Archived: Dr Maria Coutinho Also known as Trinity Medical Centre

Updated 17 October 2017

The practice, also known as Trinity Medical Centre, is based in the London Borough of Greenwich. The practice is run by one GP (female) who works full time at the practice.

The practice is situated in a purpose built building, and shares its premises with another GP surgery, as well as other health amenities such as dentist and podiatry. The practice has been operating here since March 2017.

The practice is in an area with a mixed demographic, including areas of both relatively high and relatively low deprivation. The practice has a list size of approximately 3,700. In addition to the GP who runs the practice, there are two GPs, one salaried, one long term locum (one female and one male). In total 13 GP sessions are offered per week. There is also a practice nurse a practice manager and six other administrative and reception staff. The practice is contracted to provide Personal Medical Services (PMS) and is registered with the CQC for the following regulated activities: treatment of disease, disorder or injury, family planning.

The practice is open between 8:00am and 6:30pm Monday to Friday. Except Monday when the practice is open until 8pm. The practice is closed on the weekends and bank holidays. Appointments with the GPs are available from 8.30am to 12pm and from 3.30pm to 5.30pm Monday to Friday. Appointments with nurses are available from 9am to 12.30pm and from 2pm-5.30pm Monday to Thursday. The practice has extended hours on Monday from 6:30pm until 7:30pm.

The practice has opted out of providing out-of-hours (OOH) services. Patients needing urgent care out of normal hours are advised to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on patients’ medical urgency.

Updated 17 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Maria Coutinho on 13 July 2016. The overall rating for the practice was requires improvement. The full comprehensive report on 13 July 2016 can be found by selecting the ‘all reports’ link for Dr Maria Coutinho on our website at www.cqc.org.uk.

Since the 13 July 2016 inspection the registered provider has moved location from 213 Burrage Road Plumstead London SE18 7JZ to 2 Garland Road Plumstead London SE18 2AE.

This inspection was an announced comprehensive inspection on 22 August 2017. Overall the practice remains rated as requires improvement.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• All practice policies and procedures had been updated.
• The practice had purchased a defibrillator, and all staff had been trained on how to use it.
• The provider was aware of and complied with the requirements of the Duty of Candour. Examples we reviewed showed the practice complied with these requirements.
• No full cycle audits had been conducted.
• Immunisation rates were slightly below average for all standard childhood immunisations.
• Patients did not have care plans in place.
• Fridge temperatures were monitored, however there was only an internal thermometer being used and it was not calibrated frequently. This is not in accordance with Public Health England guidance.
• 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 were treated with compassion, dignity and respect and were involved in their care and decisions about their 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.
• Patients we spoke with said they found it easy 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.

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

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Do all that is reasonably practicable to mitigate any such risks.

• Ensure quality improvement programmes are conducted to improve patients’ outcome.

• Ensure there is a system in place to monitor safety alerts.

• Ensure that patients who require care plans have them.

• Ensure staff are up to date with training.

• Ensure systems are in place to review clinical staff registration details and medical insurance annually.

• Ensure registration regulated activities are updated.

In addition the provider should:

• Review temperature monitoring on the medicine fridge to make sure it is in line with current guidance.

• Continue to review antibiotic prescribing.

• Continue to try and obtain emergency medicine Hydrocortisone.

• Update their business continuity plan.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 17 October 2017

The provider was rated as requires improvement for safe, effective and well-led .The issues identified as requiring improvement overall affected all patients including this population group.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was comparable to the local and national average:

• 67% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 70%, national average of 78%). The exception reporting rate for the service was 12%, local 8% and national 13%.

• 68% of patients with diabetes on the register had their cholesterol measured as well controlled (local 75%, national average 80%). The exception reporting rate for the service was 16%, local 9% and national 13%.

• The practice followed up on patients with

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these 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. 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 17 October 2017

The provider was rated as requires improvement for safe, effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• From the sample of documented examples we reviewed we found there were systems 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 were slightly below for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for premature babies and their families following discharge from hospital.

  Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 17 October 2017

The provider was rated as requires improvement for safe, effective and well-led .The issues identified as requiring improvement overall affected all patients including this population group.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, 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.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• 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 17 October 2017

The provider was rated as requires improvement for safe, effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• The needs of these populations 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,

• 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 17 October 2017

The provider was rated as requires improvement for safe, effective and well-led .The issues identified as requiring improvement overall affected all patients including this population group.

• The practice carried out advance care planning for patients living with dementia.

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, (local average 86%, national average 84%) which is higher than local and national average.

• The practice specifically considered 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.

• 86% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 82%, national average 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.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

Updated 17 October 2017

The provider was rated as requires improvement for safe, effective and well-led .The issues identified as requiring improvement overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers 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.

• 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 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 in normal working hours and out of hours.