Archived: St Mary Cray Practice

Updated 29 August 2017

The St Mary Cray Practice is located in the High Street, St Mary Cray, Orpington, in the London Borough of Bromley. The area is mainly residential with some industrial premises nearby. The premises is close to rail stations and bus routes with on-road parking close to the surgery. The practice is located in rented accommodation converted for use as a surgery on the ground floor and a dental practice on the first floor. The two services share the entrance door and corridor only.

The St Mary Cray Practice is based on the ground floor of the premises. The facilities include the reception area, a large separate waiting room, two GP consultation rooms, one nurse treatment room, a spare treatment/consultation room for use as required, two administration rooms and the reception/administration area.

The service operates under a General Medical Services contract providing services to 2305 registered patients. Bromley Clinical Commissioning Group (CCG) are responsible for commissioning health services for the locality. There are a large number of small GP surgeries in the vicinity (six surgeries within a radius of 0.5 miles).

The practice is currently registered with the CQC as a Partnership of two partners. One partner joined the practice in 1989 and the other in 2015.

The provider is registered with the CQC to provide the regulated activities of family planning; maternity and midwifery services; treatment of disease, disorder and injury and diagnostic and screening procedures.

Clinical services are provided by the two female GP partners (1.5 wte) and one Practice Nurse (0.3 wte).

Administrative services are provided by eight part-time members of staff including a Practice Manager (0.4 wte); Assistant Practice Manager (0.3 wte); Medical Records Summariser (0.2 wte), Medical Secretary/Receptionist (0.6 wte) and four reception staff (1.4 wte).

The reception desk is open from 8am to 12.30pm and 2.30pm to 6.30pm on Monday, Thursday and Friday and from 8am to 12.30pm and 2.30pm to 7.45pm on Tuesday. Between 12.30pm and 2.30pm when the reception is closed a recorded message on the surgery landline informs patients that the surgery is closed and will reopen at 2.30pm and that, if urgent medical attention is required the patient should call the mobile number given. The mobile number is activated at 12.30pm on these days when urgent calls are answered by the practice secretary or Practice Manager.

On Wednesday the surgery is open from 8am to 1pm only. At 1pm the answerphone message instructs patients that the surgery is closed but that if their call is urgent they can hold and their call will be automatically transferred to the out of hours service. The call is then directed to the out of hours number for the duty doctor. The Wednesday afternoon service is provided as a collaborative arrangement with another local GP.

Appointments are available with a GP from 9am to 12.30pm and 4pm to 6.30pm on Monday and Thursday; from 9am to 12.30 and 4pm to 7.45pm on Tuesday; from 9am to 12.30pm and 3.30pm to 6pm on Friday and from 9am to 12.30pm on Wednesday.

In addition to GP appointments that can be booked up to one week in advance, urgent appointments are available on the same day for patients that need them.

Booked telephone consultations are available daily.

Appointments are available with the Practice Nurse on Monday from 8.30am to 10.30am and 4pm to 6.15pm and on Wednesday from 8.30am to 1pm. On alternate weeks appointments are also available on Thursday from 2.30pm to 5.30pm.

The practice can also access appointments with the local Primary Care Access Hub (The Bromley GP Alliance). The service is available between 4pm and 8pm Monday to Friday and between 8am and 8pm Saturday and Sunday.

When the surgery is closed urgent GP services are available via NHS 111.

Updated 29 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Mary Cray Practice on 19 July 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Data from the Quality and Outcomes Framework (QOF) showed that patient outcomes for most indicators were comparable to the local and national averages.
• Uptake rates for cervical, bowel and breast cancer screening were below the local and national average. The practice were aware of this and were actively encouraging uptake of screening services.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect. Satisfaction rates regarding some aspects of consultations with GPs were lower than the local and national average. However, feedback from patients we interviewed was positive.
• Information about services and how to complain was available to patients. Improvements were made to the quality of care as a result of complaints, concerns and suggestions.
• Patients we spoke with said they were always able to make an appointment with a named 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 staff felt supported by management. 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. Documentation we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• The provider should continue to monitor and work towards improving patient satisfaction regarding consultations with the GP.
• The provider should continue to work towards increasing the immunisation rates for all standard childhood immunisations.
• The provider should continue to actively encourage patients to participate in screening programmes for cervical, bowel and breast cancer.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 August 2017

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

• The GPs and Practice Nurse worked collaboratively in the management of patients with long-term conditions.
• Patients at risk of hospital admission were identified as a priority and the practice followed up patients with long-term conditions discharged from hospital.
• Quality and Outcomes Framework (QOF) performance rates for all long-term conditions were comparable to local and national averages.
• There was a system in place to recall patients for a structured annual review to check that their health and medicines needs were being met.
• For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice was part of the local vulnerable patient scheme aimed at identifying the most vulnerable patients and working with primary and secondary care providers to deliver an enhanced level of service to these patients.

Updated 29 August 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 accident and emergency (A&E) attendances.
• Immunisation rates for standard childhood immunisations were below the national average but the practice were actively addressing this. Recent data showed an increase in immunisation rates.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors through the provision of ante-natal, post-natal and child health services.
• The practice had prioritisation protocols for children and for acute pregnancy complications.

Updated 29 August 2017

The practice is rated as good for the care of older people.

• The practice offered personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Staff were able to recognise the signs of abuse in patients and knew how to escalate any concerns.
• Housebound patients were able to request repeat prescriptions by telephone.
• The practice identified patients who may need palliative care as they were approaching the end of life. Patients were involved in planning and making decisions about their care.
• The practice followed up older patients discharged from hospital and ensured that their care plans were updated.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• 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 29 August 2017

The pr actice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Appointments were available with the GP to 6.30pm on two evenings and to 7.45pm on one evening a week.
• The practice had access to appointments with the local Primary Care Access Hub between 4pm and 8pm Monday to Friday and between 8am and 8pm Saturdays and Sundays.
• The practice was proactive in offering online services.
• A full range of health promotion and screening services were provided that reflects the needs for this age group.

Updated 29 August 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was above the local average of 82% and national average of 84%.
• 96% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was comparable to the local average of 83% and national average of 89%.
• The exception reporting rates for indicators related to poor mental health were below the local and national average.
• The practice reviewed the physical health needs of patients with poor mental health and dementia.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• For patients experiencing poor mental health the practice had information available regarding how to access local support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they had been experiencing poor mental health.
• Staff we interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 29 August 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 and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability and those who required them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.