Queens Road Surgery

Updated 8 September 2017

Queens Road Surgery is based in Southwark CCG and serves approximately 6100. The practice is registered with the CQC for the following regulated activities Diagnostic and screening procedures Treatment of disease, disorder or injury Maternity and Midwifery Services

The practice is located in an area ranked two out of 10 index of multiple deprivation (a scale used to measure deprivation a score of one being the lowest). The practice population is ethnically diverse with 7% of patient having mixed ethnicity, 8% Asian, 43% black and 4% described as within other non-white ethnic groups. The practice population has higher levels of deprivation effecting children and older people and a significantly larger proportion of working age people compared with the national average.

The practice is run by AT Medics Limited. There is one GP director who undertakes one session per week at the practice, three salaried GPs and two regular long term locums who undertake 20.5 sessions between them. There is a practice based pharmacist who works 0.6 of a whole time equivalent and there is a full time practice nurse.

The practice is open Monday to Friday. Opening hours are between 8 am till 8 pm Mondays and Thursdays. The practice closes at 6.30 pm the rest of the week. Appointments are available during these times. Extended hours appointments are offered between 6.30 pm and 8 pm Monday and Thursday.

Queens Road Surgery operates from 136 Meeting House Lane, London, SE15 2UA which premises are rented from another GP surgery that previously occupied the address. The service is accessible to patients with mobility problems as all consulting rooms are located on the ground floor.

Practice patients are directed to contact the local out of hour’s provider when the surgery is closed.

The practice operates under a Alternative Provider Medical Services (APMS) 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). These are: Meningitis provision, Childhood Vaccination and Immunisation Scheme, Extended Hours Access

Facilitating Timely Diagnosis and Support for People with Dementia, Influenza and Pneumococcal Immunisations, Patient Participation and Rotavirus and Shingles Immunisation and Unplanned Admissions.

The practice is part of GP Federation Independent Health Limited.

Updated 8 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queen Road Surgery on 1 August 2017. 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 practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with said they found it easy to make an appointment with a named GP and 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

  We saw one area of outstanding practice:

A bespoke digital software tool was used by staff at the practice to improve safety and clinical outcomes and, in addition, enabled the practice to monitor recruitment and training. The system recorded all staff training and monitored the expiry dates clinical staff’s professional registrations. Searches were regularly run at the practice which highlighted staff who required training or which professional registrations needed to be checked. The system also enabled the practice pharmacist to ensure compliance with medicines safety alerts and that patient medicines were optimised in accordance with current best practice. In addition the practice used the software to analyse patient data to ensure those with long term conditions were identified, coded and called in for periodic reviews. As a result of the software’s analysis which looked at risk factors and patient medicines, the practice increased the number of patients on their asthma register by 29% and those on their pre diabetic register by 118% between April 2016 and August 2017. The software had also been used to generate information used for an audit of diabetic patients which show a significant increase in patients who had blood sugar levels within the optimal range.

The areas where the provider should make improvement are:

• Discuss the system used to triage patients with staff to ensure that all staff are aware of their roles and responsibilities.

• Take steps to ensure that Patient Group Directions include the practice name when these are renewed.

• Consider storing all practice policies in a single location to ensure that staff are able to access these easily.

• Continue to review staffing levels in the administrative team to ensure that there are sufficient numbers of staff.

• Take steps to monitor and mitigate risks to staff and patients including the risk of legionella.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 September 2017

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

• Staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments were offered for patients with long term conditions which clinicians used to undertake reviews and draft care plans.
• The practice performed in line with local and national averages in respect of the management of diabetes.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• The practice used bespoke IT software created by AT medics to improve identification of patients with long term conditions. For example between April 2016 and August 2017 the number of patient identified as pre diabetic increased by 118%.
• All these patients had a named GP and 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 8 September 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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Staff told us on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice would provide support for premature babies and their families following discharge from hospital.
• Preconception advice was offered to patients with long term conditions including those with epilepsy and diabetes.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice hosted community midwives and worked health visitors to support this population group.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• A bespoke ante and post-natal care planning template created by AT Medics to ensure that pregnant women and those who had just given birth had their needs fully assessed and supported. The ante natal template calculated risk in pregnancy, assessed FGM and safeguarding risk within the family and assessed the mental health of expectant mothers. The template also prompted GP to check for gestational diabetes and MMR status. Post-natal care template again assessed mental health and ensured that complications resulting from pregnancy were assessed and acted upon. The practice planned to share the templates with other practices in the wider locality once they had thoroughly tested them.

Updated 8 September 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 participated in a locality initiative whereby comprehensive reviews were undertaken and care plans drafted for patients over the age of 65 who were housebound or who had not attended the practice in a significant period of time or who were aged over 80. This aimed to address both patient’s health and social needs. One hour appointments were offered for these assessments.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared with other with local care services. For example the practice would liaise with a local geriatrician over the telephone and discuss patients at community multidisciplinary team meetings.

• 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 8 September 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• 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.

• Patients could also be referred to the local primary care extended access service which provided appointments from 8 am to 8 pm seven days per week.

Updated 8 September 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 88% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Patients were invited by text, call and letters for reviews and sent reminders to increase the likelihood of attendance.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. Reviews were undertaken on a monthly basis.

• Performance for other mental health indicators was comparable to local and national averages.

• 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.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. Longer appointments were offered to those deemed to have limited capacity.

Updated 8 September 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. We were told that homeless patients could register at the practice.
• 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. Carers for these patients were invited to attend and offered an assessment.
• 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 interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.