Old Coulsdon Medical Practice

Updated 4 July 2016

The Old Coulsdon Medical Practice provides primary medical services in Coulsdon to approximately 13200 patients and is one of 59 practices in Croydon Clinical Commissioning Group (CCG). The practice population is in the third 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 and working age people is similar to the CCG and national averages and the population of older people was higher than the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded, 76% are British/Mixed British, 6% are Other White and 3% are Indian/British Indian.

The practice operates in purpose built premises. All patient facilities are wheelchair accessible with lift access to the first floor. The practice has access to five doctors’ consultation rooms and three nurse consultation rooms on the ground floor and five doctors’ consultation rooms and a health checks room on the first floor.

The clinical team at the surgery is made up of three full-time male GPs and two part-time female GPs who are partners, two female salaried GPs, three GP registrars, six part-time female practice nurses and two part-time healthcare assistants. The non-clinical practice team consists of practice manager, assistant practice manager, reception manager, five administrative staff and seven reception staff members. The practice provides a total of 49 GP sessions per week; twenty additional sessions are provided by the GP registrars.

The practice is a training practice for trainee GPs and provides teaching to medical students and nurses.

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 reception and telephone lines are open from 8:00am till 6:30pm Monday to Friday. Appointments are available from 8:00am to 11:00am and 2:00pm to 6:00pm every day. Extended hours surgeries are offered on Mondays to Fridays from 7:00am to 7:50am.

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 Croydon 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, family planning services, treatment of disease, disorder or injury and surgical procedures.

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Coulsdon Medical Practice on 26 May 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.
• 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.
• 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.
• 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.

We saw two areas of outstanding practice:

• The practice Patient Participation Group (PPG) regularly invited specialist speakers and provided educational events for patients on topics including dementia, cardiology, prostate cancer, breast cancer, arthritis and gastric reflux; about 30 to 80 patients attended these talks; these talks were followed by a question and answer session. Following these events the PPG obtained feedback from these patients and found that these educational events were very useful for patients as they provided exercise and lifestyle advice.
• The practice hosted a dementia carers support group through their Patient Participation Group (PPG) and had a held carers week. The practice also ran monthly carer support group afternoons. The PPG invited guest speakers during these support group meetings and provided talks and live demonstrations on topics such as manual handling, incontinence pads, eating and dressing.

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

• Ensure that the business continuity plan is up-to date.
• Ensure that all staff have annual basic life support training.
• Review the complaints procedure to ensure it contains all the relevant information for patients.
• Consider documenting discussions from staff meetings.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 4 July 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 national Quality and Outcomes Framework (QOF) data showed that 77% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 72% and the national average of 78%. The number of patients who had received an annual review for diabetes was 94% which was above the CCG average of 86% and national average of 88%.
• The national Quality and Outcomes Framework (QOF) data showed that 78% of patients with asthma in the register had an annual review, compared to the CCG average of 75% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• The practice provided a phlebotomy service, electrocardiography, spirometry and ambulatory blood pressure monitoring to improve monitoring of patients with long term conditions.
• 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice also had personalised care plans for these patients.
• The practice GPs had personal patient lists which facilitated continuity of care of these patients. The practice used a risk stratification tool that analysed medicine interactions and blood result anomalies on a weekly basis.
• The practice Patient Participation Group (PPG) regularly invited specialist speakers and provided educational events for patients on topics including dementia, cardiology, prostate cancer, breast cancer, arthritis and gastric reflux; about 30 to 80 patients attended these talks; these talks were followed by a question and answer session. Following these events the PPG obtained feedback from these patients and found that these educational events were very useful for patients as they provided exercise and lifestyle advice.

Updated 4 July 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 89%, which was above the Clinical Commissioning Group (CCG) average of 82% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice nurses ran daily minor illness clinics to manage patients with simple issues; the lead practice nurse was a nurse prescriber.

Updated 4 July 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.
• The practice checked their list of house-bound patients every six months to ascertain if these patients had their problems and medicines reviewed.
• The practice ran an open surgery every day from 8am to 11:30am to enable patients to be seen on the same day; this enabled improved access for older people.
• The practice GPs provided care for a local warden assisted property and a local care home for highly dependent neurologically impaired patients supporting the needs of the residents.

Updated 4 July 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 early morning appointments and telephone consultations to enable access to working age people.

Updated 4 July 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 86% which was above the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.
• 92% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 85% 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 GPs provided care for a local home for patients with mental health issues.
• The practice carried out advance care planning for patients with dementia. The practice hosted a support group for patients with dementia and their carers.
• 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. The practice had also trained many non-clinical staff in care for the patients with dementia.
• The practice used books and online resources to educate patients with mental health problems.
• The practice also used local re-enablement services to reduce social isolation and to ensure that the patients remain stimulated.
• To enable improved access to cognitive and behavioural therapy the practice had arranged a training session for clinical staff from the local NHS psychological therapies service.  This particularly helped patients with anxiety who were reluctant to travel to access this service.

Updated 4 July 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 and extended annual reviews for patients with a learning disability; 76% (37 patients) of patients with learning disability had received a health check in the last year.
• 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. The practice hosted a dementia carers support group through their Patient Participation Group (PPG) and had a held carers week. The practice also ran monthly carer support group afternoons.
• The practice had a system in place to ensure appointments were monitored for patients who were unable to chase up appointments.
• 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.