The Merton Medical Practice

Updated 12 May 2016

The Merton Medical Practice provides primary medical services in Merton to approximately 7300 patients and is one of 24 practices in Merton Clinical Commissioning Group (CCG). The practice population is in the fourth least deprived decile in England.

The practice population has a higher than CCG average representation of income deprived children and older people. The practice population of children is slightly above local and national averages, the practice population of those of working age is above local and national averages at 77% and the number of older people registered at the practice considerably lower than local and national averages; 5.5% of patients are over the age of 65. Of patients registered with the practice, 15% are White or White British, 44% are Asian or Asian British, 14% are from multiple or mixed ethnic groups and 20% are Black or Black British.

The practice operates from purpose-built premises. Consulting rooms are on the ground floor. All patient facilities are wheelchair accessible. This practice has access to five doctors’ consultation rooms and two nurses’ treatment rooms. The practice team at the surgery is led by two partners; one female part time partner and one male part time partner. The GP team is also made up of three female part time salaried GPs. The total number of GP sessions per week is 28. The nursing team consists of a part time female practice nurse and two part time female health care assistants. The non-clinical team includes a practice manager, two administrative staff and four reception staff members.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). The practice is a training practice for trainee GPs and provides teaching for medical students.

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday. Appointments are available between 8am and 6.30pm. Extended hours surgeries are offered from 6.30pm to 8pm every Monday and Tuesday evening and 6.30pm to 7pm every Wednesday and Thursday evening. The practice is closed at weekends. The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8am and directs patients to the out-of-hours provider for Merton CCG.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services, family planning services, maternity and midwifery services and treatment of disease, disorder or injury.

Updated 12 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Merton Medical Practice on 23 February 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.
• Most risks to patients were assessed and well managed with the exception of some health and safety risks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 an area of outstanding practice:

• Performance for mental health related indicators was above the Clinical Commissioning Group (CCG) and national averages; 98% of patients had received an annual review compared with CCG average of 92% and national average of 88%.The number of patients with dementia who had received annual reviews was 100% which was above the CCG average of 84% and national average of 84%. The practice ensured that they worked with patients to improve their dementia diagnosis rate. Data from October 2014 showed that the practice’s dementia diagnosis rate was over 70% which was the second highest achievement in the CCG.

The areas where the provider should make improvement are:

• Ensure there is a robust system in place to store, track and monitor the use of prescription pads throughout the practice.

• Ensure that action plans from infection control audits include all identified risks.

• Ensure that the practice has effective health and safety systems in place for equipment testing, health and safety risk assessments, the control of substances hazardous to health (COSHH) and Legionella risk.

• Consider installing a hearing loop.

• Review and improve telephone access for patients.

• Ensure that complaints are acknowledged in a timely way, in line with the practice’s complaint handling policy.

• Consider the use of patient surveys as a method for gathering targeted patient feedback to assist in improving the quality of the service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 12 May 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 above Clinical Commissioning Group (CCG) and national averages. For example, 85% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the CCG average of 73% and the national average of 78%.
• Flu vaccination rates for 2014/15 for patients with diabetes was 97%. This was above the CCG and national averages.
• Longer appointments and home visits were available when needed.
• The practice provided a phlebotomy service every weekday morning with a health care assistant.
• The practice provided a fortnightly clinic for patients with diabetes and chronic obstructive pulmonary disease (COPD).
• 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 was signed up to the national avoiding unplanned admissions enhanced service, to identify those vulnerable patients most at risk of admission to hospital and they were also signed up to a local service to identify those at risk with two or more long-term conditions. The practice used these registers of patients to ensure that patients were able to access care and treatment in a timely way.

Updated 12 May 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 Accident and Emergency (A&E) attendances.
• 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 patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 88% which was higher than national average of 75%.
• Childhood immunisation rates for the vaccinations given were above or line with Clinical Commissioning Group (CCG) averages for 2014/15.
• The practice provided postnatal care and chlamydia screening and a range of contraceptive services were provided by GPs and the practice nurse.
• The practice’s uptake for the cervical screening programme was 86%, which was above the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 12 May 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.
• Data showed that outcomes for patients for conditions commonly found in older people were above local and national averages.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided a weekly session in a local sheltered accommodation, working closely with the warden to ensure patients’ needs were met.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was 78% which was above the national average.

Updated 12 May 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 as well as a full range of health promotion and screening that reflected the needs for this age group.
• Extended hours surgeries were offered four evenings per week.
• Patients were able to receive travel vaccinations available on the NHS and they were a registered yellow fever centre.
• Smoking cessation was provided in-house by a health care assistant.
• The practice provided a phlebotomy service every weekday morning with a health care assistant.
• The practice provided NHS health checks for people aged 40–74. In 2014/15, the practice had achieved more than their Clinical Commissioning Group (CCG) target of 141, by undertaking 188 NHS health checks with a health care assistant.

Updated 12 May 2016

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

• Performance for mental health related indicators was above the Clinical Commissioning Group (CCG) and national averages; 98% of patients had received an annual review compared with CCG average of 92% and national average of 88%.
• The number of patients with dementia who had received annual reviews was 100% which was above the CCG average of 84% and national average of 84%. The practice ensured that they worked with patients to improve their dementia diagnosis rate. Data from October 2014 showed that the practice’s dementia diagnosis rate was over 70% which was the second highest achievement in the CCG.
• The practice provided special arrangements for a local home for patients with severe mental illness; providing an annual visit by a GP to ensure patients received an annual physical health check or inviting patients and the carers to the practice.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The GPs met with a consultant psychiatrist every two months to discuss practice patients receiving community mental health services.
• 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 12 May 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, carers and those with a learning disability as well as a register of those most at risk of admission to hospital.
• The practice were not signed up to the incentivised enhanced service to offer physical health checks to those patients with learning disabilities, however they had still ensured that these patients were monitored effectively and had completed 15 reviews out of 16 patients on the register which was 94%.
• The practice offered longer appointments for patients with a learning disability.
• Flu vaccination rates for 2014/15 for at risk groups was 58%. This was above the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.