East Street Surgery Also known as 301 East Street Surgery

Updated 1 February 2018

The practice operates 301 East Street, Walworth, London, SE17 2SX. The practice is based across two floors of a purpose built property, and is part of the Southwark clinical commissioning group area. Services are delivered under a Personal Medical Services (PMS) contract. (PMS contracts are locally agreed agreements between NHS England and a GP practice).

The practice has approximately 8,500 patients. The surgery is based in an area with a deprivation score of 2 out of 10 (10 being the least deprived). The practice population’s age demographic is not in line with the national average. The practice has a significantly higher than average number of patients between the ages of 25-39, and a far lower number of patients for all age groups over 54. This demographic means that disease prevalence within the practice population is also not in line with national averages. For example, the practice had fewer than expected patients

with Chronic Obstructive Pulmonary Disease (COPD) The GP team includes two partners, plus four salaried GPs (three male and three female, 3.9 whole time equivalent [WTE]). The nursing team includes one nurse practitioner (1.00 WTE) and two other nurses (1.00 WTE). The clinical

team is supported by a practice manager, a reception manager and seven other administrative or reception staff.

The practice is open from 8am to 7pm Monday to Friday. The practice offers appointments throughout the day when the practice is open. The practice provides all patients who call for an appointment a telephone call back from a GP on the same day, and then an appointment (generally on the same day) if required.

When the surgery is closed urgent GP services are available via NHS 111 and SELDOC.

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

Updated 1 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bradford & Partners on 6 December 2016. The overall rating for the practice was good, but the practice was rated as requires improvement for effectiveness. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Bradford & Partners on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 27 November 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 in 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good for all key questions.

Our key findings were as follows:

• The practice had developed stronger processes to review notifications and to ensure that when these indicated that medicines needed to be changed, patients were recalled, rather than waiting for an opportunity to make changes when the patient visited the practice or requested a prescription.
• The practice improved the follow up of patients who did not attend for cervical screening.

The practice had also, in response to our recommendations:

• Formalised how training was monitored to ensure staff completed updates.
• Acted on below average feedback on nursing care in the 2015/16 national GP patient survey. We suggested in the last report that the plan to address this be formalised. The 2016/17 national GP Patient survey showed substantial improvement in nursing feedback, with all results now in line with national average.
• Completed an audit, designed by the practice, into monitoring of patients on a medicine for high blood pressure.
• Employed a Data Quality Lead to improve templates and call/recall processes.
• Changed the appointment booking system to allow patients to book extended hours appointments in advance.
• Decided to purchase a hearing loop.
• Improved the template complaint response letter to include details of organisations that patients can contact if they are unhappy with the practice’s handling of their complaint, and updated the complaints policy and the practice website.
• Drafted terms of reference for the patient participation group (PPG), which had been presented at the June 2017 PPG meeting and were due to be discussed in detail in December 2017.

The provider should:

• Continue to review accessibility for patients who have a disability.
• Continue to monitor and act on cervical screening test uptake.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 6 February 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 similar to the national average. The practice had scored 87% for diabetes related indicators in the last QOF similar to the national average of 89%. The exception reporting rate for diabetes related indicators was 5%, lower than the national average of 11%.

• 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 6 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 72%, which was lower than the CCG average of 80% and 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, health visitors and school nurses.

Updated 6 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 patients over the age of 75 had a named GP.

Updated 6 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice had extended hours until 7pm daily for the benefit of working patients.

Updated 6 February 2017

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

• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• QOF performance for mental health related indicators was similar to the national average. The practice had scored 85% for mental health related indicators in the last QOF, which was similar to the national average of 93%. The exception reporting rate for mental health related indicators was 1%, lower than the national average of 12%.

• 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 6 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 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.