Frimley Green Medical Centre

Updated 4 April 2017

Dr Cureton and Partners provide GP services at both Frimley Green and Ash Vale surgeries. Both surgeries are able to dispense medicines to those patients living outside a one mile radius of a local pharmacy. In June 2016 Frimley Green and Ash Vale joined together as a group practice under the name of the Bartlett Group Practice. The combined practice list is 28,000 patients. There are 14 GP partners (both male and female), five salaried GPs, two GP trainees, two nurse practitioners, practice nurses, healthcare assistants, five dispensers and a range of administrative staff. There are two practice managers and two manager’s assistants.

The practice is open between 8am and 8pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning and from 2pm to 7.40pm. Extended hours appointments are offered every day and flu clinics are available during the evening and on some weekends. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for patients that need them.

Services are provided from:

Frimley Green Medical Centre, Camberley , Surrey, GU16 6QQ

and

Ash Vale Health Centre, Wharf Road, Ash Vale, Surrey, GU12 5BA

During this inspection we visited The Frimley Green Medical Centre only.

During the times when the practice is closed, the practice has arrangements for patients to access care from an out of hour’s provider. Patients are provided information on how to access the out of hour’s service by calling the surgery or viewing the practice website.

The practice has a patient demographic that is similar to the national average in all age groups. They have a slightly higher than average proportion of patients with a long standing health condition. The practice population includes those from settled traveller populations and army families.

Updated 4 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Cureton and Partners on 9 September 2016. The overall rating for the practice was good. However, during this inspection we found breaches of legal requirements and the provider was rated as requires improvement under the safe domain. The full comprehensive report for the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Cureton and Partners on our website at www.cqc.org.uk.

Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that controlled drugs used within the practice were stored securely in line with national guidance.
• Ensuring that all significant events within the practice were reported and recorded and that all staff were involved in discussions and reviews to improve practice.

This inspection was an announced focused inspection carried out on 16 March 2017. This was 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 on 9 September 2016. This focused inspection has determined that the provider is now meeting all requirements and is now rated as good under the safe domain. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The practice had reviewed security measures in place for controlled drugs. We saw evidence that only authorised staff had access to controlled drugs and that keys to the controlled drugs safe within the dispensary were stored securely in a separate key safe.
• The practice had ensured that all staff were included in the review of and learning from significant events where relevant to their role. Significant events were recorded centrally with detailed information being available for all staff to review including full details of the incident, areas of concern, suggestions for doing things differently in the future and action points.

In addition we saw evidence of:

• New meeting structures in place for clinical and non clinical staff. Staff we spoke with told us the new meeting structure supported good communication and allowed them the opportunity to be involved in formal discussions about the practice.
• Controlled drugs being monitored in line with best practice guidance. This included dispensing staff regularly recording stock movement and the balance of drugs stored, a monthly stock check and a six monthly audit. We also saw that standard operating procedures had been updated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 December 2016

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 somewhat worse than the national average, however exception reporting was lower. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 79.77% compared to the national average of 88.3%. 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 had identified clinical leads for different diseases and GPs met on a daily basis to discuss challenging cases, decision making and care improvements.

Updated 22 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 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 84.38%, which was comparable to the CCG average of 82.05% and the national average of 81.83%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There was an integrated midwifery service on site at both Frimley Green and Ash Vale.
• The practice had developed a guide for young people on accessing the services.

Updated 22 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.
• The practice identified those patients at high risk of hospital admission and developed care plans to reduce the risk of admission.
• Longer appointments were available for elderly patients with complex needs.

Updated 22 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 offered extended hours appointments on each weekday evening.
• 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 December 2016

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

• 83% 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 86%.
• Performance for mental health related indicators at was better compared to the national average. For example 94.56% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months compared with the national average of 88.47%.
• 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 22 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.
• 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 identified their most vulnerable patients and these were registered with both the ambulance and out of hour’s services.
• Monthly palliative care meetings were held with attendance from specialist palliative care and community staff.