St Paul's Cottage Surgery

Updated 15 June 2017

Operated by Brocklebank Group Practice, St Paul’s Cottage Surgery provides primary medical services in Wandsworth to approximately 7,780 patients and is one of 44 member practices in the NHS Wandsworth Clinical Commissioning Group (CCG). The practice operates under a Personal Medical Services (PMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

Wandsworth has more 20 to 40 year olds, but fewer older people than other south west London boroughs, reflected in the patient demographics for the practice with 6% of patients aged 65 or over, 76% of patients aged 18-65 years old and 18% aged 18 or younger. The practice population is in the fourth less deprived decile, with income deprivation affecting children and adults comparable to local and national averages.

The practice operates from converted residential premises adapted to allow disabled access to ground floor facilities where all patient consultations take place. The ground floor consists of reception area and waiting room, accessible facilities for patients with baby changing and breast feeding areas available, and five clinical rooms used for consultations and treatment. There are practice management facilities and staff facilities on the first floor.

The practice team at the surgery is made up of one part time lead GP who is a partner at Brocklebank Group Practice, and six part time salaried GPs. One of the GPs is male and six GPs are female. Together the GPs provide 29 clinical sessions per week. The practice has a vacancy for a full time practice nurse position, employing the services of a local nursing agency to provide full time equivalent nursing services. The practice employs one full time female health care assistant. The non-clinical team consists of one business manager, one practice manager and four administrative and clerical staff.

The practice opens between 8.30am and 6.30pm Monday to Friday. Telephone lines are operational between the hours of 8.30am and 6.30pm Monday to Friday. Appointments are available during two sessions daily. Extended hours are available on Monday, Tuesday and Thursday evenings from 6.30pm until 8.00pm. The practice also opens on Saturday mornings between 8.30am and 11.30pm for pre booked appointments.

The provider has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8.30am when the practice directs patients to seek assistance from the locally agreed out of hours provider.

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

Updated 15 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Paul’s Cottage Surgery on 19 October 2016. The overall rating for the practice was good; however the safe domain was rated as requires improvement as:

• Systems, processes and practices to keep patients safe were not always effective with regards to prescription security and checks for emergency equipment.

We also asked the practice to:

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for St Paul’s Cottage Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 16 May 2017 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 inspection on 19 October 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall the practice maintains a rating of good, with the safe domain now also rated as good.

Our key findings were as follows:

• The practice had reviewed and updated their prescription security protocol to reflect improvements made.

• The practice had installed key code locks on all clinical room doors, ensuring security of blank prescriptions when rooms were not occupied.

• The practice maintained a record of prescription use through a log of serial numbers of prescriptions delivered to the practice and a record of when those prescriptions were issued and used.

• Emergency equipment was checked appropriately and regularly by and these checks were recorded and reviewed.

The practice had also reviewed how patients with caring responsibilities were identified and recorded on the clinical system to ensure information, advice and support was made available to them. The practice strategy included new and existing patients:

• The practice ran a campaign to identify and offer information, advice and support to carers in the practice population. This campaign included posters in the waiting area and clinical areas, discussions with individual patients and including carer identification on the practice registration form for new patients. The campaign to date has identified 29 new carers.

• All carers are written to and offered advice and information as well as a structured health and social care review with a clinician. In 2016/17, 44% of carers took up the offer of an annual health and social care review.

• The campaign has also resulted in 32 patients who were previously identified as carers being voluntarily removed from the register as they no longer provide caring responsibilities. This meant the practice could target carer support and information directly to those who needed it.

• The practice currently has 61 carers on their register (0.8% of the practice population).

The areas where the provider should make improvement are:

• Continue to monitor and review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 1 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.

• Performance for diabetes related indicators was comparable to the local clinical commissioning group (CCG) average and the national average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review of their health, medicine and social care needs, managed under the clinical commissioning group (CCG) planning all care together (PACT) scheme.

• 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 1 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 A&E attendances. Immunisation rates were comparable to other practice locally and nationally for all standard childhood immunisations offered.

• 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 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.

• We saw positive examples of joint working with other agencies including health visitors and school nurses.

Updated 1 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.

• All older people had a named GP responsible for their care.

• Older people who met the criteria had their health and social care needs managed under the clinical commissioning group (CCG) planning all care together (PACT) scheme.

• Older patients discharged from hospital were followed up by their GP within 24 hours of the practice receiving notification.

Updated 1 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.

• Online services and telephone consultations were also available.

Updated 1 March 2017

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 comparable to the local clinical commissioning group (CCG) average and the national average.

• 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, with patients being guided through the care system, including following up on and rebooking missed appointments.

• 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 1 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 and travellers.

• The practice offered longer appointments for patients with a learning disability, with patients at risk of developing disease or hospital admission managed under the clinical commissioning group (CCG) planning all care together (PACT) scheme.

• 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.

• The practice recognised lower uptake for the cervical screening programme amongst particular patient groups, in particular Asian women. The practice engaged a local Asian women’s support group and set up their own practice group for Asian women, led by a female GP who spoke Urdu and the practice nurse. This group was set up to improve information for this patient group and remove barriers to accessing care.

• 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 referred patients to a Citizens Advice Bureau (CAB) representative to assist with social welfare issues.