Hilly Fields Medical Centre

Updated 15 May 2017

The practice operates from 172 Adelaide Avenue, Brockley, London, SE4 1JN. The practice is based in a converted premises, based across three floors, all of which are accessible to patients. Patients can access all floors using a lift. The practice is based in the Lewisham Clinical Commissioning Group (CCG) area.

The practice has approximately 12,500 registered patients. The surgery is based in an area with a deprivation score of 6 out of 10 (10 being the least deprived). The practice population’s age demographic is similar to the national average, although there are a higher than average number of patients between the ages of 30 and 54, and fewer patients over the age of 60.

The GP team includes six partners (all male), plus five salaried GPs (one male and four female). In total there are 9.25 whole time equivalent GPs at the practice, although this number is shared with a smaller satellite site which is registered as a separate entity with the CQC. The nursing team includes four female nurses and one male healthcare assistant. The clinical team is supported by a practice manager, a senior receptionist and 6 reception staff, an IT lead, two administrators and two secretarial staff.

The practice is open from 8.00am to 8.00pm Monday to Friday. Further extended hours are available between 9:00am and 12:00pm on Saturdays. The practice offers appointments throughout the day when it is open. The practice also has an on duty doctor who is available whenever the practice is open.

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, surgical procedures and treatment of disease, disorder or injury.

The practice was inspected under CQC’s current methodology on 25 August 2016.

Updated 15 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hilly Fields Medical Centre on 25 August 2016. The overall rating for the practice was good, although the effective domain was rated as requires improvement. The report found the practice must undertake the following:

• The practice must ensure that they set up review procedures for patients with diabetes and mental health.

The report also found that the practice should do the following:

• The practice should consider adding further detail to its business continuity plan.

• The practice should consider reviewing whether or not clinicians are coding entries on the medical database correctly.

• The practice should consider reviewing systems used to identify carers as the number on the register was lower than the national average.

The full comprehensive report of the 25 August 2016 inspection can be found by selecting the ‘all reports’ link for Hilly Fields Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 April 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 on 25 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• Quality and Outcomes framework results were improved in all areas compared to the inspection visit of 25 August 2016. This included results for diabetes and mental health indicators.

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.

• Performance for diabetes related indicators was lower than the national average. The practice had scored 62% for diabetes related indicators in the last QOF, lower than the national average of 89%. The exception reporting rate for diabetes related indicators was 5.3%, lower than the national average of 11%.

• 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.

• The practice had recently started a weekly walking group for the benefit of patients with diabetes.

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 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 83%, which was comparable to the CCG average of 81% and 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 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.

• Patients over the age of 75 had a named GP in place.

• Longer appointments were available for patients with multiple areas of poor health.

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 was open for a higher than average number of hours outside of normal working hours.

Updated 10 November 2016

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

• 88%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.
• Performance for mental health related indicators was lower than the national average. The practice had scored 56% for mental health related indicators in the last QOF, which was lower than the national average of 93%. The exception reporting rate for mental health related indicators was 2.8%, lower than the national average of 12%. Practice staff reported that this was because some of the clinicians were coding these patients incorrectly.

• 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 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, 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.