Fairhill Medical Practice

Updated 10 July 2017

Fairhill Medical Practice is a large practice based in Kingston, south London. The practice list size is 22,210. The practice population is diverse and is in an area in London of low deprivation. One of the three branches is located on the premises of a local University and as such is only accessible to patients from the University. Compared to an average GP practice in England, there is a higher than average percentage of patients in employment or full time education and a significantly higher than average percentage of patients between the ages of 15 and 29.

The practice has a Personal Medical Services (PMS) contract and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). The practice operates from three locations; the main practice is on Kingston Hill, with one branch on Fairfield South and one in the Kingston University Health Centre on the Penrhyn Road campus.

The staff team comprises five GP partners and seven salaried GPs, of which nine are female and three male. The GPs provide 66 clinical sessions per week. There is one female lead nurse, two female practice nurses and one phlebotomist. Non clinical staff include an operations manager, two practice managers, three deputy managers, two medical secretaries and 17 administrator / receptionists.

When the practice is closed patients are automatically directed from the practice telephone to the NHS 111 service, and the urgent care centre at the nearby Kingston Hospital. This information is also available on their website and in their practice leaflet.

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

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Fairhill Medical Practice on 31 August 2016. The overall rating for the practice was Good. However the practice was rated as requires improvement for providing effective services due to having higher than expected levels of exception reporting (the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects) under the Quality Outcomes Framework (QOF). The full comprehensive report can be found by selecting the ‘all reports’ link for Fairhill Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focussed inspection carried out on 25 May 2017 to confirm that the practice had carried out their plan to make the required improvements we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made.

Overall the practice is now rated as Good.

Our key findings were as follows:

• The practice had reviewed the levels of and processes for exception reporting, and had taken steps to improve outcomes for patients.

• Although the most recent published data from 2015/16 showed that the practice exception reporting rate was still higher than local and national averages in some areas, unpublished data for 2016/17 indicated that the exception reporting had decreased in a number of clinical areas.

• Up to date risk assessments for health and safety, infection control and fire safety were in place, and were subject to monitoring and review.

• The practice had increased the regularity of non-clinical staff meetings.

• Information about how to complain was on display at the practice.

The area where the provider should make improvements are:

• Continue to review and monitor recently implemented initiatives to improve exception reporting of patients in the cervical screening programme, in order to improve these measures in the Quality and Outcomes Framework.

At this inspection we found that although the practice was still below local and national averages for exception reporting under the Quality and Outcomes Framework (QOF) for some measures, evidence was seen that changes had been undertaken to reach more of these patients. This included patients with conditions such as coronary heart disease, chronic obstructive pulmonary disease, dementia and rheumatoid arthritis. Consequently, the practice is now rated as good for providing effective services, and remains good overall.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 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. The practice discussed patients at risk of hospital admission as a standing agenda item at practice clinical meetings.

• Nationally reported data for 2014/2015 showed that outcomes for patients with diabetes were in line with local and national averages.

• The practice employed a diabetic specialist nurse who ran a clinic for patients with this condition.

• Longer appointments and home visits were available when needed.

• All patients with a long-term condition had a named GP and the majority had received a structured annual review to check their health and medicines needs were being met.

• In the previous 12 months of 2014/2015, 81% of patients with asthma had an asthma review. This was in line with the local and national averages.

• 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 8 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 had recruited a practice nurse in 2015 with a special interest in sexual health and contraception. Other nurses at the practice had special interests in women’s health, travel health and young adults.

• The practice’s uptake for the cervical screening programme was 95%, which was above the Clinical Commissioning Group (CCG) average of 83% and the national average of 74%. The exception reporting rate for this measure was 32% compared to the CCG average of 9% and the national average of 6%. The practice was aware of their high exception reporting rate in this area, and had put a system in place to attempt to make repeated contact with these patients.

• 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 8 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.

• The practice held regular reviews and meetings for patients receiving end of life care.

Updated 8 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 employed clinical staff with specialist training and qualifications to better care for their patient population, which had a high proportion of young people and people in higher education.

• 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 8 February 2017

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 were comparable to CCG and national averages.

• 80% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months, compared to the CCG average of 92% and the national average of 88%.

• The number of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 89% compared to the CCG average of 83% and the national average of 84%. The practice had an exception reporting rate of 21% for this indicator, compared to the CCG average rate of 8% and the national average of 8%.

• Two of the doctors at the practice held diplomas in mental health.

• 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 8 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 children and adults, and those with a learning disability. The practice regularly updated the register with the outcomes of multidisciplinary meetings and actions being taken by the practice.

• 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.