The Derry Downs Surgery

Updated 26 May 2017

The Derry Downs Surgery is located in St Mary Cray, Orpington, in the London Borough of Bromley. The area is mainly residential with some industrial premises and a busy high street nearby. The premises is close to rail stations and bus routes with unrestricted parking close to the surgery. The practice is located in a residential property which has been converted for the sole use as a surgery. The accommodation is spacious and based over three floors. Patient facilities are mainly on the ground floor and include four consultation rooms, two treatment rooms and a large reception/waiting area.

The practice has operated from the current address since 1993. The service operates under a General Medical Services contract providing services to 5392 registered patients. Bromley Clinical Commissioning Group (CCG) are responsible for commissioning health services for the locality. There are a large number of GP surgeries in the vicinity (six surgeries within a radius of 0.5 miles).

Following the recent retirement of a partner the practice is currently registered with the CQC as an Individual. The current  provider plans to return to partnership status as soon as possible.

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, surgical procedures and diagnostic and screening procedures.

Clinical services are provided by three GPs, one practice nurse and one health care assistant (HCA).

GP services are provided by the lead GP (male) 7 sessions a week and two salaried GPs (male and female) 12 sessions per week.

The Practice Nurse works 24 hours and the HCA 20 hours per week, over four days.

Administrative services are provided by 12 part-time members of staff including a Practice Coordinator (28 hours), Administration Supervisor (20 hours), Prescription Supervisor (20 hours), Medical Records Summariser (hours as required), IT Clerk (12 hours) Medical Secretary (15 hours) and six reception staff (92 hours - 2.44 wte).

The practice reception is open between 8am and 8pm Monday and Thursday and between 8am and 6.30pm Tuesday and Friday.

On Wednesday the practice is open between 8am and midday. At midday 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 mobile number held by the duty doctor. The Wednesday afternoon service is provided as a collaborative arrangement of several local GPs.

Telephone lines were open between 8am and 6.30pm Monday to Friday, except Wednesday when telephone lines are open until midday.

Appointments are available with a GP between 9am and 7.30pm on Monday and Thursday; between 9am and 6pm on Tuesday and Friday and between 9am and 11.30am on Wednesday.

In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are available on the same day for patients that need them.

Telephone consultations are available daily.

Pre-booked appointments are available with the Practice Nurse and HCA on four days a week with extended hours on Thursday evening.

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

Updated 26 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Derry Downs Surgery on 5 April 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.
• Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment. However, satisfaction rates regarding telephone access; waiting times during appointments and some aspects of consultations with the practice nurse were lower than the local and national average.The practice were aware of this and had taken action to address this.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints, concerns and suggestions.
• Patients we spoke with said they did not always find it easy to contact the surgery by telephone but were able to make an appointment with a named GP when required 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 practice organised monthly Healthy Walks for patients. These were open to all patients and were attended by the lead GP and Practice Manager.
• The provider was aware of the requirements of the duty of candour. Examples 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 telephone access; waiting times during appointments and some aspects of consultations with the practice nurse.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 26 May 2017

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

• Nursing and GP staff had lead roles in long-term disease management.
• Patients at risk of hospital admission were identified as a priority and the practice followed up patients with long-term conditions discharged from hospital.
• The practice Quality and Outcomes Framework (QOF) performance rates for all long-term conditions were comparable to local and national averages.
• All patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The practice had implemented a comprehensive recall procedure to ensure those patients with co-morbities received one review covering all conditions.
• 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 26 May 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 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 all standard childhood immunisations were comparable to national averages.
• Children and young people appeared to be treated in an age-appropriate way.
• 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 and post-natal care and child health services.
• The practice had processes and prioritisation protocols for children and young people and for acute pregnancy complications.

Updated 26 May 2017

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

• Staff were able to recognise the signs of abuse in patients and knew how to escalate any concerns.
• 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. A bypass number was issued to certain patients with enhanced need to avoid delays when they had to contact the surgery via the main reception number.
• The practice identified patients who may need palliative care as they were approaching the end of life. It involved patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on 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 26 May 2017

The practice 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, for example, extended opening hours appointments on two evenings a week.
• The practice was proactive in offering online services.
• A full range of health promotion and screening services were provided that reflected the needs for this age group.
• The surgery monthly Healthy Walk took place at weekends to ensure all groups of patients were able to attend.

Updated 26 May 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.
• 71% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was lower than the local average of 81% and national average of 84%.
• The practice reviewed the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 95% 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 84% and national average of 89%.
• 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 in place 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 26 May 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 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.