Belmont Hill Surgery Also known as The Surgery

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 14 April 2016 at Belmont Hill Surgery. At that inspection the practice was rated good overall, but as requires improvement for some aspects of providing safe services. The full comprehensive report on the 14 April 2016 inspection can be found by selecting the ‘all reports’ link for Belmont Hill Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 18 May 2017 to check that the practice had followed their plan to address the findings we had identified in our previous inspection on 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good. Following the desk-top review we found the practice to be good for providing safe services.

Our key findings were as follows:

• Cleaning arrangements for the practice had been reviewed which included the implementation of a comprehensive cleaning schedule and audit process.
• Findings from the infection prevention and control audit had been addressed and improvements identified and actioned.
• Processes had been put in place to check emergency medical equipment was fit for use.
• Systems had been implemented to ensure blank printer prescription security and to track their use through the practice in line with national guidance.
• Improvement grant funding had been approved in principle to make adaptations in the practice relating to auditory privacy and accessible toilet facilities.
• An event had been arranged in the practice with Carers Lewisham to promote the identification of carers in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 8 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was similar to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c is 64 mmol/mol or less in the preceding 12 months was 75% (national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 99% (national average 94%).
• Longer appointments and home visits were available when needed.
• All these 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.

Updated 8 August 2016

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 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 good for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 76%, which was comparable with the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, school nurses and health visitors.

Updated 8 August 2016

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.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Patients who were on the avoidable admissions register and integrated care programme were given a separate number to call to enable them to get through to the practice quickly and by-pass the main line.

Updated 8 August 2016

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.
• The practice offered a ‘Commuter’s Clinic’ on Wednesday from 6.30pm to 7.30pm and Thursday and Friday from 7am to 8am for working patients who could not attend during normal opening hours.
• The practice was proactive in offering online services and patients could book and cancel appointments, request repeat prescriptions and update personal information through the practice website. The practice operated an automated text reminder system for appointments.

Updated 8 August 2016

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

• 73% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, which was lower than the national average (84%). However, the practice provided evidence that they had increased their dementia prevalence and diagnosis rate since the 2014/15 QOF results.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was lower than the national average (practice 74%; national average 88%). Evidence provided by the practice showed they had increased the care plans undertaken in 2015/16 and had identified 59 patients and undertaken 55 care plans (93%).
• 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 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.

Updated 8 August 2016

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. The practice had a policy to register homeless patients at the surgery address.
• 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 and 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 in normal working hours and out of hours.
• All doctors and nurses had undertaken radicalisation awareness training.
• The practice ran a twice-weekly substance misuse clinic for its patients and those within the local practices.