Links Medical Practice

Updated 31 May 2016

Links Medical Practice provides primary medical services in Downham and Mottingham to approximately 11000 patients and is one of 48 practices in Bromley Clinical Commissioning Group (CCG). The practice population is in the third most deprived decile in England.

The practice population has a higher than CCG and national average representation of income deprived children and older people. The practice population of children and working age people are higher than local and national averages with a lower than average population of older people. Of patients registered with the practice for whom the ethnicity data was recorded, 64% are British or Mixed British, 9% other white followed by 5% African.

The practice operates from two branches one in Downham and one in Mottingham. Both the branches operate on purpose built premises. All patient facilities are wheelchair accessible. The Downham practice has access to four doctors’ consultation rooms, one nurse consultation room and one healthcare assistant consultant room on the ground floor. The Mottingham practice has access to six doctors’ consultation rooms, one nurse consultation room and one healthcare assistant consultant room on the ground floor.

The practice team at the surgery is made up of four full-time male GPs, one full-time female GP and two part-time female GPs who are partners, two part-time female salaried GPs, two full-time GP registrars, three part-time female practice nurses and one part-time healthcare assistant. The non-clinical practice team consists of one practice manager, one practice secretary, and eighteen administrators and reception staff members. The practice provided a total of 68 GP sessions per week.

The practice operates under a General Medical Services (GMS) 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 GP registrars, foundation doctors and medical students.

The practice reception and telephone lines are open from 8:00am till 6:30pm on Monday to Friday. Appointments are available from 8:15am to 12:30pm and 1:30pm to 6pm every day.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8:00am and directs patients to the out-of-hours provider for Bromley CCG. The practice had recently signed up to be part of local GP Alliance and provides ten appointments seven days a week through Primary Care hubs which can be booked in advance.

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, family planning, surgical procedures and treatment of disease, disorder or injury.

Updated 31 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Links Medical Practice on 24 March 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Risks to patients were assessed and 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.
• 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.
• 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.

There were areas of practice where the provider should make improvements:

• Ensure that the chaperone processes are in line with guidelines and that staff have been trained and undertake a risk assessment to ascertain if DBS checks are required for all staff who undertake this role.
• Ensure that proof of good character are taken prior to employing new staff.
• Ensure yearly appraisals are performed for all practice staff.
• Ensure that the practice reviews the feedback from national GP patient survey to identify and act on further areas that can be improved.
• Review the complaints procedure to ensure it contains all the relevant information for patients and that complaints are responded in a timely manner.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 31 May 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 national Quality and Outcomes Framework (QOF) data showed that 78% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 87% which was above the CCG average of 78% and slightly below the national average of 88%.
• The national Quality and Outcomes Framework (QOF) data showed that 73% of patients with asthma in the register had an annual review, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All patients with long-term conditions 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 31 May 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 urgent care and 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 79%, which was below the CCG average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered weekly midwifery clinics at the surgery.
• The practice offered sexual health clinics.

Updated 31 May 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 provided a phlebotomy service at the practice for the benefit of older patients who may have difficulty in getting to the hospital.
• The GPs visited two nursing homes and one residential home on a regular basis, supporting the needs of the residents.

Updated 31 May 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 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. Around 5000 patients had registered for online access.

Updated 31 May 2016

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

• The number of patients with dementia who had received annual reviews was 88% which was above the Clinical Commissioning Group (CCG) average of 84% and national average of 84%.
• 87% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months.
• 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 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 31 May 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. These patients were flagged in their clinical system.
• The practice offered appointments for all newly registered looked after children with a named GP and had an alert set up on the computer system.
• The practice offered longer appointments for patients with a learning disability; all the patients with 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.