Central Medical Centre

Updated 14 January 2016

Central Medical Centre provides primary medical services in Merton to approximately 8400 patients and is one of 24 practices in Merton Clinical Commissioning Group (CCG). The practice population is in the fifth least deprived decile in England.

The practice population has a lower than CCG average representation of income deprived children and older people. The practice population of children, older people and those of working age are in line with local and national averages. Of patients registered with the practice, 59% are Asian and Asian British; specifically the practice has a high Sri Lankan Tamil population. Forty per cent are White British and White European. The practice has double the expected prevalence of diabetes for the patient list size due to the incidence of this in the Asian population.

The practice operates from an adapted residential property. All patient facilities are on the ground floor and are wheelchair accessible and the practice has access to seven doctors’ and nurses’ consultation rooms and one treatment room. The practice team at the surgery is made up of one full time male lead GP who is a partner and one full time female GP who is a partner, one full time male salaried GP, one part time male salaried GP and three part time female salaried GPs. In total the GPs provided 44 sessions. The practice team includes one full time female advanced nurse practitioner, one part time female practice nurse, one part time male practice nurse, one part time male health care assistant and a part time pharmacist employed by the practice. The practice team also consists of a practice manager, eight administrative staff and nine 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 provides teaching to medical students.

The practice reception and telephone lines are open from 8am to 8pm Monday, Tuesday and Wednesday; 8am to 6.30pm Thursday and Friday and 9.30am to 12.30pm on Saturdays. Appointments are available between 8.30am and 6.30pm every day. Extended hours surgeries are offered from 6.30pm to 8pm Monday, Tuesday and Wednesday and 9.30am to 12.30pm on Saturday.

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.

The practice was previously inspected on 14 May 2014 as part of a pilot, but was not rated. The provider was found to be compliant with the relevant regulations.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Medical Centre on 10 November 2015. 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.
• 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.
• Data showed patient outcomes were average or above for the locality. Audits had been carried out with evidence that they were driving performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice used innovative and proactive methods to meet patients’ needs, specifically tailoring their services for patients from vulnerable groups.
• Information about services and how to complain was available and easy to understand and a range of patient information was available in Tamil.
• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day. Patients were able to get routine appointments quickly.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Policies and procedures were not always easily accessible for staff but there was evidence that they were updated to reflect changes in practice systems.
• 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 and they had an active Patient Participation Group (PPG).
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice:

• The practice had tailored its service and there were innovative approaches to promoting patient education, especially in vulnerable groups. The practice had developed patient education information for a range of conditions in Tamil, including a diabetes book and provided new patient health checks to promote self-management. The practice reported they had shared their information leaflets with other local health services to support Tamil patients.

• The practice had tailored its services for vulnerable patients; staff were able to speak twelves languages, chaperones that spoke Tamil were available and information was available in Tamil in the patient waiting area including information for bereavement support.

• The practice had an in-house pharmacist and reviews for patients over 75 were completed jointly by the practice nurse, GP and practice pharmacist where indicated. Joint home visits were undertaken for housebound patients over 75 to complete their care plans, to ensure that patients’ holistic needs were assessed. The pharmacist was involved with ensuring that the medicines that patients from overseas were taking were replaced with appropriate UK equivalents.

The areas where the provider should make improvement are:

• Ensure that emergency equipment includes access to defibrillator pads for children.
• Ensure that the practice has a updated record of assessed risks relating to health and safety of the premises including those related to asbestos and portable appliance testing.
• Ensure the practice has systems in place to monitor staff training effectively, including mandatory training requirements and ensure that practice policies and procedures are easily accessible for staff.

• Ensure that minutes are recorded for partnership meetings so actions can be monitored.

• Consider how to improve patient satisfaction regarding access to appointments as indicated in the GP patient survey.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 14 January 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, specifically for patients with diabetes and respiratory conditions.

• Patients at risk of hospital admission were identified as a priority and were placed on the practice’s avoiding unplanned admissions register.

• Those with two or more long-term conditions were also placed on a practice register. The practice worked to provide these patients with a care plan.

• The practice monitored patients with uncontrolled diabetes and provided patient information in Tamil due to the higher prevalence of diabetes in the Asian population.

• Longer appointments and home visits were available when needed.

• All these patients had access to a structured annual review to check that their health and medication needs were being met.

• For those people with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary approach to care and there was evidence that these monthly meetings were being used effectively to monitor and improve outcomes for patients.

Updated 14 January 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.

• Data for 2014/15 showed that the practice were the second highest performing practice in the Clinical Commissioning Group (CCG) for the five in one vaccine for those under 12 months, achieving 98%.The practice were the highest performing in the CCG for the pre-school booster, achieving 92% compared with CCG average of 63%, despite the practice having a higher than average number of children under 5 years. The practice promoted uptake by monitoring those who missed immunisations and proactively asked parents and guardians to bring the immunisation records to new patient appointments due to the large number of patients from abroad.

• 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.

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

• The practice provided a winter children’s emergency clinic in 2014 to reduce accident and emergency attendances.

• The practice offered shared care midwifery services and a midwife visited the practice every two weeks.

• A full range of family planning services were offered.

• The practice offered health promotion for this population group including chlamydia screening.

Updated 14 January 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 including avoiding unplanned admissions care plans and over 75s health checks with a GP, practice nurse and practice pharmacist in the practice or at home for those who were housebound.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above Clinical Commissioning Group (CCG) and national average, for example for those with atrial fibrillation and osteoporosis.

• The percentage of people aged 65 or over who received a seasonal flu vaccination was 65% for 2014/15 and 63% for 2013/14 which was lower than national average. However, the practice had worked to promote uptake via offering a Saturday flu clinics.

Updated 14 January 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.

• Extended hours were offered three evenings a week and patients were able to access Saturday morning appointments.

• The practice was proactive in offering online services for appointments and prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group.

• A full range of family planning services were offered.

Updated 14 January 2016

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

• 96% of people experiencing poor mental health had received an annual physical health check and 70% of those with dementia had received an annual review.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Meetings were held twice yearly with local community mental health teams to discuss patients on the register.

• It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

• It was proactive in case finding and diagnosing dementia and had increased incidence of dementia over the past three months.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice hosted a psychological therapy service one day a week and were able to refer patients to this service.

• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 14 January 2016

The practice is rated as outstanding 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, housebound patients, vulnerable adults and children and those with a learning disability.

• It offered longer appointments for people with a learning disability.

• It provided annual health checks for people with a learning disability and 100% of 17 eligible patients had received a review. The practice met with the community learning disabilities nurse on an annual basis.

• One of the non-clinical staff members was able to communicate using sign language.

• The practice were pro-active in making use of new patient health checks to screen new patients with complex conditions, due to the large number of new patients from abroad and due to the high prevalence of diabetes, especially in their Asian population. They had completed 876 new patient checks in 2014/15.

• There was significant support available for patients with language barriers. The practice had recognised that the majority of their practice population were from Tamil and Sri Lankan backgrounds. There were notices in Tamil in the waiting area and the website could be viewed in other languages. The practice provided a patient information leaflet in Tamil for new patients and information relating to bereavement support was available in Tamil.

• Twelve different languages were spoken amongst practice staff including Tamil, but a translation service was available when required. Two non-clinical staff members who spoke Tamil had been specifically trained to be a chaperone for this patient population.

• The practice had tailored its service to ensure patient education was a priority, especially in vulnerable groups. The practice had worked with its staff to develop a range of patient information leaflets in Tamil. Information including detailed leaflets for diabetes, dementia and breast feeding. The practice reported they had shared their information leaflets with other local health services to support Tamil patients.

• The practice had a high prevalence of diabetic patients; double the expected prevalence for the practice list size. This was due to a high incidence of diabetes in the Asian population. The practice had published a book about diabetes in Tamil, to specifically target those with a risk of uncontrolled diabetes. The practice had also trialled a Saturday morning education session for Tamil patients for long-terms conditions such as diabetes.

• The practice were able to signpost patients to a local temple which provided social support, access to Tamil families in the area, and some health education from Tamil speaking consultants in radiology and mental health and other invited speakers.

• 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 regularly worked with multi-disciplinary teams monthly in the case management of vulnerable people and the practice attended quarterly child protection meetings.

• The practice held a clinical meeting monthly which included a discussion of patients who had attended Accident and Emergency (A&E), to assist in identifying the most vulnerable patients who had frequent A&E attendances.