Trevelyan House Surgery

Updated 30 January 2017

Grafton Medical Partners provides primary medical services in Wandsworth to approximately 40,000 patients at three sites, the practice known as Trevelyan House is one site. There are 22,000 patients registered at Trevelyan House. This is one of 43 practices in the Wandsworth Clinical Commissioning Group (CCG).

The Practice is based on the ground and first floor of a recently purpose built premises with disabled access to treatment and consulting rooms on the ground floor, as well a lift to consulting rooms on the first floor. There are three waiting areas; patients with mobility problems are always seen on the ground floor. There are facilities for wheelchair users including an accessible toilet and lowered reception desk. There is a hearing loop for patients with hearing impairments.

The practice serves a mixed inner-city population. The practice has eighteen consultation rooms and five treatment rooms. The practice team at the surgery is made up of four partners (two part-time male and two full time female),eight salaried GPs (five female and three male) and two long term locum GPs (both female). The practice is a training practice and has one registrar (a registrar is a junior doctor in training), and two F2s (F2 is a transition period of practice between being a student and undertaking more specialised training for a future career in a specialist branch of medicine such as general practice). The total number of GP sessions per week is 79. The nursing team consists of four female practice nurse (two full time and two part time), two healthcare assistants and one phlebotomist. The administrative team includes a full time practice manager and seventeen reception and administrative staff members. The practice team supporting all the Grafton Medical Partners practice sites also includes an IT support worker, a performance manager, an assistant practice manger, a practice administrator, a chief operating officer and a pharmacist. Patients are able to access a range of services offered across the three Grafton Medical Partners sites in Wandsworth CCG.

The practice is open between 8am to 6.30pm Monday to Thursday, 8am to 6.30pm Friday. They offer extended hours from 6.30pm to 8pm four evenings a week and every Saturday from 9am to 1pm. Appointments are available between 8.30am to 8pm Monday to Thursday and 8.30am to 6.30 on Friday. Extended hours surgeries are offered from 6.30pm to 8pm Monday to Thursday and 9am to 1pm on Saturday. The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8am and at weekends and directs patients to the out-of-hours provider for Wandsworth CCG.

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of treatment of disease, disorder or injury; diagnostic and screening; family planning; maternity and midwifery services and surgical procedures.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grafton Medical Partners on 9 November 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 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. Most staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they could make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. Some patients reported difficulty getting through to the practice on the telephone.
• 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 several areas of outstanding practice:

• The practice provided the over 75s with an information pack which included a booklet produced in conjunction with the Patient Participation Group (PPG), entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups.

• The practice organised a Christmas Jumper Day and a raffle, the proceeds were used to fund transport for older patients who experienced difficulties in getting to and from the practice.

The areas where the provider should make improvement are:

• Ensuring all staff, including locums, have role specific training.

• Ensure the new phone system is introduced and continue to monitor patient feedback in relation to accessing the service.

• Ensure complaints are responded to in line with the practice’s own policy.

• Ensure policies and procedures are kept up to date with relevant contact details.

• Review the process for identifying carers and the support that is provided for them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 30 January 2017

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.

• There were 1688 patients on the diabetes register.

• Performance for diabetes related indicators was comparable. For example, 68% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients 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 an in-house anticoagulation (anticoagulation is the monitoring for patients on medicines such as Warfarin that helps prevent blood clots.

Updated 30 January 2017

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 Accident and Emergency (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.

• Cervical screening had been carried-out for 92% of women registered at the practice aged 25-64, which was comparable to the CCG average of 83% and national average of 82%.

• 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 was able to refer to a local service for family planning treatment and information if family planning services were not accessible at one of the other Grafton Medical Partners practices.

• The practice had an in-house AQP (Any Qualified Provider) ultrasound service, meaning patients could aThere were appointments up to 7.30pm

• The practice offered double appointments for parents with young children.

Updated 30 January 2017

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 had a dedicated telephone line between 10am and 12pm named the ‘Blue Star Line’ for patients aged 75 and over or those on the practice’s avoiding unplanned admissions register, to ensure swift access to appointments.

• The practice employed an in-house pharmacist to assist with medicine reviews, many of which supported elderly patients.

• An information pack for the 75’s was provided, which included a booklet produced in conjunction with the Patient Participation Group (PPG), entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups.

• The practice had an in-house phlebotomy service with a dedicated phlebotomist.

• The practice organised a Christmas Jumper Day and a raffle, the proceeds were used to fund transport for older patients who experienced difficulties in getting to and from the practice.

• Annual health checks were offered to patients over 75.

Updated 30 January 2017

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.

• The practice provided extended hours and was open until 8pm four evenings a week and every Saturday morning 9am to 1pm.

Updated 30 January 2017

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

• Seventy seven percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months.

• Performance for mental health related indicators was in line with the CCG and national averages for the number of patients who had received an annual review, which was 90% compared to the CCG average of 91% and national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.

• The practice provided access to in-house counselling, psychotherapy and group therapy at another Grafton Medical Partners practice in Tooting as well as being able to refer to local psychological therapy services.

Updated 30 January 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 homeless people, travellers and those with a learning disability.

• For 2015/16, the practice had identified 97 patients on the learning disabilities register and 57 had received an annual check, which was 59%.

• There were longer appointments available for vulnerable patients including those requiring translation services and those with a learning disability.

• The practice offered face-to-face and telephone interpreting services for patients whose first language was not English, and for sign language.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  The practice commissioned a citizens advice service weekly due to the level of social needs required by the practice’s population group. They offered general advice on a range of issues including housing and benefits.

• 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.