Archived: Bermondsey and Lansdowne Medical Mission

Updated 30 July 2015

Bermondsey and Lansdowne Medical Mission operate from The Surgery at Decima Street with a branch surgery, Artesian which is a ten minute walk away. The practice started as a medical mission providing free care for the needy and today they maintain this ethos. The practice had higher than national average numbers of children 0-4 years of age and people aged 20-44 years. The practice served a culturally diverse population, with 40% from a white British background, 9% from Asian and 8% from African backgrounds. Forty three per cent of patients have long standing health conditions, 10% have caring responsibilities and 78% of patients are in paid work or full time education. It is in the fourth most deprived area of England. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of: diagnostic and screening procedures, family planning, maternity and midwifery, surgical procedures and treatment of disease, disorder or injury.

The practice provides primary medical services through a Personal Medical Services (PMS) contract. A PMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice provides a range of services including family planning and contraception services, maternity services, child and adult immunisations to just over 15,000 patients in Southwark.

The practice is a member of Southwark Clinical Commissioning Group (CCG) and is one of 24 practices in the North Southwark CCG Locality. It comprises of four partner GPs and nine salaried GPs (two male and 11 female), four practice nurses and a part time healthcare assistant. There is a full time practice manager, eight administrative staff and eleven reception staff and a cleaner. The practice is a training practice.

The practice is open from 8.00am-6.30pm Monday to Friday with appointments available from 9.00am to 12.00noon and then from 3.00pm to 5.30pm on Monday to Friday with extended opening hours provided from 6.30-8.00pm Tuesday and Wednesday at the branch surgery. The GPs completed telephone consultations and home visits for patients. The practice has opted in to providing out-of-hours services to their patients through the local Cooperative, Seldoc (South East London Doctors Cooperative is formed of GP practices across Lambeth, Southwark and Lewisham)

The practice needs to apply to CQC to update the registered partnership to reflect changes and to apply to remove the urgent care service from their registration.

Updated 30 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bermondsey and Lansdowne Medical Mission on 22 April 2015, which included a visit to the branch surgery The Artesian. Overall the practice is rated as good.

Specifically we found the practice to be good for providing safe, effective, caring, responsive and well led services. It was outstanding for providing services to older people and good for providing services to people with long term conditions; families, children and young people; working age people and those recently retired and students; people whose circumstances make them vulnerable and people experiencing poor mental health.

Our key findings were as follows:

• Patients said that they were treated with kindness and respect, their dignity was maintained, they were involved in decisions about their care and treatment and said staff were caring;
• Information about the services provided, how to get involved with the Patient Participation Group and how to complain were available and easy to understand;
• Patients reported good access to urgent on the day appointments, however they expressed concerns over the length of time they had to wait for a routine appointment with their preferred or named GP;
• Staff understood and fulfilled their responsibilities to report incidents and raise concerns;
• Risks to patients were assessed and well managed;
• There were clinical leads for the common health conditions experienced by patients at the practice including a diabetes specialist GP who provided support for patients with complex diabetes;
• Systems were in place for clinical staff to keep up to date with best practice guidance;
• Data showed the practice was above and in line with national and local averages;
• Systems were in place for audit cycles to be completed with the information shared with all GPs.

We saw several areas of outstanding practice including:

• The employment of a specialist nurse co-ordinator for older people, who carried out home visits for housebound patients, worked with other health and social care providers to ensure joined up care and was able to signpost patients and their carers to local support services;
• The support given to patients receiving end of life care and the patients relatives and carers.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

• Ensure the risk assessment regarding Disclosure and Barring Service checks for non-clinical staff who may carry out a chaperone role considers if these staff would be left alone with patients;
• Improve the system to check emergency medicines are in date;
• Provide infection control training for the cleaner;
• Apply to CQC to make the required changes to the practice registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 30 July 2015

The practice is rated good for the care of patients with long term conditions.

There was a named clinical lead for each long term condition who worked with one of the practice nurses, they reviewed each patient on the long term conditions registers at least annually. One of the GPs oversaw end of life care, working with the local palliative care team. Patients with a number of long term conditions were invited for one nurse led review instead of three or four reviews throughout the year, to reduce the number of times patients needed to attend the practice. They targeted patients with long term conditions to have the flu vaccine. The practice provided a range of urgent on the day and book in advance appointments and longer appointments were provided when necessary. The practice worked with other health and social care providers to ensure patients with complex health needs received joined up care and treatment. Patients could be referred to physiotherapists and an osteopath at the practice.

Updated 30 July 2015

The practice is rated good for the care of families, children and young people.

The practice provided urgent on the day appointments and appointments outside of school hours. Systems were in place to identify children in disadvantaged circumstances including those who are at risk and this was clearly recorded so all staff were aware. Baby and childhood immunisation rates for the practice were above and in line with the CCG average. Failure to attend appointments for immunisations were reported to the health visitor. The practice was accessible for families with pushchairs. The practice worked with midwives, who attended the practice once a week, to provide shared antenatal care and with health visitors to deliver the Healthy Child Programme. Staff told us that they treated children and young people in age-appropriate ways and we saw evidence to confirm this.

Updated 30 July 2015

The practice is rated outstanding for the care of older people.

Less than 3% of the practice patients were aged over 75. All patients over 75 had a named GP. There was a specialist nurse coordinator for older people, who signposted patients to a range of services. They attended monthly multidisciplinary team meetings to discuss patients’ needs. The practice worked with the local hospital trust and referred patients for same and next day reviews with the rapid response team and consultant geriatrician to help prevent unnecessary hospital admission. The practice provided a range of book in advance and on the day urgent appointments and GPs and the specialist nurse coordinator provided home visits for patients who were not able to attend the practice. An annual home visit was carried out to ensure reviews of care and treatment were carried out. Systems were in place for regular medication reviews. Care plans were developed with people receiving end of life care, the details were shared with the out of hours provider to ensure they were updated to any changes. Seventy five per cent of patients over 65 received their flu vaccination in the 2014-2015 season which was above the national average of 73%.

Updated 30 July 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).

The practice had a higher proportion of patients aged 20-44 than the national average. To meet the needs of working age people, the practice provided extended opening hours from 6.30pm-8.00pm two evenings a week at the branch surgery with two GPs and one nurse one evening and four GPs and one nurse the other evening and patients could request a GP telephone call back. Patients could book non-urgent appointments and order repeat prescriptions on-line. The practice invited all patients over 40 for the NHS Health Check, although had very low response rates, and continued to provide opportunistic screening for blood pressure, cholesterol and diabetes at routine appointments. Eighty one per cent of women had attended for a cervical smear test which was in line with national average.

Updated 30 July 2015

The practice is rated as good for the care of patients experiencing poor mental health.

The practice held a register of patients experiencing poor mental health who had a named GP, 91% had a care plan which is above the national average of 86% that was reviewed annually. The practice worked with multidisciplinary teams in the case management of people experiencing poor mental health, making appropriate referrals to community mental health teams and holding three monthly meetings with relevant health professionals. Patients were signposted to local services and the practice had a linked drug worker who visited the practice weekly to manage prescriptions for patients on Methadone. Data showed patients were routinely asked about their alcohol consumption and smoking status which was recorded in the electronic patient record.

The practice had a register of patients with dementia, all of whom had a named GP who with the specialist nurse coordinator for older people provided support to the patient and their carers. Advanced care planning was in place for patients with dementia.

Updated 30 July 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice had access to translation services to help them meet the needs of patients whose first language was not English. The practice held a register of patients living in vulnerable circumstances including those with learning disabilities. It had carried out annual health checks for 75% of people with a learning disability and offered longer appointments for these patients. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Staff knew how to recognise signs of abuse in vulnerable adults and were aware of their responsibilities regarding information sharing and how to contact the relevant agencies. Arrangements were in place for the practice to register patients who were homeless.