Archived: Trinity Medical Centre

Updated 3 June 2016

The Trinity Medical Centre provides primary medical services in Penge to approximately 5500 patients and is one of 48 practices in Bromley Clinical Commissioning Group (CCG). The practice population is in the fourth most deprived decile in England.

The practice population has a higher than CCG and national average representation of income deprived children and older people. The practice population of children is similar to the CCG and national average, the percentage of working age people are higher than local and national averages and the population of older people was less than the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded, 21.2% are Black, 6.8% are Mixed and 6.4% are Asian.

The practice operates in converted premises. The practice is currently being renovated to make all the patient areas wheelchair accessible. The practice has access to two doctors’ consultation rooms on the ground floor and two doctors’ consultation rooms and one nurse consultation room on the first floor.

The practice team at the surgery is made up of one full-time male GP and one full-time female GP who are partners, one part-time salaried female GP, three regular part-time locum GPs (two female and one male) and one part-time female practice nurse and one part-time healthcare assistant. The non-clinical practice team consists of practice manager, practice secretary and five administrative and reception staff members. The practice provides a total of 24 GP sessions per week.

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 8:00pm on a Monday and 8:00am till 6:30pm Tuesday to Friday. Appointments are available from 9:00am to 1:00pm and 2:00pm to 6:00pm every day. Extended hours surgeries are offered on Mondays from 6:30pm to 8:00pm.

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 Bromley CCG. The practice has recently signed up to be part of local GP Alliance and provides two appointments seven days a week through Primary Care hubs which could be booked in advance (Primary Care hubs allows patients access to a GP seven days per week, where the clinician has, with patients’ consent, full access to their GP records which allows a full general experience).

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, surgical procedures and treatment of disease, disorder or injury.

Updated 3 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trinity Medical Centre on 28 April 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.

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

• Consider documenting discussion from formal clinical meetings.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 June 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 84% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 93% which was above the CCG average of 86% and national average of 88%.
• The national Quality and Outcomes Framework (QOF) data showed that 76% of patients with asthma on the register had an annual review, compared to the CCG average of 74% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions 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.
• The practice had individual care plans for each patient and provided a copy of the care plan for each patient.

Updated 3 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 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 74%, which was below the Clinical Commissioning Group (CCG) average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Appointments were prioritised for children.
• The practice offered sexual health clinics and patients from neighbouring practices across the CCG were also able to be seen.

Updated 3 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.
• All these patients had a named GP. The practice performed housebound patient reviews annually.
• The GPs visited a local care home on a weekly basis, supporting the needs of the 40 elderly residents.
• The practice staff helped housebound patients with the delivery of prescriptions.

Updated 3 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 reflects the needs for this age group.

Updated 3 June 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 84% which was in line with the Clinical Commissioning Group (CCG) average of 84% and national average of 84%.
• 93% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 84% and national average of 88%.
• The practice had a higher than CCG and national average of patients with severe mental health conditions (112 patients); they actively monitored prescribing of these patients with the support of local community mental health team. The senior GP in the practice was helping in designing an advance primary care mental health pathway for the CCG.
• The practice had access to a counsellor who provided regular sessions at the surgery where necessary.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia. Their dementia diagnosis rate for 2015/16 was 84% which was above the national average of 62%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice referred older children and teenagers to the local wellbeing service for mental health issues.
• 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 3 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, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; 82% 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.
• 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.