Archived: Cairngall Medical Practice

Updated 16 October 2017

Cairngall Medical Practice is based in a purpose built premises at 2 Erith Road Belvedere Kent DA17 6EZ within a predominantly residential area close to a small local high street. The property comprises a large reception and waiting area and nine treatment and consultation rooms on the ground floor with the upper floors designated for staff offices and a meeting room. Services are also provided at a smaller branch surgery at 58 Cumberland Drive Bexleyheath Kent DA7 5LB which is 1.5 miles from the main surgery.

Both premises are located in the London Borough of Bexley. Bexley Clinical Commissioning Group (CCG) are responsible for commissioning health services for the borough.

Services are delivered under a Personal Medical Services (PMS) contract. (PMS contracts are local agreements between NHS England and a GP practice. They offer local flexibility compared to the nationally negotiated General Medical Services (GMS) contracts by offering variation in the range of services which may be provided by the practice, the financial arrangements for those services and who can hold a contract).

The practice is registered with the CQC as a Partnership, providing the regulated activities of family planning; maternity and midwifery services; treatment of disease, disorder and injury, surgical procedures and diagnostic and screening procedures.

The practice has 9554 registered patients. The practice age distribution is similar to the national average. The surgery is based in an area with a deprivation score of 6 out of 10 (with 1 being the most deprived and 10 being the least deprived).

At the time of this inspection there was only one GP partner in post following recent significant changes outside of the control of the provider. Negotiations were currently taking place with the CCG, NHS England and the Local Medical Committee as to the future of the practice.

Clinical services are currently provided by the GP partner (female) working 9 sessions a week; two salaried GPs (1.6 wte); three regular locum GPs (1.8 wte); one full-time Nurse Practitioner; three part-time Practice Nurses (1.7 wte) and one full-time Health Care Assistant.

Clinical services are also provided by a full-time Clinical Pharmacist employed by the practice as part of a four year pilot scheme funded jointly with the local CCG.

Administrative services are provided by a Practice Manager (0.8 wte), Business Manager (0.4 wte) and reception and administrative staff.

Reception at the Erith Road main surgery is open from 8am to 7pm Monday; from 8am to 6.30pm Tuesday, Wednesday and Friday and from 7.10am to 6.30pm Thursday. Telephone lines are open from 8am to 6.30pm Monday to Friday.

Reception at the Cumberland Drive branch surgery is open from 8am to midday and 3.30pm to 6.30pm Monday to Friday. Telephone lines are open during reception opening times only and patients are instructed to contact the main surgery when reception is closed during the midday period.

At the Erith Road main surgery booked appointments are available with a GP or Nurse Practitioner from 8.30am to 12.30pm and 2pm to 5.30pm Monday to Friday. Urgent consultations are available from 8am to 10.30 am Monday to Friday through the Walk-in service when patients can be seen by a GP, Nurse Practitioner or Clinical Pharmacist.

At the Cumberland Drive branch surgery pre-booked and urgent appointments are available with a GP from 8.30am to 11.30pm and 3.50pm to 5.30pm Monday to Friday.

Appointments are available with the Practice Nurse at the Erith Road surgery from 8.30am to midday and 3.30pm to 6pm Monday; from 2.15pm to 6pm Tuesday; from 8.30am to midday and 2pm to 6pm Wednesday and Thursday and from 8am to midday and 1.30pm to 5pm Friday.

Appointments are available with the Practice Nurse at the Cumberland Drive surgery from 8.30am to 11.30am Thursday only.

Appointments are available with the Health Care Assistant at the Erith Road surgery from 9am to 12.30pm and 2pm to 7pm Monday and from 9am to 12.30pm and 2pm to 6pm Wednesday and Friday.

The practice is closed at weekends.

When the surgery is closed, urgent GP services are available via NHS 111.

Updated 16 October 2017

Letter from the Chief Inspector of General Practice

This practice was previously inspected as part of the new comprehensive inspection programme. An announced comprehensive inspection was carried out on 28 January 2015 resulting in an overall rating of requires improvement. The ratings for the safe and caring key questions were requires improvement and for the effective, responsive and well-led key questions the rating was good.

This was followed by a second announced comprehensive inspection on 1 February 2017. The overall rating for the practice at that inspection was good. The rating for the safe, caring, effective and well-led key questions was good and for the responsive key question the rating was requires improvement.

The full comprehensive reports for both inspections can be found by selecting the ‘all reports’ link for Cairngall Medical Practice on our website at www.cqc.org.uk.

This announced focused desk-based review was carried out on 23 August 2017 to confirm that the practice had carried out their plan to make the improvements that we identified in our previous inspection on 1 February 2017. This report covers our findings and the improvements made by the practice since our last inspection.

Overall the practice remains rated as Good.

Our key findings at this inspection were as follows:

• In comparison with the previous years results (published in July 2016), data from the July 2017 national GP patient survey showed some improvement in relation to patient satisfaction rates related to accessing care and treatment at the surgery. However, results remained below the local and national averages.
• The practice had identified 95 patients as carers (1% of the practice list). The practice had previously only identified 30 patients as carers (0.3% of the practice list).
• All staff carrying out chaperone duties had received appropriate training for the role.

The areas where the provider should continue to make improvements are:

• The provider should continue to monitor satisfaction rates regarding how patients can access appointments to ensure improvements are identified and implemented where appropriate.

At our previous inspection on 1 February 2017 we rated the practice as requires improvement for providing responsive services as patient satisfaction in respect of access to services was below the local and national average. At this inspection we found that there was insufficient improvement in patient satisfaction rates. Consequently, the practice is still rated as requires improvement for providing responsive services.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 31 March 2017

The practice is rated as good for the care of people with long-term conditions.

• The Clinical Pharmacist and nursing staff worked closely with GPs and community specialist nurses in the management of patients with long-term conditions.
• Patients at risk of hospital admission were identified as a priority and their treatment reviewed as appropriate.
• The practice performance rate for the Quality and Outcomes Framework (QOF) diabetes related indicators was comparable to the local and national average.
• Longer appointments and home visits were available when needed.
• 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, staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. These patients were discussed at the monthly multi-disciplinary team meetings.

Updated 31 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 who were at risk, for example, children and young people who had a high number of A&E attendances and children who had failed to attend hospital appointments.
• Immunisation rates were comparable to the national average for all standard childhood immunisations.
• The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages
• Appointments were available outside of school hours and the premises were suitable for children and babies. Priority was given to young children at the morning walk-in clinic.
• There were positive examples of joint working with midwives, who held an antenatal clinic at the surgery every week, and health visitors who attended monthly safeguarding meetings at the practice.

Updated 31 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 Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to 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.

Updated 31 March 2017

The practice is rated as good for the the care of working-age people (including those recently retired and students).

• The needs of this population group 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 appointments were available at the surgery for one hour on Monday evening and Thursday morning and on Saturday morning between 8.30am and 12.30am.
• The practice was proactive in offering online services which included the ‘ask a Doctor’ email service for non-urgent queries and test result requests. Patients were sent texts to encourage attendance at booked appointments.
• A full range of health promotion and screening services were provided that reflected the needs for this age group.

Updated 31 March 2017

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local average of 97% and national average of 97%.
• 100% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was comparable to the local average of 97% and national average of 93%.
• Exception reporting for both indicators was comparable with the local and 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 carried out advance care planning for patients with dementia.
• The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations.
• A counsellor provided twice weekly clinics at the surgery.
• 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 31 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 offered longer appointments and annual reviews for patients with a learning disability. Of the 46 patients on the Learning Disability register 11 patients had received their annual review and 10 had booked appointments.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients 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.