Archived: Bank House Surgery

Updated 11 January 2017

Bank House Surgery is based in a single storey converted detached property which was previously a bank. It is located in the London Borough of Bromley within a predominantly residential area of Farnborough with a small local high street nearby. The property has been converted for the sole use as a surgery and now includes one consulting room, one treatment room, reception area, waiting room and an administration office. Bromley Clinical Commissioning Group (CCG) are responsible for commissioning health services for the locality.

The practice is registered with the CQC as an Organisation (AT Medics). AT Medics is a GP-led organisation providing services in 14 London CCGs providing NHS services including GP practices, walk in centres and minor injuries units. Services at Bank House Surgery are delivered under a General Medical Services (GMS) contract. The practice 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.

The practice has 2880 registered patients. The practice age distribution is slightly lower than the national average for the 15 to 34 year age group. The surgery is based in an area with a deprivation score of 9 out of 10 (with 1 being the most deprived and 10 being the least deprived).

Clinical services are provided by one salaried GP (female) providing 8 sessions per week; one regular locum GP (male) providing 2 sessions per week and one part-time Practice Nurse (0.65 wte).

Administrative services are provided by a Director of Operations (0.8 wte) and administration/reception staff (2.7 wte).

The practice provides five-week secondments for medical students from St George’s Hospital who are in their final year of training. They offer placements for six medical students each year.

The reception and telephone lines are open between 8am and 6.30pm Monday to Friday with reception extended hours provided from 6.30pm to 8.30pm on Monday. The surgery is closed at weekends.

Pre-booked and urgent appointments are available with a GP from 8am to 11.40am, 3pm to 5.30pm and 6.30pm to 8.30pm on Monday; from 8am to 11.30am and 3.10pm to 5.40pm on Tuesday; from 8am to 11am and 2pm to 3.30pm on Wednesday; from 8am to 11am on Thursday and from 9am to 11.30am and 3.30pm to 6pm on Friday.

Pre-booked appointments are available with the Practice Nurse from 1pm to 5pm and 6pm to 8pm on Monday; from 8am to midday on Tuesday, Wednesday and Friday and from 1pm to 5pm on Wednesday.

Extended hours appointments are also provided through the local GP Alliance Hub service. These appointments are available between 6.30pm and 8pm Monday to Friday and from 9am to 1pm Saturday and Sunday. Appointments must be booked through the surgery. The service is staffed by GPs from the practices who are members of the alliance and full access to GP electronic records is available for all consultations.

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

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bank House Surgery on 4 October 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Verbal consent was obtained and recorded in patients records. However, written consent was not obtained for procedures such as the insertion of an intrauterine contraceptive device (IUCD).

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

• The practice had introduced a new initiative where the Practice Nurse attended an annual late afternoon tea with the clients in three local residential care homes for patients with learning difficulties. After tea, the nurse conducted the annual review for patients and administered injections such as the flu vaccination. This initiative enabled the practice to get a holistic picture of their patients in their home environment; helped to build relationships and reduced the anxiety of the patients. It also overcomes problems such as arranging transport to appointments, carers being taken away from the home on escort duty and patients missing attendance at day centres.

There were areas where the provider should make improvements:

• The provider should obtain written consent from patients prior to carrying out procedures such as the insertion of an intrauterine contraceptive device (IUCD).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 11 January 2017

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

• GPs worked closely with practice nursing staff and community specialist nurses in the management of patients with long-term conditions.

• Patients at risk of hospital admission were identified as a priority.

• The practice performance rate for the Quality Outcomes Framework (QOF) diabetes related indicators was above the local and national average.  

• Longer appointments and home visits were available when needed.

• Patients had a named GP and 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. These patients were discussed at the quarterly multi-disciplinary team meetings.

Updated 11 January 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 A&E attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this. The practice had produced an information leaflet for young people explaining how to use the services provided by the practice.

• The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages.

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

• We saw positive examples of effective joint safeguarding working.

Updated 11 January 2017

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 in its population.

• Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to local and national averages.

• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.

Updated 11 January 2017

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.

• Extended hours appointments were available at the surgery one evening a week.

• 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 11 January 2017

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

• 93% 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 83% and national average of 84%.

• 100% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was above the local average of 84% and national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health including those with dementia. The practice carried out advance care planning for patients with dementia.

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

• A counsellor provided a clinic at the surgery once a week.

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

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

• The practice is a member of the Bromley Dementia Action Alliance (a movement formed to support and encourage communities and organisations to take action to assist people with dementia to live well and to reduce the need for crisis intervention. )

Updated 11 January 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The Practice Nurse attended an annual late afternoon tea with the clients in three local residential care homes for patients with learning difficulties. After tea she conducted annual reviews and administered injections such as flu vaccinations.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments and annual reviews for patients with a learning disability which was available through a home visit if requested to avoid stress to the patient. In the current year all patients on the learning disability register had received an annual review.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed 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.