Roselawn Surgery

Updated 30 January 2017

Roselawn Surgery provides primary medical services in New Malden to 5,946 patients and is one of 23 practices in Kingston Clinical Commissioning Group (CCG).

The practice population is in the third least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 14%, which is higher than the CCG average of 12%; and for older people the practice value is 15%, which is higher than the CCG average of 13%. The practice has a lower proportion of patients aged 55+ than the national average, and a higher proportion of male patients aged between 35 and 54. Of patients registered with the practice, the largest group by ethnicity are white (64%), followed by Asian (26%), mixed (4%), black (3%) and other non-white ethnic groups (3%).

The practice operates from a 2-storey converted residential premises. A small amount of car parking is available at the practice, and there is space to park in the surrounding streets. The reception desk, waiting area, and four consultation rooms are situated on the ground floor. The practice manager’s office, two consultation rooms, the health visitor’s room, and a storage room are situated on the first floor. A lift is available.

The practice team at the surgery is made up of one part time female GP and two part time male GPs who are partners, in addition, one part time female salaried GP is employed by the practice. The practice also employs one part time female nurse, one part time nurse practitioner, and one part time healthcare assistant. In total 18 GP sessions and five nurse practitioner sessions are available per week. The clinical team are supported by a practice manager, reception manager, four reception/administrative staff, and a secretary.

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 is open between 8:30am and 7:30pm on Mondays and until 7pm on every other week day apart from Thursdays when the practice is closed from 1pm. Appointments are from 9am to 12pm every morning, and 4pm to 6:30pm every afternoon apart from Thursdays when the practice is not open for routine appointments (during this time GPs can be contacted by telephone to respond to emergencies). Extended hours surgeries are offered between 6:30pm and 7:30pm on Mondays and between 6:30pm and 7pm on Tuesdays.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roselawn Surgery on 8 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 in place for reporting and recording significant events.
• Overall, risks to patients were assessed and well managed; however, further consideration of the role of the nurse practitioner was needed in order to ensure that risks are identified and mitigated.

• 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; however, further consideration of the role of the nurse practitioner was needed in order to ensure that arrangements are in place to monitor and support this extended role.
• 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; however, patients had to request complaints leaflets from reception staff. Improvements were made to the quality of care as a result of complaints and concerns.
• Overall, 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. The practice had considered feedback they had received about appointments running late, and had made changes to their appointment system in order to address this.
• 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 practice had effective governance arrangements in place; however, in some cases records, such as meeting minutes and records of audits, lacked detail.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• They should risk assess the role of the nurse practitioner, including a consideration of the scope of her knowledge and competence, and ensure that arrangments are in place to mitigate the risks identified.
• They should review the risks associated with allowing staff to begin work at the practice without full background checks having been completed, to ensure that these are adequately mitigated.
• Ensure that complaints leaflets are available to patients without them needing to request them.
• Ensure that more detailed records are kept of management activity, such as meeting minutes and records of audits.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 30 January 2017

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.
• Overall, performance for diabetes related indicators were comparable to the CCG and national averages. The practice achieved 96% of the total QOF points available for diabetes indicators, compared with an average of 96% locally and 90% nationally
• 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. 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 30 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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of 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.
• Data available at the time of the inspection showed that cervical screening had been carried-out for 88% of women registered at the practice aged 25-64, which was comparable to the CCG average of 83% and national average of 82%. However, their exception reporting rate for cervical screening was higher than average at 12% compared to 9% locally and 6% nationally; they explained that this reflected the cultural beliefs of a large proportion of their patient population.
• 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 the local health visitor, who was based at the practice.

Updated 30 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.
• 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 patients who resided in a local care home and a nursing home, and the managers from these homes were members of the practice’s Patient Participation Group. We met with the deputy manager of one of the homes and received a comment card from the manager of another.
• The practice met regularly with district nurses, community matrons and the local palliative care team to ensure that the needs of older patients were addressed.

Updated 30 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.
• 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. This included the introduction of a Facebook page in order to better engage with patients in this age group.
• The practice provided a full package of travel immunisations, including yellow fever.

Updated 30 January 2017

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

• The practice had 38 patients diagnosed with dementia and 81% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG and national average of 84%; however, the practice had a 0% exception reporting rate for this indicator, compared to an average of 6% locally and 7% nationally.
• The practice had 60 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 94% of these patients, compared to a CCG average of 96% and national average of 89%. They had a 0% exception reporting rate for this indicator, compared to a local average of 12% and national average of 13%.
• 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 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 30 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, refugees and asylum seekers, and those with a learning disability.
• 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 identified that they had a high proportion of patients who did not speak English. All of the GPs were multilingual and spoke the same languages (Hindi and Tamil) as a large group of their patients, and they would conduct consultations with patients in these languages. A pack of information in other languages was available to assist staff in communicating with non-English speaking patients and to provide them with information about services available.
• During the inspection we spoke to the manager of a local care home for people with learning disabilities, who told us that the practice provided an excellent service to their patients.