Lambton Road Medical Partnership Also known as Dr Dhalla and Dr Molony Partnership

Updated 30 November 2017

Lambton Road Medical Partnership provides primary medical services in Merton to approximately 17600 patients and is one of 23 practices in Merton Clinical Commissioning Group (CCG).

The practice population has grown steadily from 14000 patients in 2013, when two local practices merged to form Lambton Road Medical Partnership. The practice population is in the least deprived decile in England. The practice population has a lower than average representation of income deprived children and older people. The practice population of children and the number of older people registered at the practice is in line with local and national averages. The practice population of those of working age is also in line with local and national averages at 67%, however of those of working age, specifically patients between the ages of 30-44 are higher than local and national averages. Of patients registered with the practice, approximately 80% are White or White British, 14% are Asian or Asian British and 6% are Black or Black British.

The practice operates from purpose built health centre that opened in 2013. The Practice is based on the first floor with lift access. All consulting rooms and patient areas are wheelchair accessible. The practice has access to 12doctors’ consultation rooms, four nurses’ consultation rooms and one treatment room. The practice also has some administrative offices on the second floor.

The practice team at the surgery is made up of seven partners; however three partners provide clinical sessions at the practice. Two of the partners are part time female GPs and one partner is a part time male GP. There are 11 part time female salaried GPs and two part time male salaried GP. There are also two locum GPs employed at the practice. The total number of GP sessions per week is 54. The nursing team consists of four part time female practice nurses and one part time male practice nurse. The non-clinical team includes a practice manager and an assistant practice manager supported by an office manager, five administrative staff and 18 reception staff members. The practice team also includes an IT support worker and a pharmacist who work between Lambton Road Medical Partnership and another provider organisation linked to the partnership in a neighbouring CCG.

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 GPs and provides teaching for medical students.

The practice reception and telephone lines are open from 8am to 8pm Monday to Thursday, 8am to 6.30pm on Friday and 9am to 1pm on Saturday. Appointments are available between 8.30am and 12pm every morning and 3pm and 5.30pm every afternoon. Extended hours surgeries are offered from 6.30pm to 8pm Monday to Thursday and 9am to 1pm on Saturday. The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8am and at weekends and directs patients to the out-of-hours provider for Merton CCG.

The practice is registered as a partnership of seven partners with the Care Quality Commission to provide the regulated activities of diagnostic and screening services, family planning services, maternity and midwifery services, treatment of disease, disorder or injury and surgical procedures. The seven partners are also registered with the Care Quality Commission as another provider organisation to provide regulated activities in another CCG area and the two partnership organisations are linked.

Updated 30 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Lambton Road Medical Partnership on 12 April 2016. 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 timely access to mandatory training specifically safeguarding training, fire safety training and basic life support training.

A further announced desk-based focused inspection was carried out on 14 December 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous comprehensive inspection on 12 April 2016. During the desk-based inspection we found that safeguarding training and fire training were still not up to date for some staff. Consequently, the practice was still rated as requires improvement for providing safe services.

The full comprehensive report and desk-based focussed inspection report can be found by selecting the ‘all reports’ link for Lambton Road Medical Partnership on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 23 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation 17 that we identified in our previous inspection on 14 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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

Our key findings were as follows:

• Of 50 staff training records checked, 47 members of staff had undertaken annual basic life support training. Three members of staff had training booked for November 2017.

• All 50 staff members had undertaken the appropriate level of safeguarding children’s training.

• All staff members had undertaken the appropriate level of safeguarding adult’s training.

• All staff had completed annual fire training apart from one locum GP.

• All staff had completed annual infection control training apart from one locum GP.

• All staff had completed annual information governance training apart from two locum GPs.

• Five members of clinical staff had received training in the Mental Capacity Act; however shortly following the inspection the remaining 16 clinical staff had undertaken online MCA training apart from 2 locum GPs.

• The practice had put in place a new procedure to monitor staff training records.

• Since the previous inspection the practice had installed a new telephone system with an automated appointment system, which was being regularly audited.

• Since the previous inspection the practice had increased reception staffing by two additional full-time roles.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Keep records of assurance of mandatory training for temporary staff including locum GPs.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 June 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.
• The practice provided an in-house anticoagulation monitoring service for practice patients.
• Longer appointments and home visits were available when needed.
• Performance for diabetes related indicators was in line with averages. For example, 78% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 73% and the national average of 78%.
• The number of patients who had received an annual review for diabetes was 95% which was above the CCG average of 89% and national average of 88%.
• 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 28 June 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 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 82% which was comparable to the Clinical Commissioning Group (CCG) average of 83% and the national average of 82%.
• A full range of family planning services were provided by the practice.
• 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 28 June 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had a dedicated telephone line between 10am and 12pm named the ‘Blue Star Line’ for patients aged 75 and over or those on the practice’s avoiding unplanned admissions register, to ensure swift access to appointments.
• The practice employed an in-house pharmacist to assist with medicine reviews, who specifically focussed on a review of prescribing for practice patients in a local nursing home.
• The practice provided the over 75’s with an information pack which included a booklet produced in conjunction with the Patient Participation Group (PPG), entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups.

Updated 28 June 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 extended hours from Monday to Thursday in the evening in additional to Saturday morning, to meet the needs of their working-age population who were not able to attend during normal 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.
• The practice were based in a local health centre and patients were conveniently able to access a phlebotomy service within the same premises.

Updated 28 June 2016

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

• Performance for mental health related indicators was above the CCG and national averages for the number of patients who had received an annual review at 96%; compared with Clinical Commissioning Group (CCG) average of 92% and national average of 88%.
• The number of patients with dementia who had received annual reviews was 94% which was above the CCG average of 84% and national average of 84%.
• The practice hosted a weekly psychological therapy service and also a weekly bereavement counselling run by a voluntary organisation. This was available to patients from across Merton CCG.
• 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 28 June 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, travellers and those with a learning disability.
• Of 21 patients on the practice’s learning disability register, 14 patients had received a health check in 2014/15 which was 67%.
• 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 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.