Grand Drive Surgery

Updated 23 November 2017

Grand Drive Surgery provides primary medical services in Merton to approximately 9000 patients and is one of 23 practices in Merton Clinical Commissioning Group (CCG). The practice population is in the least deprived decile in England.

The practice population has a lower than CCG and national average representation of income deprived children and older people. The practice population of children is below the CCG and national averages and the practice population of working age people is in line with the CCG and above the national average; the practice population of older people is in line with the local and above national averages. Of patients registered with the practice for whom ethnicity data was recorded 72% are White British and 28% others.

The practice operates in converted premises. All patient facilities are wheelchair accessible. The practice has access to six GP consultation rooms and one nurse and one healthcare assistant consultation room on the ground floor.

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). The practice is a training practice for trainee doctors and GPs.

The clinical team at the surgery is made up of four female GPs who are partners, two female salaried GPs, two female practice nurses and one female healthcare assistant. The non-clinical practice team consists of practice manager, assistant practice manager and 10 administrative and reception staff members. The practice provides a total of 35 GP sessions per week; in addition seven sessions are provided by GP trainees.

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday. Appointments are available from 8am to 6.30pm Monday to Friday. Extended hours surgeries are offered on Wednesdays to Fridays from 7.30am to 8am and on Thursdays from 6.30pm to 8.30pm.The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8am and directs patients to the out-of-hours provider for Merton CCG.

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

Updated 23 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Grand Drive Surgery on 10 January 2017. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. This was because not all staff had received annual basic life support training or mental capacity act training in line with their roles. The provider had not ensured that fire drills were regularly carried out.

The full comprehensive report can be found by selecting the ‘all reports’ link for Grand Drive Surgery on our website at www.cqc.org.uk.

This inspection was an announced desk-based follow up inspection carried out on 18 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation 12 Safe care and treatment, that we identified in our previous inspection on 10 January 2017. This report covers our findings in relation to those requirements and also where additional improvements have been made since our last inspection.

Overall the practice is rated as good. Specifically the practice was now found to be good for providing safe services.

Our key findings were as follows:

• The practice had carried out six monthly fire drills and maintained a record of these.

• All staff had received annual basic life support training.

• All doctors had received Mental Capacity Act training. The practice nurses had undertaken mental capacity act training as part of safeguarding adults training.

• Significant events were discussed with relevant staff.

• The practice had implemented a clear system for monitoring and acting on medicines and safety alerts.

• The practice had a clear system to monitor uncollected prescriptions.

• Failsafe thermometers had been installed on all refrigerators used to store medicines.

• The practice had an improved system in place to ensure all staff had received or had yearly appraisals booked.

• The practice had put in place a process to ensure that patients with a learning disability received an annual health check.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 15 March 2017

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. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
• The national Quality and Outcomes Framework (QOF) data showed that 86% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 72% and the national average of 78%. The number of patients with diabetes who had received a foot examination in the preceding 12 months was 94% which was above the CCG average of 84% and national average of 89%.
• The national QOF data showed that 74% of patients with asthma in the register had an annual review, compared to the CCG average of 75% and the national average of 76%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had a significantly below average unplanned hospital admissions for patients with long-term conditions.
• The practice GPs had personal patient lists which facilitated continuity of care of these patients.
• The practice patients had access to in-house anticoagulation clinics which reduced the need for patients to visit a hospital. 

Updated 15 March 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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of urgent care and Accident and Emergency (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 were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 85%, which was in line with the Clinical Commissioning Group (CCG) average of 81% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice patients had access to antenatal care and postnatal care through GP clinics which included 6-8 week checks.
• The practice recorded the immunisation status of all patients under the age of 25 and these patients were invited to complete the course of immunisations.
• The practice patients had access to in-house clinics for menorrhagia (menstrual period with excessive bleeding) and coil fitting.

Updated 15 March 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice healthcare assistant regularly visited housebound patients and performed domiciliary phlebotomy; this covered the shortages with local domiciliary phlebotomy services.
• Longer appointments and home visits were available for older people with long term conditions when needed.
• All patients over the age of 75 had a named GP which helped with the continuity of care.
• One of the practice GPs helped design a local health centre and helped in the development of Holistic Assessment and Rapid Investigation (HARI). This enabled the practice to arrange rapid assessment of patients in a local environment for many conditions.

Updated 15 March 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.
• 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. About 24% (2,150 patients) of patients in the surgery had registered for online access.
• The practice offered extended hours appointments with GPs and nurses which suited working age people.

Updated 15 March 2017

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

• 97% of 83 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 90% and national average of 89%.
• The number of patients with dementia who had received annual reviews was 85% which was in line with the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice performed a review of all patients over the age of 75 during 2014 and 2016; this significantly improved their dementia diagnosis rate and the practice had the second highest dementia prevalence out of the 24 local practices.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice held quarterly meetings with their local mental health lead to discuss patients with severe mental health conditions.

Updated 15 March 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 homeless people, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability. Only 69% (20 patients) out of 29 patients with a learning disability had received a health check in the last year.
• 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.
• The practice had alerts set up for vulnerable children and families on their electronic patient management system.