Vanbrugh Group Practice, The Greenwich Centre

Updated 7 March 2018

Vanbrugh Group Practice is a large general practice in Greenwich. The practice was established in the 1950s but moved into the current purpose-built premises in The Greenwich Centre in 2015. The premises are rented from NHS Property Services.

The surgery is based on the second (top) floor of The Greenwich Centre. The floor is shared with Oxleas NHS Foundation Trust Community Services. The Centre also includes a gym, library and cafe on the lower floors.

The practice accommodation is based over one floor which can be accessed by a lift. Facilities include a large administration office and practice manager’s office which could be accessed via the rear of the reception desk; a patient records and scanning office; 13 consultation/treatment rooms; a dedicated minor surgery room; staff kitchen and lounge area; library; baby feeding room and baby changing room. There is a large waiting area with dedicated children’s area and a large reception desk and seminar/meeting room which is shared with Oxleas NHS Foundation Trust.

The surgery is based in an area with a deprivation score of 6 out of 10, with 1 being the most deprived and 10 being the least deprived. The practice age distribution has a much higher than average number of patients in the 0 to 4 year age group and the 25 to 40 year age group.

Vanbrugh Group Practice operates under a Personal Medical Services (PMS) contract providing services to 14,279 registered patients. (PMS contracts are local agreements between NHS England and a GP practice. They offer local flexibility compared to the nationally negotiated General Medical Services (GMS) contracts by offering variation in the range of services which may be provided by the practice, the financial arrangements for those services and who can hold a contract).

Greenwich Clinical Commissioning Group (CCG) is responsible for commissioning health services for the locality.

The provider is registered with the CQC as a Partnership of four partners providing the regulated activities of diagnostic and screening procedures; family planning; treatment of disease, disorder and injury; surgical procedures and maternity and midwifery services.

Vanbrugh Group Practice is a training practice usually providing placements for two GP Registrars each year. (A GP Registrar is a qualified doctor training to become a GP. GP Registrars are allocated longer appointments to see patients at the beginning of their placement and are provided with support by a GP during their sessions). Two of the GPs are GP trainers.

The practice is also a teaching practice offering placements to medical students and Foundation Year 2 (FY2) doctors (FY2 is a grade of medical practitioner undertaking the Foundation Programme which is a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist general practice training). The practice also provides a maximum of four places for third-year medical students in each of the three annual intakes.

The practice participates in research studies in association with the Clinical Research Network.

GP services are provided by the four (male and female) partners (2.8 wte) and eight salaried GPs (3.8 wte). There are also usually two GP Registrars providing patient appointments.

Clinical services are also provided by two Specialist Practitioner Practice Nurses (1.4 wte); one Practice Nurse (0.5 wte); one District Nurse for the elderly (0.4 wte); one Primary Care Assistant Practitioner (0.7 wte) and one Healthcare Assistant (0.9 wte).

Administrative services are provided by one full-time Practice Manager; one full-time IT Lead; one Typist (0.7); one Scanning Clerk (0.48 wte); two Data Entry Clerks (1.2 wte); one Prescription Clerk (0.8 wte) and eight Receptionists (4.8 wte).

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday.

Appointments are available with a GP between 7am and 7pm on Monday and Friday; between 7am and 6pm on Tuesday; between 8am and 5pm on Wednesday and between 8am and 7pm on Thursday. Daily emergency clinics provide appointments for patients requiring urgent care and partners also offer on the day urgent appointments after their morning surgery as required.

Appointments are available with a Specialist Practitioner Practice Nurse between 9am and 5.50pm on Monday and Thursday; between 8am and 5.50pm on Tuesday and Friday and between 9am and 10.30am on Wednesday.

Appointments are available with a Practice Nurse between 8am and 3.15pm on Monday; between 9.30am and 4.45pm on Tuesday and between 2pm and 5.45pm on Wednesday. A District Nurse for the Elderly provides visits to housebound patients on two days per week.

Appointments are available with the Primary Care Assistant Practitioner or Healthcare Assistant between 8am and 5.45pm on Monday and Thursday; between 8am and 4.45pm on Tuesday and Wednesday and between 8am and 5.15pm on Friday.

A GP surgery was also held at Morden College on Monday, Wednesday and Friday morning for its Morden College residents. (Morden College is an independent charity providing care services based in Blackheath. They provide accommodation for independent living, accommodation with some domestic support and residential care with nursing.)

In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are available on the same day. Telephone consultations are also available daily.

When the surgery is closed urgent GP services are available via NHS 111.

Patients also have access to GP services out of hours at the two GP Access Hubs which are open on Saturday from 9am to 5pm; Sunday from 9am to 5pm and Monday to Friday from 4.30pm to 8pm (by appointment only). Appointments are booked via the surgery or through NHS 111. GPs are able to book advance appointments for their patients on Saturday and Sundayand on the same day for weekday appointments. Patients are seen by a Greenwich GP with access to their GP medical records. Details of patient consultations are recorded directly onto the patient’s registered GP’s records. Both Access Hub sites were four miles from the surgery.

Updated 7 March 2018

At our previous announced comprehensive inspection of Vanbrugh Group Practice on 15 August 2017 the overall rating for the practice was good. The provider was rated as good for providing effective, caring, responsive and well-led services and requires improvement for providing safe services. The full comprehensive report of the inspection can be found by selecting the ‘all reports’ link for Vanbrugh Group Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 February 2018 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 at our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection, carried out on 13 February 2018, we found that the provider had addressed all the issues identified at the previous inspection. The provider was now meeting the requirements of the regulations. 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. The system now included the detailed identification and recording of all learning outcomes resulting from investigations carried out.
• The practice had systems in place to minimise risks to patient safety. These now included a comprehensive cold chain policy which included the action staff should take if fridge temperatures fell outside of the recommended range and the regular checking of emergency equipment and medicines.
• A process was in place to monitor that results were received for all cervical screening samples sent for testing. Inadequate sample rates were routinely monitored.
• A new process had been introduced to check that all patients referred under the two-week wait process received an appointment within the required timescale.
• The practice had addressed the issue of a large number of records awaiting coding by revising the criteria for coding to ensure it was now selective and by allocating additional administrative time to carry out the task.
• There was now a reliable process for checking uncollected repeat prescriptions. This process included a monthly check by the prescription clerk when uncollected prescriptions were passed to a GP for review and action taken where necessary.
• At the previous inspection we noted that patient satisfaction rates regarding the ease with which they were able to get through to the practice by telephone were below the CCG and national averages. Since the previous inspection the provider had installed a new telephone system and had employed two additional members of reception staff to help reduce the pressure at key times.
• At the previous inspection we saw that privacy of communication at the reception desk was limited due to the open-plan aspect of the reception and waiting area. Since the previous inspection the provider had rearranged the seating to ensure patients were not sitting close to the reception desk and had installed background music so that conversations at the desk were less audible.
• Staff reported that patients had been giving very positive feedback regarding the new telephone system and introduction of music in the waiting area.

Professor Steve Field  CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 12 October 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice performance rate for most Quality and Outcomes Framework (QOF) indicators were comparable to local and national averages. The diabetes related indicator was below the local and national average but the practice were addressing this.
• The practice followed up patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 October 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children who were at risk.
• Immunisation rates for some standard childhood immunisations were below the national target. The practice were aware of the n eed to improve performance and had taken action to address this.
• Children and young people were treated in an age-appropriate way. The practice had achieved ‘You're Welcome’ status (The ‘You’re Welcome’ programme in Greenwich supports services to become ‘young people friendly’).
• Appointments were available outside of school hours and the premises were suitable for children and babies. There was a children’s play area in the waiting room and baby changing and feeding rooms.
• The practice worked with midwives and health visitors to support this population group and held regular meetings with the health visitor who was based on the premises.

Updated 12 October 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice employed a District Nurse for the elderly to carry out treatment and assessments for housebound patients.
• The practice involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up older patients following discharge from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible

Updated 12 October 2017

The pra ctice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Extended opening hours were available on three mornings and three evenings each week.
• The practice was proactive in offering online services. The practice e ncouraged online registration for booking appointments, ordering medications and viewing results. The practice uptake rate for online services was one of the highest in the local CCG.
• A full range of health promotion and screening services were provided that reflects the needs for this age group.

Updated 12 October 2017

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

• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local average of 87% and national average of 84%. The practice carried out advance care planning for patients living with dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs but uncollected prescriptions were only checked six-monthly.
• 97% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was comparable to the local average of 82% and national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 12 October 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 those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse and were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.