The Chesser Surgery

Updated 10 November 2016

The Chesser Surgery provides primary medical services in Carshalton to approximately 6700 patients and is one of 27 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the fifth less deprived decile in England.

The practice population has higher than CCG and national average representation of income deprived children and older people. The practice population of children and working age people is below the local and in line with the national average; the practice population of older people is above the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded, 66% are white British or mixed British, 6% Asian and 6% are African.

The practice operates in purpose built premises. All patient facilities are wheelchair accessible. The practice has access to five doctors’ consultation rooms, one nurse and one healthcare assistant consultation room on the ground floor. There is also a room for breastfeeding.

The clinical team at the surgery is made up of two full-time male GPs and two part-time female GPs who are partners, one full-time female practice nurse and one full-time female healthcare assistant. The non-clinical practice team consists of one practice manager, one reception manager and eight administrative and reception staff members. The practice provides a total of 28 GP sessions per week.

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 GPs.

The practice reception and telephone lines are open from 8:00am till 6:30pm Monday to Friday and Saturdays from 9:00am to 11:30am. Appointments are available from 9:30am to 12:30pm and 3:30pm to 6:30pm every day. Extended hours surgeries are offered on Mondays to Fridays from 6:30pm to 7:30pm and on Saturdays from 9:00am to 11:30am.

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 Sutton CCG.

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

Updated 10 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Chesser Surgery on 4th October 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.
• Risks to patients were assessed and well managed with the exception of health and safety risk assessment of the premises ; however the practice held a risk register and monitored risks for both staff and patients.
• 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; however the provider was not sending response letters to all patients who had lodged a complaint.
• 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. However patients reported experiencing long waits when they attended for appointments.
• 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.

There were areas of practice where the provider should make improvements:

• Review practice procedures to ensure all the recommendations from the legionella risk assessment are actioned.
• Ensure that a health and safety risk assessment of the premises is undertaken and that sharps bins are safely stored.
• Review practice procedures to ensure all prescribed medicines are linked to patient problems in patients’ medical notes in the clinical system.
• Review how they inform patients of any late running of the surgeries and work to reduce the length of time patients have to wait to be seen.
• Review how patients with caring responsibilities are identified to ensure information, advice and support is made available to them.
• Review practice procedures to ensure response letters are sent to all patients who had lodged a complaint.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 10 November 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. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
• The national Quality and Outcomes Framework (QOF) data showed that 84% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 78%. The number of patients who had received an annual review for diabetes was 80% which was in line with the CCG average of 81%.
• The national QOF data showed that 80% of patients with asthma in the register had an annual review, compared to the CCG average of 73% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• All patients with a long term condition who become terminally ill were considered for end of life care planning and were discussed at multidisciplinary team meetings.
• The practice provided a phlebotomy service at the practice which suited older patients who may have difficulty in getting to the hospital and the practice told us this service had improved monitoring of patients with long term conditions.

Updated 10 November 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 urgent care and Accident and Emergency (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 80%, which was in line with the Clinical Commissioning Group (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.
• The practice patients had access to antenatal care through weekly midwife led clinics.

Updated 10 November 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.
• Longer appointments were offered for patients aged over 75 to allow more time for patients to communicate difficult issues and to effectively deal with complexities associated with this age group. This allowed clinicians to perform tasks such as dementia screening, arrange investigations, perform medication reviews, make referrals and signpost to appropriate support services.

Updated 10 November 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 extended hours appointments with GPs and nurses which were suitable for working people.

Updated 10 November 2016

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

• The number of patients with dementia who had received annual reviews was 85% which was in line with the Clinical Commissioning Group (CCG) average of 81% and national average of 84%.
• 95% of 55 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 87% and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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. These patients were prioritised and were seen by a GP as soon as possible.
• 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 10 November 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, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; All 31 patients with learning disability had received a health check in the last year; the surgery had a system in place in which patients were called for annual reviews on their birthday.
• 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.