Surbiton Health Centre

Updated 21 March 2016

Langley Medical Practice provides primary medical services in Surbiton to approximately 7,000 patients and is one of 26 practices in Kingston Clinical Commissioning Group (CCG).

The deprivation score for the patient population is 9.9, which is slightly lower than the CCG-wide score of 11.1, and significantly lower than the nationwide score of 21.8. 10.4% of the practice’s children live in income deprived households, compared to a CCG average of 12.3% and national average of 19.9%, and 12.6% of the practice’s older people are income deprived, compared to a CCG average of 12.7% and national average of 16.2%.

The practice also has a lower than average proportion of patients with vulnerabilities which may result in a higher demand for services, for example, 39% have a long-standing health condition (CCG average 48%, national average 54%) and 0.4% are unemployed (CCG average 5.5%, national average 5.4%). The proportion of the practice’s population with a learning disablility was the same as the national average and slightly more than the CCG average (0.43% of its total patient population compared to a CCG average of 0.28) and they have a slightly lower than average proportion of patients with a mental health condition (0.65% compared to a CCG average of 0.81% and national average of 0.88%).

The age profile of the practice population is largely in line with CCG averages, however, they have fewer than average patients aged between 20 and 29 at 11.9% (compared to a CCG average of 15.7% and national average of 13.7%). Of patients registered with the practice, the largest group by ethnicity are White British (79%), followed by Asian (13.3%), black (2.2%), mixed (3.6%), and other non-white ethnic groups (1.9%).

The practice operates from purpose-built premises which houses three other GP practices and other community-based health services. It is close to public transport links, and has on-site parking for patients. Patient facilities are all based on the ground floor, with disabled facilities available. The practice has access to four doctors consultation rooms and two nurse consultation rooms. The practice team at the surgery is made up of five GPs. There are three partners (two male (completing one whole time equivalent and one 0.51 whole time equivalent), one female (one whole time equivalent)), plus two female salaried GPs (completing one full time equivalent and one 0.75 whole time equivalent). In addition, there are three female practice nurses (completing 1.51 whole time equivalent between them). The practice team also consists of a practice manager, and five administrative and reception staff members.

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's reception is open from 8.00am to 6.30pm Monday to Friday. Extended hours GP appointments are available between 7.00am and 8.00am on Monday, and Wednesday mornings and between 6.30pm and 8.00pm on Tuesday evenings. Extended hours nurse appointments are available between 7.30am and 8.00am on Monday, Tuesday and Wednesday mornings.

When the practice is closed patients are advised to contact the agreed local out of hours provider.

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, family planning, and surgical procedures.

The practice has not been previously inspected.

Updated 21 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Surbiton Health Centre (Langley Medical Practice) on 7 January 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 an effective system in place for reporting and recording significant events.
• 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.
• 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.
• 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.
• 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.

We saw one area of outstanding practice:

The practice provided in-house clinics for dermoscopy and dermatology (including cryotherapy), musculoskeletal medicine, gynaecology (including chlamydia screening and coil fitting), and a nurse-led  chronic obstructive pulmonary disease clinic. The impact of providing these specialist services had been reviewed by the practice, and they had identified a significant reduction in hospital referrals, for example, referrals had reduced by 53% for dermatology, 27% for orthopaedics, and 14% for respiritory medicine.

However there were areas of practice where the provider should make improvements:

• The practice should consider whether any action should be taken in response to patient feedback about the difficulties in contacting the practice by phone.

• The practice should review the information available in the waiting area and consider whether additional health promotion literature should be made available.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 21 March 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’s overall QOF achievement for diabetes indicators was 92%, which was the same as the CCG average and slightly above the national average of 89%. They performed better than the CCG and national averages for the proportion of diabetic patients with a blood pressure reading of 140/88 mmHg or less, with 95% achieving this compared to a CCG average of 80% and national average of 78%.

• The practice had provided an asthma review to 74% of its patients within the previous 12 months, which was comparable to the CCG average of 73% and national average of 75%.

• Longer appointments and home visits were available when needed.

• The practice ran educational sessions for patients aimed at people with long-term conditions, for example, a session on portion control for patients with diabetes, which was run jointly by the dietician connected to the practice and one of the GPs. Sessions on management of back pain and coping with stress and anxiety were scheduled for 2016.

• The practice actively targeted patients with long term conditions during routine appointments to ensure that their condition was being controlled, for example, during the annual Saturday “flu day” patients with asthma and chronic obstructive pulmonary disease were identified and the opportunity was taken to discuss management plans and check inhaler technique.

  All patients with a long term condition 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.

• The practice provided in-house clinics for dermoscopy and dermatology (including cryotherapy), musculoskeletal medicine, gynaecology (including chlamydia screening and coil fitting), and a nurse-led  chronic obstructive pulmonary disease clinic. The impact of providing these specialist services had been reviewed by the practice, and they had identified a significant reduction in hospital referrals, for example, referrals had reduced by 53% for dermatology, 27% for orthopaedics, and 14% for respiritory medicine.

Updated 21 March 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 A&E attendances. Immunisation rates were higher than the CCG average for all vaccinations.

• 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 proportion of patients at the practice who had attended for cervical screening  was  84%, which was higher than the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The waiting area was suitable for young children and nursing mothers, with a lego wall for children to play with, and a breast feeding room available off of the waiting area.

• Health visitors were available onsite, and staff provided examples of information sharing and joint working with them.

Updated 21 March 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.

• All patients aged over 75 had a named GP, and care plans were developed for patients identified as most at risk of requiring emergency hospital admission.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. They also used a rapid response team which allowed patients who required urgent home visits during clinic times to be seen by a doctor within 2 hours.

• One of the key performance indicators that the practice had selected as part of their PMS contract involved targeting hard to reach over 75 year olds who had not been seen in the past three years.

Updated 21 March 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 five hours of extended access opening per week, which as in excess of their contractual requirement.

• The practice was proactive in offering online services and a limited number of telephone consultations.

• A full range of health promotion and screening that reflects the needs for this age group was provided, including chlamydia screening for all sexually active 15-24 year olds, and a full range of contraceptive services including coil and implant fitting.

• In house referrals for dermoscopy and dermatology (including cryotherapy), musculoskeletal medicine, and gynaecology (chlamydia screening, coil fitting) were popular with working age people.

Updated 21 March 2016

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

• 75% of patients diagnosed with dementia had had had their care reviewed in a face to face meeting in the last 12 months, which is slightly lower than the national average of 84%, however, their relatively low numbers of patients with dementia (prevalence around 35% lower than the national average) may have resulted in this result being distorted.

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan documented in their records in the preceeding 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 21 March 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, such as those with a learning disability and those receiving palliative care.

• The practice did not currently have any homeless patients, but staff told us they had registered homeless patients in the past and would use a friend or relative’s address or the address of the practice.

• 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 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. All staff had received child and adult safeguarding training to the required level.