practice.
• Ensure the computer alert system of vulnerable patients is consistently maintained.
• Ensure all consulting rooms where vaccines and medicines are administered have the appropriate colour-coded sharps bins available in line with the disposal of waste legislation.
• The provider should implement a failsafe process to ensure patients receiving high risk medicines are reviewed as appropriate.
• Ensure blank prescriptions are tracked through the practice in line with national guidance.
• Ensure staff know how to access clinical protocols relevant to their role.
• Ensure that all correspondence relating to patients, including pathology results, are actioned in a timely manner.
• Develop an ongoing audit programme that demonstrates continuous improvements to patient care.
• 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.
• Performance for diabetes related indicators was comparable with CCG and national average. For example, patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 70% (CCG average 73%; national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 90% (CCG average 88%; national average 94%).
• 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.
• Longer appointments and home visits were available when needed.
• All these patients had 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.
• The practice encouraged patients to refer to Self-Management UK (support for people living with long-term health conditions which enabled individuals to manage their health condition on a day-to-day basis.

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.
• Performance for diabetes related indicators was comparable with CCG and national average. For example, patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 70% (CCG average 73%; national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 90% (CCG average 88%; national average 94%).
• 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.
• Longer appointments and home visits were available when needed.
• All these patients had 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.
• The practice encouraged patients to refer to Self-Management UK (support for people living with long-term health conditions which enabled individuals to manage their health condition on a day-to-day basis.

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• 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.
• The practice offered Holistic Health Assessments to identify the care needs of its elderly patients.

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 as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered a ‘Commuter’s Clinic’ on Wednesday from 7am to 8am and 6.30pm to 7.30pm for working patients who could not attend during normal opening hours.

Updated 4 November 2016

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

• 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 71% (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 94% (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 79% (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 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.
• Patients who were on the avoidable admissions register and integrated care programme were given a separate number to call to enable them to get through to the practice quickly and by-pass the main line. This facility had been extended to carers and those cared for.