Archived: Charterhouse Surgery Also known as The Charterhouse Surgery

Updated 18 January 2018

The Charterhouse Surgery provides primary medical services in Orpington, Bromley to approximately 7400 patients and is one of 48 practices in Bromley Clinical Commissioning Group (CCG). The practice population is in the least deprived decile in England.

The practice population has a lower than CCG and national average representation of income deprived children and older people. The practice populations of working age people and older people are higher than local and national averages and the population of children and younger people is lower than local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded, 68% are white British, 2% are Asian and 1% are Black/African.

The practice operates in converted premises. All patient facilities are wheelchair accessible. The practice has access to four doctors’ consultation rooms, one nurse consultation room and one nurse practitioner consultation room on the ground floor.

The clinical team at the practice is made up of two part-time female GP partners, two part-time long-term male locum GPs, one part-time female practice nurse and one part-time female nurse practitioner. The non-clinical practice team consists of an interim practice manager and 13 administrative or reception staff members. The practice provided a total of 26 GP sessions and eight nurse practitioner sessions per week.

The practice had significant changes in partnership and management structure during the period between March 2014 and July 2015 where six GP partners, a practice manager, two practice nurses, a nurse practitioner and six reception staff left the practice. Another GP partner had shortly before our inspection visit, also left the practice.

The practice operates under a General Medical Services (GMS) 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 8am till 6:30pm Monday to Friday. Appointments are available from 8:30am to 11:30am and 4pm to 6pm Monday to Friday.

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 is a member of local GP Alliance and provides at least three appointments each day seven days a week through Primary Care Hubs; weekend appointments could be booked in advance.

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

Updated 18 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Charterhouse Surgery on 5 April 2016. The practice was rated inadequate in safe and requires improvement overall. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Charterhouse Surgery on our website at www.cqc.org.uk.

Following a period of six months after publication of the April 2016 inspection report an announced comprehensive inspection was carried out on 24 November 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Charterhouse Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 27 September 2017. Overall the practice is still rated as inadequate.

Our key findings were as follows:

• The provider had addressed some of the concerns identified in the last inspection. However, patients were still at risk of harm as the system in place for the monitoring of patients on high risk medicines was ineffective.
• The Quality and Outcomes Framework (QOF) outcomes for patients with long-term conditions had slightly improved since the last inspection especially for patients with Chronic Obstructive Pulmonary Disease (COPD); however outcomes for patients with diabetes, mental health and asthma still required further improvement.
• The practice only provided 26 GP sessions each week and this was reflected in significantly below average national GP patient survey results in relation to access to appointments. Whilst the practice was aware of this it had experienced a further loss of clinical staff since our last inspection.
• There was a leadership structure and staff felt that the support from management had improved since the last inspection; however this was not sufficient. The practice had policies and procedures to govern activity and held regular governance meetings; however some of the policies and protocols were not up to date.
• Results from the national GP patient survey published in July 2017 were generally below the local and national averages.
• Some of the patients said that the recent changes made by the practice had improved telephone access and made it easier to make an appointment with a GP, with urgent appointments available each day. However some of the patients still indicated difficulty in accessing appointments.
• There was a system in place for reporting and recording significant events and there was evidence of learning and communication with staff.
• Staff were aware of current evidence based clinical guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way for patients including the safe management of medicines.
• Ensure that all patients’ needs are identified and care and treatment met their needs.
• Ensure all practice policies and protocols are up to date.

In addition the provider should:

• Review the results of the national GP patient survey results and address low scoring areas to improve patient satisfaction especially in access.

This service was placed in special measures in 30 March 2017 on publication of November 2017 report. Insufficient improvements have been made and the practice is still rated overall as inadequate and remains in special measures.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 January 2018

The provider was rated as inadequate for providing safe services and for being well-led and requires improvement for being effective, caring and responsive. The issues identified as inadequate affected all patients including this population group.

• Unvalidated national Quality and Outcomes Framework (QOF) data for 2016/17 provided by the practice indicated a slight improvement in outcomes of patients when compared to the 2015/16 data.
• The national QOF data showed that 69% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 76% and the national average of 78%. The number of patients who had received an annual review of their diabetes was 67%.
• 49% (2.8% exception reporting) of patients with Chronic Obstructive Pulmonary Disease (COPD) had received annual reviews compared with the CCG average of 89% and national average of 90%. A review of 2016/17 results indicated that the outcomes for patients with COPD had generally improved when compared to 2015/16 results. In 2016/17 75% of patients with COPD had received an annual review.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
• The national QOF data showed that 66% of patients with asthma on the register had an annual review, compared to the CCG average of 73% and the national average of 76%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• Structured annual reviews were undertaken to check that patients’ health and care needs were being met.

Updated 18 January 2018

The provider was rated as inadequate for providing safe services and for being well-led and requires improvement for being effective, caring and responsive. The issues identified as inadequate affected all patients including this population group.

• Immunisation rates were in line with average 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.
• The practice’s uptake for the cervical screening programme was 84%, which was in line with the Clinical Commissioning Group (CCG) average of 82% and the national average of 81%.

Updated 18 January 2018

The provider was rated as inadequate for providing safe services and for being well-led and requires improvement for being effective, caring and responsive. The issues identified as inadequate affected all patients including this population group.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were generally below average.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 18 January 2018

The provider was rated as inadequate for providing safe services and for being well-led and requires improvement for being effective, caring and responsive. The issues identified as inadequate affected all patients including this population group.

• The practice did not offer extended hours appointments with GPs or nurses to suit the needs of this age group. The practice patients had access to local GP hub where evening and weekend appointments could be obtained.
• 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 18 January 2018

The provider was rated as inadequate for providing safe services and for being well-led and requires improvement for being effective, caring and responsive. The issues identified as inadequate affected all patients including this population group.

• 74% of 55 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was below the CCG average 83% and national average of 89%.
• The number of patients with dementia who had received annual reviews was 82% which was in line with the Clinical Commissioning Group (CCG) average of 82% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

Updated 18 January 2018

The provider was rated as inadequate for providing safe services and for being well-led and requires improvement for being effective, caring and responsive. The issues identified as inadequate affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; 80% of patients with a learning disability had received a health check in the last year (four out of five patients).
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.