The Family Surgery

Updated 8 July 2016

The Family Surgery is situated in the London Borough of Bromley. Bromley Clinical Commissioning Group (CCG) is responsible for commissioning health services for the locality.

Services are provided from one location at 7 High Street, Green Street Green, Orpington, Kent BR6 6BG. The premises is leased, ground floor accommodation in a small commercial complex in Green Street Green High Street. A pharmacy is situated in the adjoining property. The premises includes a large reception office, a large waiting room, two consultation rooms and two treatment rooms.

The practice has 3936 registered patients. The practice age distribution is similar to the national average for most age groups with a slightly lower than average rate for patients 20 to 40 years  and a slightly higher than average rate for patients 65 years and over. The surgery is based in an area with a deprivation score of 10 out of 10 (with 10 being the least deprived).

The practice operates under a General Medical Services (GMS) contract. They provide several 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 registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services, maternity and midwifery services, treatment of disease, disorder or injury and surgical procedures. There are currently two partners.

Clinical services are provided by two full time GP partners (male) and two part-time female Practice Nurses (0.7 wte). The administrative staff include a Practice Manager (1.0 wte) and administration, reception and secretarial staff (2.9 wte).

The practice reception and telephone lines are open from 08.00 and 18.30 hours Monday to Friday. Pre-booked and urgent appointments were available from 8.30 to 12.00 hours and 14.00 to 18.30 hours Monday to Friday. The practice is closed at weekends. When the surgery is closed the out of hours GP services provider is accessed via NHS 111.

A practice leaflet was available and the practice website www.thefamilysurgeryorpington.nhs.uk included details of services provided by the surgery and within the local area.

Updated 8 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Family Surgery on 9 March 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events and the practice shared these with other providers. Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Feedback from patients about their care was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• 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.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements and staff felt supported by management.

• The practice proactively sought feedback from staff and patients, which it acted on.

• The practice actively reviewed complaints and how they are managed and made improvements as a result.

• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

• The practice used every opportunity to learn from internal and external incidents to improve patient safety and to make improvements to patient care. Learning was based on a thorough analysis and investigation of all incidents, both internal and external, and lessons were shared both internally and externally.
• An annual staffing needs audit is carried out to ensure administrative and technological demands of delivering the GP contract are being met. Appropriate changes are implemented promptly.

There was one area where the provider should make improvements:

• The provider should review arrangements for patients to access a female GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 July 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.

• Nationally reported QOF data for 2014/15 showed that outcomes for patients with diabetes were below the CCG and national average. However the practice had taken action to address the issue and current data showed an  improvement.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions had a named GP and a structured annual review of their health and medicines needs. 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 July 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 and young people who had a high number of A&E attendances.

• Immunisation rates were 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.

• Cervical screening rates were comparable with the CCG and national average.

• 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 and health visitors.

Updated 8 July 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.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mixed.

• The percentage of people with chronic obstructive pulmonary disease (COPD) who received a seasonal flu vaccination was above the CCG and national average.

• Longer appointments and home visits were available for older people when needed.

Updated 8 July 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 and those recently retired 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. Patients could book appointments and order repeat prescriptions online.

• A full range of health promotion and screening was available that reflects the needs for this age group.

Updated 8 July 2016

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

• The percentage of patients with diagnosed poor mental health who had a comprehensive agreed care plan in the last 12 months was 91.7%. This was comparable to the national average of 88.5%.

• The percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was 71.9%. This was lower than the national average of 84.0%.

• The practice regularly worked with multi-disciplinary teams in the management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice told patients experiencing poor mental health 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 when they had been experiencing poor mental health.

Staff had a good understanding of how to support patients with mental health needs and dementia. All staff, both clinical and non-clinical, had received Mental Capacity Act training and several staff had undertaken dementia awareness training.

Updated 8 July 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 those with a learning disability. Annual health checks had been carried out for all people with a learning disability.

• 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 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.