Francis Grove Surgery

Updated 11 February 2016

Francis Grove Surgery provides primary medical services in Wimbledon to approximately 11800 patients and is one of 24 practices in Merton Clinical Commissioning Group (CCG). The practice population is in the least deprived decile in England.

The practice population has a lower than CCG and national 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, 57% are White British and Mixed British and 27% are Pakistani or British Pakistani.

The practice operates from purpose-built premises over two floors. All patient facilities are wheelchair accessible and there is a lift access to the first floor. The practice has access to six doctors’ consultation rooms on the ground floor and four nurses’ consultation rooms and a treatment room on the first floor. The practice team at the surgery is made up of two full time male lead GPs who are partners, two part time female GPs who are partners, two part time female salaried GPs, one part time female locum GP, two full time female practice nurses, one part time female health care assistant and a temporary part time respiratory nurse. The practice team also consists of a practice manager, an assistant practice manager, four 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 final year medical students.

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday. Appointments are available between 8am and 1pm every morning and 3.30pm and 6pm every afternoon. Extended hours surgeries are offered with both GPs and practice nurses from 6.30pm to 7.30pm on Monday and Wednesday and 7.15am and 8am on Tuesday and Thursday.

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 and treatment of disease, disorder or injury. A fourth partner was applying to be added to the partnership at the time of the inspection. The practice were not registered to provide the regulated activities of maternity and midwifery services and family planning services as per the CQC (Registration) Regulations 2009 at the time of the inspection but an application has since been submitted.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Francis Grove Surgery on 19 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.
• 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.
• The practice worked to improve patient outcomes, including with other local providers to share best practice. For example, the practice nurses recruited patients for research studies and actively took part in carrying out research.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. For example, with local dementia services.
• 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.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

We saw several areas of outstanding practice including:

• As well as providing the anticoagulation clinic in-house, the practice nurses undertook home visits to provide this service to their known housebound patients, allowing for continuity of care. The practice had gathered patient satisfaction information for the anticoagulation service annually to ensure it was continuing to meet patients’ needs. We were shown evidence of surveys for the last two years.
• The majority of the practice population were of working-age. The practice had implemented a well-women’s drop in service once weekly for cervical screening, chlamydia screening, family planning advice and immunisations for pregnant women. This had been running for four years. Following feedback gathered from patients using the drop in service, the practice offered more extended hours sessions for those of working-age with the practice nursing team, to improve access to these services. Patients were very positive about this service that was offered by the practice.
• The practice promoted a local dementia hub and had close links with this service. The practice nursing team organised a dementia open day in May 2015 during Alzheimer’s awareness week, specifically for dementia sufferers and carers. The Patient Participation Group (PPG) also assisted with arrangements for a Saturday flu drop in clinic in September 2015, where representatives from the dementia hub and older people’s services were invited to provide information and support to patients and carers.

However there were areas of practice where the provider should make improvements:

• Ensure that all clinical staff are trained to the required level for safeguarding children.

• Ensure that the reasons for changes made to practice systems are clearly communicated to all staff and ensure that non-clinical staff are given enough time in staff meetings to provide suggestions and feedback.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

Updated 11 February 2016

The practice is rated as outstanding 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 had a register of those with two or more long term conditions in addition to the avoiding unplanned admissions register.

• The practice monitored patients against a higher target than the national Quality and Outcomes Framework (QOF) target, to ensure they were reviewing more patients with the potential for uncontrolled diabetes. Some patients with uncontrolled diabetes were reviewed every two months. Data showed that 81% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 73% and the national average of 78%. The number of patients who had received an annual review for diabetes was 95% which was above the CCG average of 89% and national average of 88%.

• Longer appointments and home visits were available when needed, including practice nurses undertaking home visits to patients requiring anticoagulation services who were known patients on the practice’s housebound patient list.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver multidisciplinary care.

Updated 11 February 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. The practice also had a sub-register of children at risk.

• Immunisation rates were mixed for standard childhood immunisations. The practice were in line with Clinical Commissioning Group (CCG) average for the five in one vaccine; however they were the lowest performing in the CCG area for the pre-school booster. The practice had worked to address this by sending pre-booked appointments and robust re-call processes were in place.

• The practice supported pregnant mothers by sending them a pregnancy information leaflet which included details of their pregnancy pathway and information about recommended immunisations and dietary advice.

• 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.

• We saw good examples of joint working with midwives, health visitors and school nurses.

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

Updated 11 February 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 completed health checks for those aged over 75 and had undertaken an audit to ensure those most at risk had their health checks completed as a priority.

• Those most at risk were on the practice’s avoiding unplanned admissions register.

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

• The practice had run a Saturday flu clinic to promote uptake of the flu vaccination for the over 65s and this was promoted via the practice newsletter and on the website.

Updated 11 February 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. For example, the practice offered a Women’s drop in service once weekly for cervical screening, chlamydia screening, pregnancy immunisations and family planning services. The practice had gathered patient feedback about this service to ensure it was meeting their needs. Cervical screening rates were 83% for 2014/15 which was in line with local and national averages.

• The practice nurses took part in the 'Pace Up' research trial to improve the physical activity of those aged 45-74 and patients responded positively about being involved in this.

• The practice offered extended hours services two evenings and two mornings per week with GPs and also with practice nurses to provide access to those who were unable to attend the drop in clinic.

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

Updated 11 February 2016

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

• 96% of practice patients with severe mental health needs had received an annual review and care plan in the last 12 months which was above Clinical Commissioning Group (CCG) and national averages.

• 76% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which was lower than Clinical Commissioning Group (CCG) and national averages.

• The practice nurses carried out advance care planning for patients with dementia and had started to include those with dementia on the national Co-ordinate My Care (CMC) register so that advanced decisions would be able to be seen by other health services.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support people with mental health needs and dementia. The practice had close links with a local dementia hub and had invited support workers from the hub to speak with patients during the Saturday flu clinic and a dementia open day at the practice in May 2015.

Updated 11 February 2016

The practice is rated as good for the care of people who 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.

• It offered longer appointments for people with a learning disability and had completed 88% of annual reviews for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told 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.