Grove Medical Centre

Updated 5 January 2017

The practice operates from one site in Deptford, South East London. It is one of 41 GP practices in the Lewisham Clinical Commissioning Group (CCG) area. There are approximately 8,700 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning services, maternity and midwifery services, and treatment of disease, disorder or injury.

The practice has a personal medical services contract with the NHS 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). These enhanced services include childhood vaccination and immunisation, dementia, extended hours access, improving online access for patients, influenza and pneumococcal immunisation, learning disabilities, risk profiling and case management, rotavirus and shingles immunisation, and unplanned admissions.

The practice has an above average population of male and female patients aged from birth to nine years and from 20 to 44 years. Income deprivation levels affecting children and adults registered at the practice are above the national average. The practice identified through their own analysis that they had a high patient turnover rate of 33% per year due to a highly transient local population.

The clinical team includes a female GP partner and a male GP partner, three female salaried GPs (one of whom is on maternity leave), four female long term locum GPs and a male long term locum GP. The GPs provide a combined total of 28 to 30 fixed clinical sessions per week. There are three female long term locum practice nurses. The clinical team is supported by a practice manager, a finance manager, and six reception/administrative staff. The practice was accredited as a training practice for doctors in their final year of training.

The practice is open from 8.00am to 6.30pm Monday to Friday. It is closed on bank holidays and weekends. Appointments with GPs are available from 9.00am to 12.20pm and from 2.30pm to 6.20pm Monday to Friday. Appointments with nurses are available from 9.00 am to 1.00 pm and from 2.00pm to 6.00pm. Extended hours are available from 6.30pm to 7.30pm every Tuesday and Wednesday.

The premises operates over two floors of a purpose built building. There are 10 consulting rooms, two treatment rooms, and five clinical rooms which are used by external health professionals such as health visitors, midwives, a dietician, physiotherapists and smoking cessation advisers. There is a waiting area, a reception area, and three toilets on the ground floor, and a training centre which is used for training and meetings. There are administrative rooms and staff toilets on the first floor. There is wheelchair access throughout the ground floor, disabled parking and baby changing facilities available.

The practice directs patients needing urgent care out of normal hours to contact the local contracted out of hours service South East London Doctors On Call.

Updated 5 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grove Medical Centre on 29 July 2016. Overall the practice is rated as good.

• There was an open and transparent approach to safety and an effective system in place for reporting, recording and investigating significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance; however the practice was an outlier for exception reporting for several indicators in relation to the Quality and Outcomes Framework (QOF).
• Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and a strong focus on continuous improvement at all levels. There were high levels of staff satisfaction and staff felt supported by the practice’s leaders. 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 some areas of outstanding practice:

• The practice engaged with the local community through being a member of South London Citizens (SLC), an organisation that organises communities to act together for social justice and the common good. Their work with SLC included successfully approaching Lewisham council with to repair faulty street lighting in order to improve security in the local area, and being accredited as a ‘City Safe Haven’ where they could keep people who were fleeing threatening situations safe until the police or other appropriate support arrived. In addition, staff had received in-house training to enable them to identify female patients who may be at risk of undergoing female genital mutilation, and to understand the legal implications of this practice and their responsibilities in reporting such cases to the appropriate bodies. The lead GP visited multi-faith communities in the locality to raise awareness of the legal, moral and psychological implications of this practice.

There is one area in which the practice should make improvements:

• Whilst acknowledging the practice’s high patient turnover rate, the practice should put into plan actions to address the high levels of exception reporting.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 5 January 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.

• Nationally reported data for showed that outcomes for patients with diabetes were above national averages. For example in the previous 12 months, 86% of patients with diabetes had well-controlled blood sugar (national average 78%). However, exception reporting was higher than expected.

• Nationally reported data showed that outcomes for conditions commonly found in older people were in line with national averages. For example in the previous 12 months, 81% of patients with hypertension had well-controlled blood pressure (national average 83%). However, exception reporting was higher than expected.

• 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, 85% of patients with asthma had an asthma review. This was above the national average of 75%).

• In the previous 12 months, 91% of patients with chronic obstructive pulmonary disease had a review of their condition. This was in line with the national average of 90%; however, exception reporting was higher than expected.

• 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 5 January 2017

The practice is rated as good for the care of families, children and young people.

• Staff had received training to enable them to recognise signs of radicalisation in young people and adults.

• 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 attendances to Accident & Emergency.

• Immunisation rates for vaccines administered to young children were relatively high in comparison with local averages.

• 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.

• In the previous 12 months, 86% of women aged between 25 to 64 years had a cervical screening test. This was in line with the national average of 82%.

• 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 5 January 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. All patients aged over 75 years had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. They provided care to patients in two local care homes where they had scheduled a joint visit with a consultant geriatrician to address any complex care needs.

• The practice had a red light reminder system beside the staff exit which ensured that all scheduled home visits were completed for each day.

Updated 5 January 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 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.

• Extended hours opening was available until 7.30pm every Tuesday and Wednesday for working people who were unable to attend during normal opening hours.

Updated 5 January 2017

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

• The practice provided training to raise awareness of mental health issues in the local community and in Africa.

• In the previous 12 months, 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting, which was above the national average of 84%. However, exception reporting was higher than expected.

• In the previous 12 months, 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan in their record. This was in line with the national average of 89%. However, exception reporting was higher than expected.

• 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 5 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice participated in activities that raised awareness of the legal and psychological implications of Female Genital Mutilation in the local community.

• The practice had been accredited as a ‘City Safe Haven’ where they could keep people who were fleeing threatening situations safe until the police or other appropriate support arrived. They gave us examples of where this service had been successfully used by two patients.

• 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, and 69% of 29 patients with a learning disability had received a review of their care in the previous 12 months.

• 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.

• Staff had received training to improve their awareness of the risks of radicalisation and their responsibilities in relation to it.