The Gardens Surgery

Updated 3 November 2016

We carried out an announced comprehensive inspection of The Gardens Surgery on 25 November 2015 where the practice was rated good overall. However breaches of regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified, and we rated the practice to require improvement for providing safe services.

The specific concerns in the previous inspection related to safety were:

• Not all staff had received the appropriate level of safeguarding or basic life support training.

• Not all staff who acted as chaperones had received a Disclosure and Barring Service check prior to being designated a chaperone.

• The practice was not conducting fire drills on a regular basis.

• Prescriptions kept in printers were not always appropriately stored and secured when clinical rooms were vacant.

• Children’s oxygen masks were not stored with the practice’s supply of oxygen which would have hindered their ability to respond effectively in an emergency.

• Some staff were not aware of the practice’s business continuity arrangements and there was no member of staff who had overall responsibility for disaster recovery.

In addition to this we found that some staff members had not been appraised within the previous 12 months.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 17(1).

We undertook this focussed inspection on 5 August 2016 to check that they had followed the action plan provided and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Gardens Surgery on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

• All staff had completed basic life support and safeguarding training within the last 12 months.

• All staff had received the requisite level of chaperoning training and background checks.

• The practice had carried out a fire drill where action points were learned from and implemented.

• The practice had implemented systems and processes to ensure that prescriptions held in printers were stored securely.

• The practice had stored the oxygen masks with the practice’s oxygen supply.

• The practice had made improvements to its business continuity arrangements. There were now packs with emergency supplies which could be used if the premises were not in operation and there was a designated person who was responsible for overseeing and making any required changes to the practice’s business continuity arrangements.

In addition to addressing the breaches of regulation which impacted on safety, the practice had taken additional action on the basis of our last report:

• The practice was in the process of giving reception staff customer service training and most staff appeared to have completed this.

• All staff had been appraised.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

Updated 4 February 2016

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

• The surgery offered a weekly diabetic clinic which was run by one of the practice nurses. Input and advice were often sought from the community diabetic team. The nurse who leads the clinic organised virtual clinics annually with a local consultant to review diabetic patients.

• One of the other nurses were responsible for the management of patients with Asthma and COPD; offering diagnostic spirometry and referrals to pulmonary rehabilitation services.

• Nurses offered ambulatory blood pressure monitoring for the detection of hypertension.

• Performance for diabetes related indicators was similar to the national average. In 2014/15 The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months was 72.5% compared to the national average of 77.5%. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 88.8% compared with the national average of 88.3%.

• Longer appointments and home visits were available when needed and patients at risk of hospital admission were identified as a priority.

• The practice had registers of people with long term conditions which they use to recall patients as and when appropriate.

• All patients had a named GP and were offered a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 4 February 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 A&E attendances.

• The practice ran a baby clinic offering parents  access to a health visitor, developmental checks with a doctor and immunisations which are administered by one of the practice nurses. This was in addition to a separate immunisation clinic.

• Immunisation rates were higher than the national average for nearly all standard childhood immunisations. The practice had a higher proportion of infants (those aged between 0 – 4 years old) than the average practice in England. The practice sent alert letters to parents to advise when routine immunisations were due.

• GPs within the practice made use of a telephone clinic with a paediatrician at the local hospital for advice when required.

• 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 had implemented a telephone triage service to offer advice to parents over the phone. This had the effect of reducing the number of appointments, promoting self-care and increasing the number of patient contacts.

• The local area had a high prevalence of childhood obesity. Clinical staff offered opportunistic height and weight measurement and offered parents advice on how to manage their child’s weight.

• Premises were suitable for children and babies.

Updated 4 February 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 within its patient population. One of the practice nurses participated in the Southwark and Lambeth Integrated Care Partnership (SLIC). This initiative offered annual health checks for housebound patients. On the basis of this visit the nurse liaised with relevant services including social services, gerontology and voluntary agencies to ensure that these patients received holistic care and treatment packages.

• The practice had a register of frail older patients which identified those who were at risk of admission. Reception staff had access to this register and would alert GPs when these patients contacted the practice.

• The practice offered older people home visits and urgent appointments for those with enhanced needs.

• The care of older patients was discussed in monthly district nursing meetings which were attended by the practice’s clinicians and community matron.

• Patients over the age of 75 were offered NHS health checks.

Updated 4 February 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 offered sexual health advice when patients requested this and screening for sexually transmitted infections to all new patients at the practice.

• The practice’s telephone triage service allowed patients to obtain advice over the telephone as opposed to having to take time out to attend the surgery. The practice offered travel immunisations.

• The practice was proactive in offering online services including online appointment booking and prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.

• The percentage of women aged 25 or over and who have not attained the age of 65 whose notes record that a cervical screening test has been performed in the preceding 5 years was 87.1% this is compared to 81.8% nationally and 79.9% in the CCG area.

• Weight management services, for instance referral to a dietician or for a programme of exercise, were offered opportunistically. Patients were also referred to the local health hub which provides weight management services.

• Patients who were over forty years old were proactively offered health checks carried out by the practice healthcare assistant.

Updated 4 February 2016

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

• Performance for mental health related indicators was lower compared to the national average. For instance the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 78.1% compared to the national average of 88.3%. However this had significantly improved when compared with the previous year’s figures.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They referred patients at risk of dementia to the local memory clinic and utilised the services of a dementia specialist nurse.

• It carried out advance care planning for patients with dementia and one of the nurses within the practice is lead for dementia.

• The practice has offered counselling services on site for the past 20 years through the improving access to psychological therapies service. Three counsellors offered sessions at the practice.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. Patients were contacted and offered a nurse visit or follow up appointment. Patient’s care plans were then reviewed and updated.

• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 4 February 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 those with a learning disability. These patients were flagged on the patient’s records and would be telephone triaged and managed appropriately.

• Although the practice informed us that they did not have any homeless patients registered with them at present; they were able to outline the registration procedure for a homeless patient or a member of the travelling community.

• The practice offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. For instance multi-disciplinary team meetings were held with MacMillan nurses regarding patient’s end of life care.

• It had told 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.