Archived: South Fulham Heatlh Clinic

Updated 27 June 2016

The Surgery – Dr Das and Partners is a single location GP service which provides primary medical services through a General Medical Services (GMS) contract to approximately 3,300 patients in the Fulham area of West London. The practice shares premises with another GP practice at the Bridge House Centre for Health, just off Wandsworth Bridge Road. The patient population includes a cross-section of socio-economic and ethnic groups. The practice serves a relatively young population group with above average numbers in the 20 to 34 years age range.

The practice team is made up of three GP partners (1.55 whole-time equivalent (WTE) providing 14 GP sessions each week); the practice manager who is also a partner (1 WTE); the business development manager and partner (0.11 WTE); and a locum GP (0.11 WTE); a practice nurse (0.43 WTE); an agency nurse (0.11 WTE); an assistant practice manager, and two reception staff (total 2.36 WTE); and a receptionist/healthcare assistant. There are three male and one female GPs (including the locum), one female practice nurse and one female agency nurse.

The practice is open between 7.00am and 7.00pm Monday to Friday and between 8.00am and 10.00am Saturday. Appointments are available from 9.30am -12.00 noon and 3:30pm - 7:00pm Monday and Tuesday; 10.00am -12.30pm and 4.30pm - 7.00pm Wednesday; 9.30am -12.00 noon and 4.30pm - 7.00pm Thursday; and 10.00am -12.30pm and 4.30pm - 7.00pm Friday. Extended hours appointments were offered every Saturday between 8.00am and 10.00am on Saturdays. In addition to pre-bookable appointments that can be booked up to one month in advance, urgent appointments are also available for people that need them.

The practice has out of hours (OOH) arrangements in place with an external provider and patients are advised that they can also call the 111 service for healthcare advice.

The inspection was carried out to follow up a comprehensive inspection we carried on 9 October 2014 when we found the practice was not meeting the fundamental standards of quality and safety for:

• Staff recruitment
• Maintenance of accurate records on staff including training and appraisal

Updated 27 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery – Dr Das and Partners on 23 March 2016. This was to follow up a comprehensive inspection we carried out on 9 October 2014 where we found the practice was not meeting the essential standards of quality and safety. There were deficiencies with regard to pre-employment recruitment checks and accurate record keeping about staff training and appraisal, and overall we rated the practice as requires improvement. At our recent inspection the practice had made improvements in all of the areas identified previously and overall the practice is now 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, with the exception of those relating to security of prescriptions and the management of emergency medicines.
• 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.
• Patients said they were able to make an appointment with their preferred GP and 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 the majority of 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 areas where the provider should make improvements are:

• Review the arrangements for ensuring the security of prescriptions and complete a documented risk assessment of emergency medicines where it is decided not to stock medicines recommended in national guidance.

• Risk assess the co-location of administrative staff in the same office as staff from another practice occupying the premises with regard to confidentiality of patient information.
• Review the lone worker policy to ensure it reflects current arrangements for staff working alone.
• Ensure all clinical staff are up to date in relation to their duties under the Mental Capacity Act 2005 by arranging further training where appropriate.
• Review systems to improve the identification of carers and provide support.

Professor Steve Field ( CBE FRCP FFPH FRCGP ) 

Chief Inspector of General Practice

Updated 27 June 2016

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

• Nursing staff had a key role in chronic disease management and patients at risk of hospital admission were identified as a priority.
• QOF performance for diabetes related indicators was below the CCG and national average for 2014/15. However, the practice was now undertaking more robust data quality monitoring with a view to improving coding and ensuring QOF registers were fully up to date. In addition, the practice proactively encouraged diabetic patients to manage their own care, for example, by giving training to check blood sugar levels and providing dietary advice and information on healthy eating and referral to a dietician for additional support where appropriate.
• Longer appointments and home visits were available when needed.
• The practice carried out monthly reviews of patients on long term condition registers to identify patients at risk of sudden deterioration in health. All patients in need of a review were sent a text message or written to inviting them to attend the practice.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 27 June 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 not attended for appointments.
• Immunisation rates broadly in line although generally lower than average for standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 60%, compared to the CCG average of 62% and the national average of 82%.
• The practice provided contraception and sexual health services including contraception advice and emergency contraception, smear testing and chlamydia screening.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Children under 10 years old were seen on the same day if urgent. We saw positive examples of joint working with midwives and health visitors. The practice ran ante natal, post-natal and baby clinics, including a joint clinic with health visitors for six-eight week baby checks. There was a fast access service for babies to see a GP.
• The Meningitis C vaccination was offered to all new university students.

Updated 27 June 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.
• Staff worked together and with other health and social care professionals to understand and meet the range and complexity of patients’ needs and to assess and plan ongoing care and treatment.
• Care and treatment was planned with appropriate reviews and care plans to meet the identified needs of patients over the age of 75. All patients in this group had a named GP.
• There were effective risk assessment processes in place to identify patients over age 75 at risk of hospital admission and the practice had put in place risk management plans as part of their care planning.
• The practice referred patients over age 75 with complex needs to a local ‘Virtual Ward’ and a multidisciplinary older people’s rapid access (OPRAC) service for assessment and treatment.
• Routine immunisations including shingles, pneumococcal and flu were promoted and offered to this population group

Updated 27 June 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 reflected the needs for this age group.
• In- house services included phlebotomy; electrocardiograms (ECGs), ambulatory blood pressure monitoring (ABPM); spirometry; and wound care management.
• The practice ran regular women and men’s health clinics and health and exercise advice was given at routine appointments.
• Risk calculations were made for patients aged over 30 with a strong risk of cardiovascular disease and incorporated into care planning.

Updated 27 June 2016

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

• 91% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average.
• Performance for other QOF mental health related indicators was mixed compared to national averages; two indicators were below and two above average.
• 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice participated in a local enhanced service scheme to deliver a shift in care from acute mental health services to community and primary care settings.
• The practice opportunistically screened patients at risk of dementia and referred them to a memory clinic if appropriate.
• There were effective follow up procedures in place for vulnerable patients who did not attend appointments, including patients with mental health problems.

Updated 27 June 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, and those with a learning disability. Annual health checks were provided for patients with learning disabilities.
• 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.

• There were effective follow up procedures in place for vulnerable patients who did not attend 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.