Greystone House Surgery

Updated 23 December 2016

Greystone House Surgery offers personal medical services to the people of Redhill, Reigate, Merstham and Earlswood. There are approximately 13,300 registered patients.

The Greystone House Surgery is run by six partner GPs (three male and three female). The practice is also supported by four salaried GPs (all female) which include GPs with a special interest in rheumatology, family planning and palliative care. Additionally there is one nurse practitioner, three nurses and three health care assistants. The team also includes a practice manager and an office manager and 18 administrative and reception staff.

The practice currently has two GP trainees and also teaches medical students.

The practice runs a number of services for its patients including asthma and COPD clinics, child immunisation, diabetes clinics, well women clinics, smoking cessation, ECGs and 24 hour blood pressure monitoring, new patient checks and travel health clinics. The practice also carries out minor surgical procedures including vasectomy and cryotherapy on the premises.

The practice also hosts additional services for the benefit of patients from other surgeries as well as their own. This includes the district nurse team, midwives, neurology and gynaecology services. There are also several community providers that work from the practice such as ultrasound services, wellbeing prescriber, retinopathy, bowel screening, a smoking cessation advisor and counsellors.

Services are provided from:

99 Station Road, Redhill, Surrey, RH1 1EB.

The practice has two levels; all surgeries and treatment rooms are situated on the ground floor and support services such as counsellors, consultants, midwives and ultrasound services are on the first floor. As the building is built on a slope, both floors have direct access to the ground to ease disabled access.

Opening hours are Monday to Friday 8.30am to 6.30pm. The practice is shut between 12.30pm and 1.30pm. There are extended surgery hours on Monday to Friday from 7.30am and until 8pm on Tuesday evenings. In an emergency the emergency clinician can be contacted between 8am and 8.30 am and at lunchtime by telephone. Pre-bookable appointments with GPs are available up to one week in advance.

When the surgery is closed patients can access out of hours care via the 111 telephone number.

The practice population has a slightly lower number of patients aged 65+ than the national average and an average number aged 18 years or less. There is a lower than average number of patients with a long standing health condition and slightly lower than average number of patients with a caring responsibility. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than average for England and slightly higher than for the local Clinical Commissioning Group (CCG).

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greystone House Surgery on 19 October 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.
• The practice had comprehensive business continuity plans in place in case of major incidents occurring.
• 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 or their ‘buddy’ 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 clear 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.

We saw one area of outstanding practice:

An annual summary of complaints and significant events was posted on the website and noticeboards emphasising the practice’s commitment to a transparent, learning culture which benefitted both patients and the practice.

However there were areas of practice where the provider should make improvements:

To review the reasons for the high level of exception reporting in respect to cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

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

• Nursing staff had roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Each GP had special interests and overall responsibility for a long term condition (LTC).

• Registers were held of patients with each LTC and were used to identify, recall and monitor patients with each condition.

• Self-management was promoted and a Wellbeing Advisor was based at the practice for holistic care, advice, support and sign-posting to other organisations (voluntary sector and social care).

• The practice worked with the local Medicines Management team who carried out audits and ensured that they prescribed effectively and appropriately.

• Other specific services included psoriasis clinics, reviews of patients with stoma products by a GP and acupuncture also carried out by one of the GPs.

• The percentage of patients with diabetes, on the register, in whom the last long term glucose level was 64 mmol/mol or less was 84% (clinical commissioning group (CCG) average 80%, national average 78%).

• 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.

• The practice worked with a local hospice, district nurses and community matrons in managing patients approaching the end of life, following a nationally recognised framework.

Updated 23 December 2016

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 similar or higher than the local clinical commissioning group rates, and similar to or lower than the national rates, 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 percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 90% (CCG average 81%, national average 82%).

• All patients were seen on the day if requested and children were seen first if attending for triage.

• The midwives ran ante-natal clinics at the practice. Post-natal checks were carried out at six weeks.

• Doctor and practice nurse appointments were co-ordinated for baby’s eight week check and first immunisations.

• Flu vaccines were offered to pregnant women and children. Clinics were available after school and on Saturdays. The practice had an interest in patients with gestational diabetes.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw that the practice regularly met with midwives and health visitors.

• To welcome children, together with their patient participation group (PPG), the practice held an art competition with prizes for children who entered, and continued to display the entries around the surgery.

• The practice wrote to patients who turned 16, informing them of the confidential nature of their consultations and aspects of access to make it easier for them to contact them. They also trialled after school drop-in sessions.

Updated 23 December 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.

• Each nursing and residential homes had a named GP to enhance continuity of care. Larger homes had weekly/fortnightly ward rounds to proactively review patients and plan care. Homes could use the practice bypass number.
• The practice worked with the home managers and Community Matrons to reduce inappropriate 999 calls or unnecessary unplanned admissions, and had set up systems to ensure patient wishes were met regarding their preferred place of death.
• Home visits occurred daily and clinicians met up and discussed housebound patients at the end of morning surgery. One of the GPs met the community matron monthly to discuss the management of patients on their caseload. Additionally the practice held quarterly multi-disciplinary team meetings.
• Patients identified at risk of unplanned admissions were offered a personalised care plan, which (with consent) was shared with the Out of Hours and ambulance services.

• All patients over 65 were notified of their named accountable GP.

Updated 23 December 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 including viewing records, making appointments, ordering prescriptions, and emailing. They sent texts for appointment reminders, information regarding for example flu clinics, and accepted text cancellations.

• They offered a full range of health promotion and screening that reflected the needs for this age group.

• The practice used the Electronic Prescription Service to transfer prescriptions to patients’ pharmacy of choice.

• The practice offered extended surgery hours from 7.30am every weekday and on Tuesday afternoons until 8pm for patients who found it difficult to attend during regular hours. Appointments could be made for GPs, phlebotomy and new patient checks.

Updated 23 December 2016

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

• 81% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record was 94% (CCG average 93%, national average 88%).

• One GP was the dementia and Mental Capacity Act lead for the practice and the practice had recently increased their prevalence figures for dementia from 58.5% to 74%.

• Staff had a good understanding of how to support patients with mental health needs and dementia. They were Dementia Awareness trained and were aware to raise concerns should a show signs of cognitive impairment.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• Patients with complex mental health needs were invited for annual physical/psychological reviews and 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, they could also self-refer to in-house psychological therapies or counselling.

Updated 23 December 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, 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.

• The practice provided care for a local home for people with learning difficulties.

• 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.

• Annual reviews were carried out at a location which the patient was most comfortable with.

• The practice used an interpreter/translator as required and had trained a member of staff in sign-language. Alerts were added to patients’ records to highlight special needs requiring longer appointments.

• The practice made it as easy as possible for all women to be seen and fully register all children to ensure they had access to immunisations.

• The practice welcomed homeless patients, liaised with local support groups, and used the practice address or their mobile as a point of contact. They worked with the local alcohol & addiction multi-disciplinary team counsellor.

• The practice had a carer’s lead who liaised with carers and a local carer’s association. They prescribed carer breaks and actively seek out young carers. Alerts are added to highlight the potential need for flexibility. They offered annual checks for carers with a clinician and also a member of the carers association.

• They had recently organised a number of coffee mornings in conjunction with their patient group for more isolated patients.