Binfield Road Surgery

Updated 17 November 2017

Binfield Road Surgery is part of Lambeth CCG and serves approximately 7200 patients. The practice is registered with CQC for the following regulated activities: treatment of disease, disorder or injury; surgical procedures; family planning; diagnostic and screening procedures and maternity and midwifery services.

The practice population has a significantly higher proportion of working age people and lower proportion of patients over 65 compared to the national average. The number of infants on the patient list is comparable to the national average. It is located within the third most deprived decile on the index of multiple deprivation. The practice informed us that 60% of patients do not speak English as a first language and that the turnover of patients is between 25 – 30% per year.

The practice is run by three partners and the practice also employs a salaried GP. Three of the GPs are male and one is female. There is one nurse practitioner and two practice nurses. The practice is a teaching practice but does not have any students at present. The GPs provide 4.25 whole time equivalent and nurse practitioner 0.75 whole time equivalent. There is 1.55 whole time equivalent provided by the practice nurses with booked and emergency appointments available Monday to Friday.

The practice is open between 8 am and 6.30 pm Monday to Friday with the exception of Tuesday and Thursday when the surgery is open until 7.15 pm. Appointments were available during these times.

Binfield Road Surgery operates from 1 Binfield Road, London, Lambeth SW4 6TB. The premises are owned by the partnership. The service is accessible to those who have mobility problems. Practice patients are directed to contact the local out of hours provider when the surgery is closed.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These are: Childhood

Vaccination and Immunisation Scheme, Extended Hours Access, Facilitating Timely Diagnosis and Support for People with Dementia, Minor Surgery, Remote Care Monitoring, Rotavirus and Shingles Immunisation and unplanned admissions.

The practice is a member of a GP federation which is comprised of several practices who aim to work together to collectively provide services to patients in the locality.

Updated 17 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Binfield Road Surgery on 7 March 2017. The practice was rated good overall and requires improvement for providing services that were safe. The full comprehensive report from the March 2017 inspection can be found by selecting the ‘all reports’ link for Binfield Road Surgery Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 23 October 2017 to confirm that the practice had carried out their plan to meet the recommendations we made in our previous inspection on 7 March 2017. This report covers our findings in relation to those recommendations made at our last inspection.

At our previous inspection undertaken on 7 March 2017, we rated the practice as requires improvement for providing safe services as:

• Two members of staff were acting as chaperones without having had a DBS check undertaken prior to employment.

• The fire risk assessment did not provide a comprehensive assessment of fire risks in the practice.

In addition to the breaches of regulation we identified we also suggested areas where the provider should make improvements including:

• Take steps to make the practice complaints procedure easily accessible to patients and provide formal written response to written complaints.

• Review systems for the storage and monitoring of Patient Group Directions (PGD).

• Continue to work on embedding learning from significant events.

• Continue to work on improving patient satisfaction regarding waiting times.

• Consider recording multidisciplinary team and clinical meetings in a separate document in addition to within individual patient records.

The practice is now rated as good for the key question: Are services safe?

Our key findings were as follows:

• All staff had received a DBS check and a practice policy had been drafted which required all staff who undertook the chaperoning role to have a DBS check. In addition their recruitment policy had been updated to refer to the new DBS policy.

• The practice had updated their internal fire risk assessment using Health and Safety Executive guidelines.

In addition:

• The practice provided us with a complaint log of recent complaints although this did not indicate that formal written responses were sent to patients when they complained in writing. The practice provided a copy of the complaint poster used to advertise the complaints policy.

• The practice provided copy of their PGD policy which placed the responsibility for ensuring PGDs were valid on the individual practitioner with signed copies of these being kept by the practice.

• The practice provided an example of a recent significant event which demonstrated learning and action taken.

• The practice continued to minute multidisciplinary discussions in patient records and kept a log of the patients discussed in each meeting in an effort to reduce the administrative burden on clinical staff.

No further action had been taken to assess whether there had been any improve patient satisfaction with appointment waiting times. The period where data had been collected for the most recent national GP patient survey results pre dated the action the practice had taken to improve satisfaction with waiting times.

Areas where the practice should make improvement:

• Continue with action to assess the impact of this on patient satisfaction.

• Consider employing someone with suitable expertise in fire safety to undertake a fire risk assessment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 28 April 2017

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

• One of the partners specialised in long-term disease management and members of the nursing team were specialised in particular long term conditions. Patients at risk of hospital admission were identified as a priority.

• The percentage of patients on the practice’s diabetic register with well controlled blood sugar was 77% compared with 72% in the CCG and 78% nationally. The percentage of these patients who had healthy cholesterol levels was 78% compared with 80% in the CCG and 80% nationally.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• 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 28 April 2017

The practice is rated as good for the care of families, children and young people.

• From the 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 relatively high for all standard childhood immunisations.

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

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

• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

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

Updated 28 April 2017

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

• 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 by drafting complex care plans for those over 65 who were housebound and for patients over the age of 80 years old under the locality wide Holistic Health Assessment programme. This aimed to address both health and social needs of these patients to ensure a comprehensive package of care was provided.

• 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.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• 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.

• They held monthly multidisciplinary meetings with a geriatrician.

Updated 28 April 2017

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

• 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, extended opening hours.

• 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.

On occasion when the practice could not offer same day appointments for acute conditions patients could be referred to the local GP access hub run by the federation.

Updated 28 April 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 who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the Clinical Commissioning Group (CCG) and national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example the practice ran a weekly clinic for patients with drug and alcohol dependency issues. This was supported by a drug and alcohol support worker. The clinic was moved to a weekday evening as an increasing number of these patients had obtained employment.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Performance for other mental health indicators was comparable to local and national averages.
• 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 28 April 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 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.