Archived: Eltham Medical Practice Also known as The Court Yard Surgery

Updated 26 July 2016

The practice operates from two sites in Eltham, London; its main site in Eltham Community Hospital Passey Place and its branch site in Well Hall Road. It is one of 42 GP practices in the Greenwich Clinical Commissioning Group (CCG) area. There are approximately 13,700 patients registered at the practice. 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 has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include extended hours access, dementia, influenza and pneumococcal immunisations, learning disabilities, minor surgery, online access, patient participation, risk profiling and case management, rotavirus and shingles immunisation, services for violent patients, and unplanned admissions.

The practice has an above average population of male and female patients aged from birth to nine years, males aged 35 to 39 years, and females aged from 25 to 54 and 65 to 69 years. Income deprivation levels affecting children and adults registered at the practice are above the national average.

The clinical team includes two male partners, a male salaried GP, a female salaried GP and a female locum GP. The GPs provide a combined total of 35 fixed sessions per week. There are three female salaried practice nurses and two female nurse practitioners. The clinical team is supported by a practice manager, a business manager and information technology lead, and 20 administrative/reception staff.

The practice is open from 8.00am to 6.30pm Monday to Friday, and is closed on bank holidays and weekends. The Well Hall Road branch site is closed from 12.00pm to 1.00pm on Mondays, Tuesdays, Thursdays and Fridays. Appointments with GPs and nurses are available at various times between 8.00am and 6.30pm Monday to Friday. Extended hours are available from 7.00am to 8.00am on Thursdays and from 6.30pm to 8.15pm on Tuesdays and Thursdays.

The premises at the main and branch sites operate over two floors of purpose built buildings. At the main site, which is shared with another GP practice, there are five consulting rooms, a treatment room, shared reception and waiting areas, two wheelchair-accessible toilets, a breastfeeding room, baby changing room and two meeting rooms on the ground floor. There is a shared administrative room on the first floor. There is disabled parking available.

At the branch site there are three consulting rooms, a treatment room, a wheelchair-accessible patient toilet, baby changing facilities, a reception and waiting area on the ground floor, with three staff offices on the first floor. There is car parking and disabled parking available.

The practice does not provide out-of-hours (OOH) services. It directs patients needing urgent care out of normal hours to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on the urgency of their medical concerns.

Updated 26 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eltham Medical Practice on 19 May 2016. Overall the practice is rated as requires improvement.

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

• Significant events had been investigated thoroughly and learning from these was shared among clinical staff, but some staff did not have a clear understanding of significant events or the process for reporting them. Some incidents had not been recorded.

• Risks to patients were not always well assessed or well managed. This was in relation to ineffective medicines management systems, the absence of electrical safety checks, mandatory training and some recruitment checks. There was no documentation of fire drills.

• Data showed patient outcomes were in line with the national average.

• There was evidence that audits were driving improvements to patient outcomes.

• The national GP patient survey published in January 2016 showed the practice was rated in line with local and national averages for several aspects of consultations with GPs and nurses.

• The majority of patients we spoke with said they were treated with compassion, dignity and respect. However, several of them had found it difficult to get appointments.

• Information about services and avenues of support was not always available for patients to access. Complaints had not been managed in line with recognised guidance and contractual obligations.

• There was a governance structure in place and all staff felt supported by the practice’s leaders, but not all of the practice’s processes had been managed effectively.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff, ensure all clinical staff have indemnity insurance in place and maintain records of their professional registration.

• Ensure all mandatory training is completed and documented.

• Ensure the system for managing medicines is effective and that stock is properly controlled.
• Ensure electrical equipment is checked regularly to ensure it is safe to use.

• Ensure its complaints procedures are in line with current legislation, guidance and contractual obligations.

In addition the provider should:

• Ensure all staff have a good understanding of significant events, and implement a significant event protocol.

• Consider providing training for clinical staff on the Mental Capacity Act.

• Ensure outstanding appraisals are completed, and inductions are documented for all new staff.
• Ensure fire drills are documented.
• Continuously monitor feedback from patients to identify and act upon any further areas for improvement, particularly in relation to access to appointments.
• Consider advertising the private room available to patients who wish to have confidential discussions.

• Improve the process for identifying and providing support for carers and arrange interpreters for patients who are unable to speak English.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 July 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for being safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Nationally reported data showed that outcomes for patients with diabetes were average. For example, 78% of patients with diabetes had well-controlled blood sugar levels. This was in line with the national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and the majority had received a structured annual review to check their health and medicines needs were being met.

• 72% of patients with asthma had an asthma review in the previous 12 months. This was in line with the national average of 75%.

• 92% of patients with chronic obstructive pulmonary disease had received a review, including an assessment of breathlessness, in the previous 12 months. This was in line with the national average of 90%.

• 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.

Updated 26 July 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for being safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice provided services such as end of life care, medicine management and daily medical cover for patients in a children's hospice. They also liaised with teams from two children's hospitals in London to provide a holistic package of care to children and their families during their hospital stay.

• 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 Accident and Emergency (A&E) attendances.

• Patients told us that children and young people were treated in an age-appropriate way.

• 81% of women aged between 25 and 64 years had a cervical screening test in the previous 12 months. This was in line with 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 and health visitors.

Updated 26 July 2016

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for being safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were average. For example, 84% of patients with hypertension had well controlled blood pressure in the previous 12 months. This was in line with the national average of 84%.

Updated 26 July 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for being safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 opening was available on one morning and two evenings a week.

• The practice was proactive in offering online services such as appointment booking cancellation, and repeat prescription requests.

• The practice offered a range of health promotion and screening that reflects the needs for this age group.

Updated 26 July 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for being safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Nationally reported data showed that outcomes for patients with dementia were average. For example, 78% of patients with dementia had a face-to-face review of their care in the previous 12 months. This was comparable to the national average of 84%. The practice had conducted its own analysis which showed an improvement to 81% in 2015/2016 but this data had not been published or independently verified at the time of our inspection.

• Nationally reported data showed that outcomes for patients who had poor mental health were average. For example, 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their record. This was comparable to 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 carried out advance care planning for patients with dementia, and 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 26 July 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for being safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 for patients with a learning disability and regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had a proactive long term conditions care coordinator who had designed modified care review invitations to encourage patients with learning disabilities to attend their appointments.

• 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. However, there was no evidence to demonstrate that all staff had received mandatory safeguarding training.