Archived: Palace Road Surgery

Updated 23 June 2016

Palace Road Surgery is based in the Lambeth Clinical Commissioning Group (CCG) area serves approximately 7100 patients. The practice is registered with the CQC for the following regulated activities Treatment of disease, disorder or injury, Family Planning and Diagnostic and Screening Procedures.

The practice population has a higher proportion of working age people compared to the national average and a slightly lower than average percentage of people who are aged 65 and over. The practice has a comparable number of children and young people. The practice is ranked within the third most deprived decile on the Index of Multiple Deprivation (IMD). The numbers of those within and out of employment are similar to national averages.

The practice is run by three male partners. There are two long term locums; one male and one female. There are three practice nurses and a healthcare assistant. The practice hosts final year medical students from a local hospital. There is a team of practice management, administrative and reception staff.

The practice is open between 8 am and 6.30 pm Monday to Friday. Appointments are from 9 am to 12 pm and 2pm till 6 pm. Extended surgery hours are offered between 9 am till 12 pm on Saturdays with appointments available from 9 am till 11am. The practice offers 30 GP sessions per week with booked and emergency appointments five days per week and booked appointments available on a Saturday.

The practice is currently located at 3 Palace Road which is former residential property which is owed by the partnership. The practice informed us that they were moving to purpose built premises at 1 Palace Road at the end of the summer and that there had previously been delays in moving to the new premises.

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, Facilitating Timely Diagnosis and Support for People with Dementia, improving patient access online, Minor Surgery, Patient Participation, Remote Care Monitoring and Rotavirus and Shingles Immunisation and Unplanned Admissions.

The practice is part of South West Lambeth Federation.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Palace Road Surgery on 9 March 2016. Overall the practice is rated as requires improvement.

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

• Some risks to patients were assessed and well managed. However the cleanliness of the practice in some areas was unsatisfactory.

• We found that consent was not always documented and that one of the audits the practice had completed did not aim to optimise patients in accordance with current NICE guidelines. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

The areas where the provider must make improvements are:

Ensure that the practice provides and maintains a clean and appropriate environment that facilitates the prevention and control of infections.

Must ensure that there are appropriate systems in place for recording consent.

The areas where the provider should make improvement are:

Consider putting in place formalised care plans for service users where appropriate.

Review the practice’s clinical auditing process with a view to improving patient outcomes in accordance with national clinical guidance.

Ensure that all staff are aware of the location of emergency medicines and which medicines are available.

Ensure that a record is kept of staff inductions.

Consider advertising translation services in the reception area.

Consider undertaking a review of patients to verify why the prevalence of Coronary Heart Disease is lower than the national average.

Consider ways to increase the number of diabetic patients who receive a seasonal flu vaccination.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

The provider was rated as requires improvement for safety and effectiveness. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

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

• The practice undertook annual reviews of patients with long term conditions with consultant specialists from the local hospital.

• 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 medicine 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 23 June 2016

The provider was rated as requires improvement for safety and effectiveness. The issues identified as requiring improvement 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 patients with asthma, on the register, who have had an asthma review in the preceding 12 months was 81.12% compared with 75.35% nationally.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 78.88% compared with 81.83% nationally.

• 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, health visitors and school nurses.

Updated 23 June 2016

The provider was rated as requires improvement for safety and effectiveness. The issues identified as requiring improvement 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice participated in the holistic health assessment scheme; undertaking holistic assessments for elderly housebound patients and putting together a package of care which met all their health and social care needs.

Updated 23 June 2016

The provider was rated as requires improvement for safety and effectiveness. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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 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.

• The practice offered appointments outside of working hours including a surgery on Saturday.

Updated 23 June 2016

The provider was rated as requires improvement for safety and effectiveness. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• Performance for mental health related indicators was similar to the CCG and national average. 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 89.1% compared with 88.4% nationally. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 73.2% compared with 89.5% nationally. The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 95% compared to 84% nationally. The percentage of patients with physical and/or mental health conditions whose notes record smoking status in the preceding 12 months was 90.5% compared to 94.1% nationally.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health.

• The practice provided GP support for two services which accommodated patients with mental health problems.

• The practice hosted local psychology and counselling services.

• 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 23 June 2016

The provider was rated as requires improvement for safety and effectiveness. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice provided support for patients with complex healthcare needs living in supported accommodation.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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 in normal working hours and out of hours.