Eversley Medical Centre

Updated 31 October 2017

Eversley Medical Centre has approximately 10633 patients and is in Croydon, south London, very close to Croydon University Hospital. The surgery is based in converted premises. There is no parking for patients, but the area is well served by public transport. The building has level access and a lift.

Compared to the England average, the practice has more children as patients (aged up to 19) and aged 20 – 44 and fewer patients aged 50+ than at an average GP practice in England.

The surgery is based in an area with a deprivation score of three out of 10 (one being the most deprived), and has a higher level of income deprivation affecting older people and children. Compared to the England average, more patients are unemployed.

Eight doctors work at the practice: four male and four female. Four of the doctors are partners and there are four salaried GPs). Some of the GPs work part-time. The practice has 40 GP sessions per week.

There are three practice nurses and a health care assistant, and a non-clinical team including a practice manager, reception and administrative staff.

The practice is open between 8am – 7.30pm on Tuesdays and Thursdays and 8am – 6.30pm on Mondays, Wednesday and Fridays. Appointments with GPs are available from 8.30am to 11.30am and 3.30pm and 6.30pm every day, and until 7.30pm on Tuesday and Thursday. When the practice is closed cover is provided by a local service that provides out-of-hours care.

The practice offers GP services under a Personal Medical Services contract in the Croydon Clinical Commissioning Group area. The practice is registered with the CQC to provide family planning, surgical procedures, diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.

This is the second time that the CQC has inspected the practice.

Updated 31 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eversley Medical Centre on 23 November 2016. The overall rating for the practice was good, with a rating of requires improvement for the key question ‘Are services responsive to people’s needs?’

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Eversley Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 12 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 23 November 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:

• Complaints handling had improved. The policy was now in line with recognised guidance and contractual obligations and the complaints we reviewed had been managed in line with the new policy.
• The practice was monitoring and taking action to improve patient satisfaction with aspects of access, particularly by telephone.

In response to our recommendations, the practice had also:

• Carried out an audit of patients on high risk medications.
• Created a new system to monitor the care of patients with diabetes and an improved recall and care planning system. We saw positive feedback from a patient about this system. The practice had also run group consultations for six patients with diabetes. Evidence from the practice showed that all six patients had improved control of their diabetes (measured by HbA1C) and would recommend the approach to a friend.
• Developed a new system for recalling patients for cervical screening, which included making appointments for eligible patients to have screening when in the practice for another appointment (to increase the likelihood of attendance) and creating telephone consultation slots for nurses to contact patients who are reluctant to be tested. Data showed that this was beginning to improve uptake, with a 2% improvement so far.
• Developed a consistent system of review of policies to ensure that they remain complete and in line with latest best practice. Details of two examples were provided, including how the updated policies were shared with staff.
• Strengthened systems to improve uptake of breast and bowel screening, with letters and structured phone consultations for patients who did attend.

Following this inspection, the practice should:

• Continue to monitor and act on patient feedback on telephone access.
• Continue to monitor and take action to improve care and outcomes for patients with diabetes and the uptake of cancer screening (bowel, breast and cervical).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 22 March 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.
• The practice had a range of services in place to support patients with long term conditions, including chronic obstructive pulmonary disease monitoring with spirometry, an electrocardiogram service, phlebotomy, and specialised wound care clinics with Doppler studies (to check the blood flow in patients with ulcers).
• Performance for some diabetes related indicators was below average. In response, the practice took part in a pilot scheme for group consultations, employed a diabetes specialist nurse and was signed up to local incentive schemes to improve outcomes for patients with pre-diabetes and diabetes.
• 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 22 March 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 74%, which was below the CCG average of 81% and the national average of 82%. The practice was aware that their screening rates were below average, and had an action plan to increase uptake.
• 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 22 March 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.
• Older patients had a named GP to support their care.

• Older people were given priority appointments.
• The practice had arranged for a community pharmacist to do home visits for medicines reviews.
• There was a recall system for all older patients who had no surgery contact for 6 months. The practice audited the number of reviews for older patients, and increased uptake from 79% to 89% in April 2016.

Updated 22 March 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 22 March 2017

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

• 84% 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.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had developed a joint care template to share information and plan care effectively with members of the community care team.
• 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.
• Patients with dementia were given 20 minutes appointments as standard, and their carers encouraged to have an assessment by the practice carers’ lead.
• The practice provided injections of anti-psychotic medication to people stabilised on this medicine.

Updated 22 March 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 had chosen to focus some of its quality improvement activity in this area, and had increased the number of carers and the number of vulnerable people identified.
• 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.
• The practice had established a programme of support for carers, including a practice lead and a monthly carers group. Carers were encouraged to have their annual health check, and 50% of carers had had health checks at the time of the inspection.