Park Road Group Practice

Updated 12 August 2016

Park Road and Old Dean Surgeries offers personal medical services to the population of Camberley, Surrey and the surrounding area. There are approximately 14,000 registered patients. Park Road and Old Dean Surgeries has two sites. The main site is Park Road Surgery and there is a branch surgery, Old Dean Surgery. We did not visit Old Dean Surgery as part of this comprehensive inspection.

Park Road Surgery is a large purpose built building which has a first floor. The ground floor has full disabled entrance access with a large seated reception area. The GP consulting rooms and treatment rooms are all located on the ground floor. The first floor has access by stairs or lift, where staff offices and facilities are located. There is a toilet for people with disabilities on the ground floor, which has baby changing facilities.

Park Road and Old Dean is a training practice for GP trainees and FY2 doctors. (FY2 doctors are newly qualified doctors who are placed with a practice for four months and will have their own surgery where they see patients). The practice is also involved in research and is a Royal College of General Practitioners (RCGP) Research Ready accredited practice.

Park Road and Old Dean Surgeries are run by five partner GPs (four male and one female). The practice is also supported by five salaried GPs (three male and two female), one GP retainer (female), six practice nurses and two healthcare assistants and a phlebotomist. The practice also has a team of receptionists and administrative staff, a care co-ordinator and a practice manager. (A GP retainer is a GP who works up to four sessions a week in general practice).

The practice runs a number of services for its patients including asthma reviews,child immunisation, diabetes reviews, new patient checks and holiday vaccines and advice.

Services are provided from two locations:-

Main Surgery

Park Road Surgery, The Surgery, 143 Park Road, Camberley, Surrey, GU15 2NN

Opening Hours are:-

Monday to Friday 8am to 8pm

Saturday morning by appointment only Park Road

Branch Surgery

Old Dean Surgery, Berkshire Road Clinic, Camberley, Surrey, GU15 4DP

Opening Hours are:-

Monday to Friday 8am to 6pm with the exception of Wednesday afternoon when the practice is closed after 1pm. However, from 6pm - 8pm and after 1pm to 8pm Wednesdays, patients are seen at the Park Road Surgery instead.

During the times when the both practices are closed, the practice has arrangements for patients to access care from an Out of Hours provider.

The practice population has a higher number of patients aged between 40 to 49 and 60 to 80 years of age than the national and local clinical commissioning group (CCG) average. The practice population shows a lower number of patients aged from birth to 9 and 15 to 39 years of age than the national and local clinical commissioning group (CCG) average. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for England. Less than 10% of patients do not have English as their first language.

Updated 12 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Road and Old Dean Surgeries on 23 June 2016. Overall the practice is rated as Outstanding.

Our key findings across all the areas we inspected were as follows:

• Outcomes for patients who use services were consistently very good. Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed very well in obtaining 97% of the total points available to them for providing recommended care and treatment to patients.
• 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 found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice engaged effectively with local community groups and charities to improve community services and patient access, working with local groups around long term conditions and community wider issues.
• Risks to patients were assessed and well managed.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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 areas of outstanding practice:

• There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that meets those needs and promoted equality. This included patients who were in vulnerable circumstances or who had complex needs.
• There was a strong ethos within the practice for community development and engagement. The practice had arranged local talks for their patients and those living in the vicinity. For example, the practice had held sessions on understanding dementia and ‘how to look after your heart’ both events had been well attended with over 100 people attending. The practice had also held an afternoon tea party for patients that may be considered vulnerable or isolated and was planning to build on the success of this event by staging more. They also supported the local Alzheimer’s café and the local ‘safehaven’ and had given talks about access to services.
• The practice had informative care plans for vulnerable patients which were accessible to other agencies, including out of hours and ambulances services. These provided up to date and necessary information to ensure that patients choice of care was taken into account and informed these services of the route of care a patient required and had requested. This had reduced the number of patients attending hospital.
• Emergency appointments for children under five were seen within three hours of calling the practice and the practice had dedicated appointment slots available. This had reduced the number of young patients attending A&E.
• The GPs meet on a daily bases to discuss referrals for patients. This ensured shared learning for the appropriate ongoing support for patients. The practice recorded and reviewed referrals discussed at these meetings. The practice could evidence a positive decrease in unnecessary referrals showing that patients care was managed by effective different methods instead.

• The practice had translated key information and health procedures for those patients who did not have English as a first language. One of the nurses was able to use Makaton for patients with learning disabilities who used this communication method. (Makaton uses signs, symbols and speech to help people communicate) Pictorial information of procedures were also available to help patients with communication difficulties.
• Language specific information had also been sent to invite patients to attend the practice for immunisations. The practice had seen a rise in their immunisations figures from 75% to over 90% since starting this process.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. The practice had introduced the role of a patient care co-ordinator to support the practice’s vulnerable patients. This included patients over 75 years, patients considered vulnerable, patients within nursing homes, and those on the avoiding unplanned admissions register. The role involved liaising with the integrated community team and other service providers to ensure care packages were in place for these patients and also for patients post discharge from hospital. It also provided a single point of contact within the practice for patients, their relatives and other service providers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 August 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 had a wide range of expertise. For example, diabetes, respiratory and two nurses were trained in Macmillan cancer care.
• 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.
• 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. Patients were invited for an annual review of their condition by letter or text.
• The practice had reviewed patient access and appointments with specialist practice nurses were available throughout the day from 7.30am to 8pm.
• Patients were supported to help self manage their long term condition by using agreed plans of care and were encouraged to attend self-help groups.
• Information packs were given out to patients who had been newly diagnosed with diabetes, including translated copies for other languages to help patients understand their condition.
• Performance for diabetes related indicators was comparable with the local clinical commissioning group (CCG) and national averages. For example, 80% of patients with diabetes, whose last measured total cholesterol was in a range of a healthy adult (within the last 12 months), was the same as the national average of 80% and the clinical commissioning group (CCG) average of 81%.
• 91% of patients with chronic obstructive pulmonary disease (COPD) had a review undertaken including an assessment of breathlessness, which was slightly above the national average 90%

Updated 12 August 2016

The practice is rated as outstanding 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.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff.
• The practice was able to arrange support for younger patients by referrals to a youth counsellor who was based at the practice.
• 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.
• 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.
• Appointments for children under five were seen within three hours of calling the practice. This had reduced the number of young patients attending A&E.
• The number of women aged between 25 and 64 who attended cervical screening in 2014/2015 was 81% which was comparable to the clinical commissioning group (CCG) and national average of 82%
• The practice promoted cancer screening by opportunistic health promotion.
• The practice had a variety of self help leaflets and information. This included information targeted to parents of young children and a young person’s guide – a leaflet providing information about how to access services at the practice and the local area.
• The practice offered family planning and routine contraception services including implant/coil insertion.

Updated 12 August 2016

The practice is rated as outstanding for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Older patients with complex care needs and those at risk of hospital admission all had personalised care plans that were shared with local organisations to facilitate the continuity of care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice employed a full time dedicated care coordinator who oversees the care of patients aged over 75. The care co-ordinator worked closely with the Integrated Care Team, and was a vital link between the patient, the family and the multi-disciplinary team (MDT).
• The practice looked after patients at several care and residential homes. Designated GPs visited daily and were in consultation to agree weekly ward rounds. All these patients had a full comprehensive care plan upon admission which highlighted any additional concerns or equipment that may be needed. We also saw these were regularly reviewed and annually updated.
• The practice ensured that appointments were available throughout the day to accommodate those patients who relied on alternative transportation.
• The practice had organised a dementia workshop which had raised awareness of support available.
• The practice had hosted a Sunday afternoon tea get together for its vulnerable and older patients at risk of isolation and plans were in place for this to be hosted again.
• The practice ran in house clinics for enhanced services so that patients did not need to attend hospital appointments. For example, leg ulcer dressings, warfarin (INR) monitoring and audiology.

Updated 12 August 2016

The practice is rated as outstanding 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 from 8am to 8pm every weekday. Early morning appointments from 7.30am were able two days a week on Tuesdays and Thursdays. Every other Saturday morning appointments were available.
• The practice offered advice by telephone each day for those patients who had difficulty in attending the practice and there were daily evening emergency appointments available.
• Patients were able to access their repeat prescription online and were able to have this collected by a pharmacy of their choice, which could be closer to their place of work if required.
• The practice offered NHS health-checks and advice for diet and weight reduction.
• The practice offered in-house enhanced service for patients which reduced the need to be seen at a hospital. For example, 24 hour blood pressure and minor operations.
• Appointments for family planning and routine contraception services were available throughout the day.

Updated 12 August 2016

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

• 93% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented, in the last 12 months which was higher than the 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 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 including patients suffering from dementia and held specific instruction of patient’s needs. For example, who to contact in a crisis.
• The practice ensured that ambulance and out of hours, services had up to date information in relation to patient care. For example, South East Coast Ambulance Service (SECAM) were given information on those patients that could be supported by the practice if experiencing poor mental health rather than taking the patient to A&E.
• The practice tried to ensure that those patients who failed to attend appointments or turned up late due to poor mental health were seen opportunistically.
• Patients experiencing poor mental health were given routine weekly appointments with the same GP to help provide continuity of care.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practiced worked closely with local services including the Alzheimer’s café.
• The practice carried out advance care planning for patients with dementia.
• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84% and the clinical commissioning group (CCG) average of 87%.
• The practice’s managers were trained as “Dementia Friendly” staff and the practice aimed to become a dementia friendly organisation by 2017.
• The practice ran a patient event in the summer of 2015 on understanding dementia with over 100 patients attending.

Updated 12 August 2016

The practice is rated as outstanding 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 engaged with homeless people who were based locally. They could register at the practice and were signposted to the relevant services available.
• 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.
• The practice had translated key information and health procedures (such as blood pressure tests) for those patients who did not have English as a first language.
• Information packs were given out to patients who had been newly diagnosed with diabetes including translated copies for other languages to help understand their condition.
• Patients with learning disabilities were supported through individual health checks along with literature available in Makaton explaining some procedures. For example, blood tests and what to do in an emergency.