Berrylands Surgery, Surbiton Health Centre

Updated 1 April 2016

Berrylands Medical Practice provides primary medical services in Kingston to approximately 4000 patients and is one of 26 practices in Kingston Clinical Commissioning Group (CCG). It is one of two practices whose provider is Canbury Medical Centre.

The practice has a higher than average deprivation score for children and older people.

The practice has a lower than CCG and national average proportion of patients who are unemployed, have a learning disability, poor mental health or a long-standing health condition.

The practice has a higher than average proportion of patients aged between 30 and 39 and a slightly higher than average proportion of females over 85 years. The ethnic mix of the practice’s patient population is approximately 79.3% white, 12.7% Asian, 3.8% mixed, 2.3% black, 1.9% other non-white ethnic groups.

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 and baby changing facilities available. The practice has access to three doctors’ consultation rooms and two nurses’ consultation rooms.

The practice team is made up of four GPs, two of whom are partners and form the provider, Canbury Medical Centre (one male (0.5 whole time equivalent (WTE)), one female (0.75 WTE), and two female salaried GPs (all 0.5 WTE). In addition, there are two female practice nurses (one 0.4 WTE, one 0.3 WTE). The practice team also consists of a practice manager (who manages both practices run by the provider), and nine administrative and reception staff members (several of whom work at both practices).

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 open between 8am and 6.30pm Monday to Friday. Extended hours surgeries are available on Mondays and Fridays. Appointments are available between 7.30am and 7.30pm on Mondays, 8am to 6.30pm on Tuesdays, Wednesdays and Thursdays, and 7.10am to 6.30pm on Fridays.

When the practice is closed patients are advised to contact the 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 1 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berrylands Medical Practice on 14 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, however, there was no documented consideration of the risk to patients in cases where the decision was made to deviate from the recruitment procedure.

• 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 GP, however, the practice’s performance with regards to patients accessing a named GP of their choice was lower than the CCG and national average.

• 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.

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

• The provider should ensure that when a new member of staff is employed, complete records are kept of the recruitment process (including application form, interview notes, references and the results of any pre-employment checks). They should also ensure that in all cases suitable pre-employment checks are completed prior to a new member of staff beginning work.

• Ensure that a Patient Participation Group (PPG) is established.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 1 April 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 performance in relation to long-term conditions was comparable to CCG and national averages. For example, QOF achievement for the percentage of patients with hypertension in whom the last blood pressure reading was 150/90 mmHg or less was 81%, the CCG average was 83% and the national average was 84%. The percentage of patients with asthma who had received a review in the preceding 12 months was 73%, which was the same as the CCG average and slightly below the national average of 75%. The practice had recorded having carried-out a review in the preceding 12 months of 93% of patients with chronic obstructive pulmonary disease (COPD), compared to a CCG average of 95% and national average of 90%.

• The practice’s overall performance in relation to diabetes indicators for the year 2014/15 was significantly lower than CCG and national averages at 59% of the total QOF points available, compared with an average of 92% locally and 89% nationally. In particular, the number of diabetic patients who had a blood pressure reading of 140/80 mmHg or less in the preceding 12 months was 67% (CCG average was 80% and national average was 78%); and the number with a record of a foot examination and risk classification in the preceding 12 months was 66% (CCG and national average 88%). In response to these scores, the practice had recruited a GP with a specific interest in diabetes who had begun to run two diabetes clinics twice weekly. They had also introduced a re-call system for diabetic patients to ensure that patients received a timely invite for an annual review. The practice’s QOF scores for the current year to date were viewed and their overall achievement for diabetes indicators was comparable to CCG and national averages.

• Longer appointments and home visits were available when needed.

• All patients who were at risk of unplanned admission 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 1 April 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. Six-weekly safeguarding meetings were routinely scheduled to discuss patients where there were concerns. Immunisation rates were comparable to CCG averages for all standard childhood immunisations.

• The proportion of women whose notes record that a cervical screening test had been performed in the preceding five years was 73%, which was below the CCG average of 82%. We were told by the practice that there had been a coding problem which had led to a number of smear tests not being accurately recorded for reporting purposes (which had now been resolved), and that a significant proportion of their patients went elsewhere for cervical screening.

• 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. The practice had a dedicated health visitor clinic once a week.  

Updated 1 April 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.

• Every patient aged 75 and over had a named GP.

• The practice liaised closely with the district nursing team and offered joint home visits where appropriate.

• The practice carried-out dementia screening on its patients, and periodically performed a search audit to identify any patients with dementia who had been missed from the dementia list.

Updated 1 April 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, including online appointment booking and repeat prescription requests, as well as a full range of health promotion and screening that reflected the needs for this age group.

• Extended hours appointments were offered with both early morning and evening appointments available.

Updated 1 April 2016

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

• Ninety seven percent of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the preceding 12 months, which was above the CCG average of 92% and national average of 88%.

• Sixty-three percent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was considerably below the CCG and  national average of 84%. The practice was working on improving this, and had conducted an audit of patient records to ensure that all patients with dementia were correctly identified and included on their list. The practice carried out advance care planning for patients with dementia and we viewed an example of these plans, which was found to be sufficiently detailed.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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. One of the GPs had completed a diploma in mental health in order to offer improved services to patients and advice and support to colleagues in managing these patients.

• An in-house counsellor was available.

Updated 1 April 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.

• The practice had one patient who was homeless, who had been registered to a local church which provided help to homeless people.

• 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.