The Leith Hill Practice

Updated 24 February 2017

The Leith Hill Practice offers personal medical services to the population of Dorking in Surrey and the surrounding area. There are approximately 8,000 registered patients. The Leith Hill Practice has a main site and a smaller branch surgery; both surgeries are able to dispense medicines to those patients living outside a one mile radius of a local pharmacy.

The Leith Hill Practice is run by four partner GPs (two male and two female). The practice is also supported by a salaried GP, a nurse practitioner, three practice nurses and three phlebotomists. The practice also has a team of administrative staff and manager, a team of receptionists and manager and part time finance assistant, business manager and practice manager. There is a dispensing team consisting of two managers and 12 dispensing staff.

The Leith Hill Practice is a training practice for GP trainees and FY2 doctors. (FY2 doctors are newly qualified doctors who are placed with a practice for 4 months and will have their own surgery where they see patients)

The practice runs a number of services for its patients including asthma reviews, child immunisation, diabetes reviews, new patient checks and holiday vaccines and advice.

Services are provided from two locations - :

Main Surgery

The Old Forge Surgery, 168 The Street, Capel, Dorking, Surrey RH5 5EN

Opening Hours are Monday to Friday 8am to 6.30pm

The surgery is able to offer evening appointments Monday to Thursday from 6.30pm to 7pm

Branch Surgery

Northbrook Surgery, Warwick Road, South Holmwood, Dorking, Surrey, RH5 4NP

Opening Hours are Monday to Friday 8am -1pm

During this inspection we visited The Old Forge Surgery. We did not inspect the branch surgery – Northbrook Surgery.

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

The practice population has a higher number of patients aged between 45 to 79 years of age than the national and local clinical commissioning group (CCG) average. The practice population shows a lower number of patients aged from birth to 9 and 15 to 39 years of age than the national and local CCG average. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for England. Less than 10% of patients do not have English as their first language.

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Leith Hill Practice on 21 April 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 April 2016 inspection can be found by selecting the ‘all reports’ link for The Leith Hill Practice 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 infection control audits were documented and completed in the required timeframes. Where needed action plans were created with dates for completion which were monitored.
• Ensuring that security measures for controlled drugs were reviewed to include the secure storage of keys when the practice was closed.

This inspection was an announced focused inspection carried out on 01 February 2017 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 21 April 2016. The focused inspection has determined that the provider was 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’s infection control lead was the practice nurse. We saw evidence of their advanced training for infection control. Infection control audits were undertaken every six months and there had been a recent Infection control audits in May and December 2016. We saw that actions had been recorded to address any concerns found and these were regularly discussed at meetings. All staff had received training on infection control.
• 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 cabinet were stored securely in a separate key safe.

In addition we saw evidence of:

• The recording of minutes and actions from partner meetings held. These were then disseminated to staff not present to support shared learning.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 June 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.
• 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.
• Performance for diabetes related indicators was higher than the clinical commissioning group (CCG) and national average. For example, 95% of patients on the diabetes register, had a record of a foot examination and risk classification within the preceding 12 months which was above the national average of 88%.
• The practice hosted physiotherapy and osteopathy clinics which patients could be referred to.

Updated 17 June 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 81%, which was comparable to the national average of 82%.
• Data showed 67% of female patients aged between 50 and 70 years, had been screened for breast cancer in the last 36 months which was comparable to the clinical commissioning group average of 72%.
• 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 and health visitors.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse.
• Safeguarding policies and procedures were readily available to staff.
• The practice ensured that children needing emergency appointments would be seen on the day.
• The practice offered a minor injuries service, to help avoid unnecessary visits to A&E.

Updated 17 June 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 held out-reach flu clinics due to its rural location.
• Older patients with complex care needs and those at risk of hospital admission had personalised care plans that were shared with local organisations to facilitate the continuity of care.
• The practice was proactive in inviting patients to the practice for an over 75 health check.
• Patients over the age of 75 were allocated a named GP and were encouraged to see the same GP for continuity of care.

• The practice worked with community nurses and the community pharmacies to provide dosset box pre-packed daily medicine to improve compliance and safety.
• The practice worked closely with local support groups. For example, local groups who could help provide transport for elderly patients.

Updated 17 June 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 reflects the needs for this age group.
• The practice offered advice by telephone each day for those patients who had difficulty in attending the practice.
• The practice had reviewed patient access and was able to offer evening appointments Monday to Thursday until 7pm.
• Electronic Prescribing was available which enabled patients to order their medicine on line and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.
• The practice offered NHS health-checks and advice for diet and weight reduction.

Updated 17 June 2016

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

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• 95% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 which was comparable to the national average of 88%.
• 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.
• The practice was promoting a local service (MASH) for single isolated men, especially those who had received a recent bereavement.

Updated 17 June 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 could accommodate those patients with limited mobility or who used wheelchairs.
• Carers and those patients who had carers, were flagged on the practice computer system and were signposted to the local carers support team.
• The practice ran a quarterly drug dependence clinic for maintenance treatment of patients with stable addiction problems.