Archived: Falmouth Road Group Practice

Updated 2 February 2017

Falmouth Road Group Practice provides primary medical services in Southwark to approximately 6700 patients. The practice is part of Southwark Clinical Commissioning Group (CCG). Falmouth Road Group Practice is one of 24 practices in the North Southwark CCG Locality. The practice area is in the fourth most deprived borough in England. The practice population has a higher than national average representation of income deprived children and older people. The majority of the practice population is of working age; approximately 80% are aged 18-64. Of patients registered with the practice, 34% are White or White British; 34% are Black or Black British and 21% are Asian or Asian British.

The practice has ground floor ramped access. All consulting rooms and facilities are on the ground floor. Parking including disabled parking is available. The Falmouth Road Group Practice clinical team is made up of one full time male GP who is a partner, one full time female GP who is a partner, two full time female GPs, one part time female GP, a full time female practice nurse and a part time female health care assistant. The GPs offer 43 sessions per week. The team is also made up of a full time practice manager, a patient services manager and nine reception and administrative staff. The practice also hosted psychologists.

The practice operates under a Primary Medical Services (PMS) contract and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice reception and telephone lines are open from 8am to 6.30pm, Monday to Friday. Appointments are offered between 9am and 12.30pm every morning and 3pm to 5.15pm every afternoon. Extended hours surgeries are offered on Tuesday from 6.30pm to 8pm with a GP and a practice nurse. The practice is closed at weekends.

The practice has opted out of providing out of hours (OOH) services to their own patients and directs patients to the out-of-hours provider. Since April 2015, the practice has taken part in a pilot project as part of Southwark CCG, directing patients to an extended access service within the locality, which is open from 8am to 8pm, seven days a week. The practice is also able to direct patients to this service.

Falmouth Road Group Practice is registered as a partnership with the Care Quality Commission, to provide the regulated activities of diagnostic and screening procedures, family planning services, maternity and midwifery services and treatment of disease, disorder and injury.

The practice is a member of GP federation Quay Health Solutions.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Falmouth Road Group Practice on 20 October 2016 following previous inspections of the practice on 29 April 2015 and 5 January 2016. As a result of our initial inspection on 29 April 2015 the practice was placed into special measures. Inspections undertaken on 5 January 2016 and 20 October 2016 were intended to establish whether or not the practice had made sufficient improvement to enable them to be taken out of special measures. The practice remained in special measures after the inspection conducted on 5 January 2016. We found that the practice had not made sufficient improvement at our inspection on 20 October 2016 and is rated inadequate overall.

On the basis of our findings and the provider’s history of non-compliance we served a notice to cancel the provider’s registration under section 17 (1) (c) of The Health and Social Care Act 2008 on the basis that the provider was not carrying out the regulated activities in accordance with the relevant requirements of the 2014 Regulations.

Our key findings across all the areas we inspected were as follows:

• Risks to patients were not always assessed or well managed. For example the practice had not complied with the recommendations in their health and safety risk assessment and insufficient attention was paid to infection control.
• The practice nurse was not administering medicines in line with legislation and one of the partners did not have adequate medical indemnity cover in place.
• National patient survey scores were below national and local averages and some of these scores were lower than those at the time of previous inspections. However feedback obtained from patients during the inspection process indicated that most patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said that access had generally improved. However it was evident from speaking to staff that there were not always a sufficient number of staff to meet patient demand. Urgent appointments were available the same day but patients could not book appointments online.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and most 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.
• 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.
• There was an effective system in place for reporting and recording significant events however there was no evidence that patient safety alerts were being acted upon.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the clinical training to provide them with the skills, knowledge and experience to deliver effective care and treatment. However some essential training had not been completed by all staff including basic life support, infection control, child safeguarding and information governance.

Had we not served a notice proposing to cancel the provider’s registration, we would have set out the following list of ‘musts’ for their action:

• Put systems in place to ensure that valid Patient Group Directions are always in place for nursing staff administering medicines, that there are systems in place to monitor cervical screening samples and that clinical staff do not undertake consultations with patients without adequate professional indemnity insurance.

• Ensure that all mandatory training is completed in accordance with current guidance.

• Ensure that arrangements are in place to identified and mitigate against risks associated with infection control, health and safety and management of prescription pads and review arrangements around emergencies to ensure that all staff are trained, know how to operate emergency equipment and that all emergency medicines are secure and fit for purpose

• Ensure that there are systems in place to take and record action in response to patient safety alerts.

The areas where we would have said the provider should make improvement are:

• Ensure that all relevant staff are made aware of learning from significant events.

• Continue work on improving the management of patients in accordance with local and national targets.

• Give consideration to the style of complaint responses.

• Ensure that all staff receive adequate supervision, that all clinical employees are appraised annually and continue to work on improving staff morale and ensure that all staff are given adequate support.

• Put systems in place to improve the identification of and support offered to carers.

• Consider reviewing the level of staffing at the practice.

• Continue with action to engage with patients and address areas of concern or dissatisfaction raised in the national patient survey.

• Enable patients to book appointments online.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 2 February 2017

The provider was rated as inadequate for safe, caring, responsive and well led and requires improvement for effective resulting in an overall rating of inadequate. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance in respect of the management of diabetic patients was lower than local and national averages. However benchmarking data for 2016/17 indicated improvement in the management of these patients. The practice nurse and one of the GPs held a weekly diabetic clinic and also held reviews of the most challenging diabetic patients with the support of a secondary care consultant with a view to optimising their care in accordance with current best practice.

• From records seen there was evidence of annual reviews and care plans being completed for those with long-term 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.

• Longer appointments and home visits were available when needed.

Updated 2 February 2017

The provider was rated as inadequate for safe, caring, responsive and well led and requires improvement for effective resulting in an overall rating of inadequate. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• 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 A&E attendances.

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

• The percentage of women who received cervical screening within the last 12 months was comparable to local and national averages.

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

• The practice held a baby clinic every Wednesday afternoon with the GP, Nurse and the Health Visitors. An antenatal clinic was held every Tuesday.

Updated 2 February 2017

The provider was rated as inadequate for safe, caring, responsive and well led and requires improvement for effective resulting in an overall rating of inadequate. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice told us that elderly patients were treated as a priority and that appointments at the end of surgery were reserved for these patients.

• The practice nurse offered in house phlebotomy which limited the need for frail elderly patients to travel to access this service.

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

Updated 2 February 2017

The provider was rated as inadequate for safe, caring, responsive and well led and requires improvement for effective resulting in an overall rating of inadequate. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• The practice did not offer online appointments. Repeat prescription requests were accepted by the by practice via email. The practice provided a full range of health promotion and screening that reflected the needs for this age group.

• In response to an internal patient survey the practice had adjusted the services to try and improve access.

Updated 2 February 2017

The provider was rated as inadequate for safe, caring, responsive and well led and requires improvement for effective resulting in an overall rating of inadequate. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• 66% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average.

• The performance in respect of other mental health indicators was mixed. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 monthsThe percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 87% compared to the national average of 84%.

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

• 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 would run an ad hoc mental health clinic on Mondays.

Updated 2 February 2017

The provider was rated as inadequate for safe, caring, responsive and well led and requires improvement for effective resulting in an overall rating of inadequate. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• The practice held a register of patients with a learning disability.

• The practice offered longer appointments for patients with a learning disability. In 2015/16 the practice had 14 patients with learning disabilities and had conducted only three annual health checks. Currently the practice had 11 patients with learning disabilities and had only undertaken one so far in 2016/17.

• 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.

• All but one staff member was able to outline 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 in normal working hours and out of hours.