London Lane Clinic

Updated 11 January 2017

London Lane Clinic is based in a large two storey, purpose-built property built in 1994 in the London Borough of Bromley. It is located within a predominantly residential area of Bromley with a large shopping centre nearby. Bromley Clinical Commissioning Group (CCG) are responsible for commissioning health services for the locality.

The property includes nine consulting rooms and one treatment room on the ground floor with a further two treatment rooms on the first floor. The first floor also includes two large meeting/teaching rooms, five administration rooms, a counsellor’s room and several rooms used by the local health visiting team. There is also a large reception area on the ground floor and several waiting areas throughout the building.

Services are delivered under a Personal Medical Services (PMS) contract. (PMS contracts are local agreements between NHS England and a GP practice. They offer local flexibility, compared to the nationally negotiated General Medical Services (GMS) contracts, by offering variation in the range of services which may be provided by the practice; the financial arrangements for those services and the provider structure, ie who can hold a contract).

The practice is registered with the CQC as a Partnership, providing the regulated activities of family planning; maternity and midwifery services; treatment of disease, disorder and injury and diagnostic and screening procedures.

The practice has 15194 registered patients. The practice age distribution is similar to the national average. The surgery is based in an area with a deprivation score of 8 out of 10 (with 1 being the most deprived and 10 being the least deprived).

London Lane Clinic is a training practice offering placements to GP Registrars (GP Registrars are qualified doctors undergoing specialist GP training). The practice usually provides a placement for one GP Registrar each year.

GP services are provided by the five GP partners (male and female) providing 40 sessions per week; three part-time salaried GPs providing 14 sessions per week; one Registrar providing 7 sessions per week and a sexual health doctor providing 1 session per week. In addition to this the GPs cover the Saturday surgery (1 session per week).

Clinical services are also provided by two part-time Practice Nurses (1.8 wte) and three part-time Health Care Assistants (1.3 wte).

The reception is open from 8am to 8.20pm on Monday and Wednesday; from 8am to 6.30pm on Tuesday, Thursday and Friday and from 8.15am to midday on Saturday. The surgery is closed on Sunday. Telephone lines are open from 8am to 6.30pm Monday to Friday.

Pre-booked appointments are available with a GP from 8.10am to 9.30am and 1.30pm to 8.15pm on Monday; from 8.10am to 9.30am and 2pm to 6pm on Tuesday; from 8.10am to 9.30am and 2pm to 8.15pm on Wednesday; from 8.10am to 9.30am and 1.30pm to 6pm on Thursday; from 8.10am to 9.30am and 3pm to 6pm on Friday and from 8.15am to 11.45am on Saturday.

Urgent consultations with a GP are available through the daily open access surgery between 8.10am and 10.30am Monday to Friday.

Extended hours GP appointments are also provided by the local GP Alliance Hub service. These appointments are available between 6.30pm and 8pm Monday to Friday and from 9am to 1pm Saturday and Sunday. Appointments must be booked through the surgery. The service is staffed by GPs from the practices who are members of the alliance and full access to GP electronic records is available for all consultations.

Pre-booked appointments are available with the Practice Nurse from 8.30am to 12.30pm and 2pm to 6pm Monday to Friday.

Pre-booked appointments are available with the Health Care Assistant from 9am to 1pm on Monday; from 8.30am to 12.30pm and 2pm to 5.45pm on Tuesday, Wednesday and Thursday and from 8.30am to 11am on Friday.

When the surgery is closed urgent GP services are available via NHS 111.

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at London Lane Clinic on 2 November 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 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 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.
• Urgent consultations were available the same day for patients who needed them. However patients said they found it difficult to book a routine appointment less than two weeks in advance.
• 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.
• The practice had identified only 37 patients as carers (0.2% of the practice list). However, in an attempt to increase the identification and support for carers the Health Care Assistant had been nominated a Carer’s Champion for the surgery and had undergone a carers support induction programme provided by the local carers support service.

There was one area where the provider should make improvements:

• The provider should continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to all carers registered with the practice.

Professor Steve Field  CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 11 January 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff worked closely with GPs and community specialist nurses in the management of patients with long-term conditions.
• Patients at risk of hospital admission were identified as a priority.
• The practice performance rate for the Quality and Outcomes Framework (QOF) diabetes related indicators was comparable to the local and national average.
• Longer appointments and home visits were available when needed.
• 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. These patients were discussed at the multi-disciplinary team meetings held every two months.

Updated 11 January 2017

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 who were at risk, for example, children and young people who had a high number of 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 we saw evidence to confirm this.
• The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages.
• 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, who held an antenatal clinic at the surgery every week. Health visitors were based in the clinic and attended safeguarding meetings at the practice as required.

Updated 11 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.
• Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to local and national averages.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• The practice had Visiting Medical Officer (VMO) agreements with several local nursing and residential care homes. Partners held lead responsibility for one location each.

Updated 11 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.
• Extended hours evening and Saturday appointments were available at the surgery for patients who could not attend during normal working hours.
• The practice was proactive in offering online services. The practice Patient & Data Support Worker held promotional sessions in reception to encourage uptake of the service. 
• A full range of health promotion and screening services were provided that reflects the needs for this age group.

Updated 11 January 2017

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

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local average of 83% and national average of 84%.
• 97% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was higher than the local average of 84% and 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 told patients experiencing poor mental health how to access various support groups and voluntary organisations.
• A counsellor provided a weekly clinic at the surgery.
• The practice had a system in place to follow up patients who had attended A&E 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 11 January 2017

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 and those with a learning disability.
• The practice offered longer appointments and annual reviews 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 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.