Archived: Silverlock Medical Centre

Updated 5 June 2017

Silverlock Medical Centre is part of Southwark Clinical Commissioning Group (CCG) and serves approximately 7200 patients. The practice is registered with the CQC for the following regulated activities treatment of disease, disorder or injury; maternity and midwifery services; diagnostic and screening procedures.

The practice has a significantly higher proportion of people aged 20 – 39 with almost double the national unemployment rate. The practice is situated within one of the second most deprived areas of the country on the index of multiple deprivation. The practice has a lower proportion of patients aged over 40 compared to the national average.

The practice is run by three GPs of mixed gender and a female nurse. The Silverlock Medical Centre has been a teaching practice since 2014.

The practice is open between 8.00am to 6.30pm Monday to Friday except Tuesday and Wednesday when the practice closes at 8.00pm. The practice offers 23 GP sessions per week (four of these sessions are currently covered by locum staff) with booked and emergency appointments.

Silverlock Medical Centre operates from the bottom floor of a tower block. The practice is spread over two areas which are separate and independently accessible from the outside. The property is rented from Southwark Council and AT Medics are responsible for maintenance. The building is wheelchair accessible.

The practice was taken over by AT Medics in 2012. We were told that the practice inherited a range of challenges from the previous provider including poor governance, management of notes and problems with patient access. The new provider told us that they took successful action and addressed all of these concerns; for example the practice increased appointment availability by 95% between 2012 and 2016 and have doubled the number of patients seen within the same period.

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

The practice operates under an 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: Childhood Vaccination and Immunisation Scheme, Extended Hours Access, Facilitating Timely Diagnosis and Support for People with Dementia, Improving Patient Online Access, Influenza and Pneumococcal Immunisations, Minor Surgery, Patient Participation, Risk Profiling and Case Management, Rotavirus and Shingles Immunisation and Unplanned Admissions.

The practice is part of GP federation Quay Health Solutions.

Updated 5 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Silverlock Medical Centre on 21 July 2016. The practice was rated good overall and requires improvement for safe. The full comprehensive report from this inspection can be found by selecting the ‘all reports’ link for Silverlock Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 10 May 2017 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 in our previous inspection on 21 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection undertaken on 21 July 2016 , we rated the practice as requires improvement for providing safe services and issued a requirement notice for breaches of regulation 12 of the Health and Social Care Act Regulations 2014 as:

• The practice did not have systems in place to monitor the professional registrations of clinical staff.

• Not all staff had completed essential training in accordance with recommendations and guidelines.

• Risks associated with the spread of common communicable diseases, fire, legionella, equipment and emergencies had not been adequately assessed and mitigated.

In addition to the breaches in regulation we suggested the practice should take the following actions:

• Put processes in place to regularly review and update practice policies.

• Include local safeguarding contacts and practice leads within the practice’s safeguarding policy.

• Improve uptake of breast screening and review procedures used to identify patients with

Coronary Heart Disease.

• Introduce a programme of quality improvement which focuses on improving clinical care.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Undertake appraisals for all salaried staff.

The practice is now rated as good for the key question: Are services safe?

Our key findings were as follows:

• The practice had put in place a system to ensure that regular checks of professional registrations were undertaken.

• Staff had completed essential training in accordance with recommendations and guidelines including fire safety and infection control.

• The practice had complied with the recommendations in their legionella risk assessment.

• All electrical equipment had been tested to ensure that it was safe to use.

• The practice provided evidence that staff had either been vaccinated against common communicable diseases or supplied risk assessments to justify the absence of immunisations for certain members of staff.

• The practice had a full complement of emergency medicines which reflected current guidelines and their business continuity plan contained contact information for all members of staff.

In addition:

• The practice sent us a sample of policies demonstrating that reviews were being completed on a regular basis. The practice’s safeguarding policies for adults and children identified the practice leads and contained information for external contacts within the community.

• The practice told us that they were using a new breast screening alert on their clinical system to alert clinicians to patients who were eligible for breast screening. The practice also informed us that they provided leaflets both in the surgery and on their website. The practice informed us that they would actively contact patients who failed to attend for their breast screening appointment. There had been an increase in the percentage of females aged 50-70 screened for breast cancer in last 36 months from 48% at our last inspection to 55%. However this was still below the local average of 63% and the national average of 73%.

• The practice told us that they were using computer software to increase the identification of patients with coronary heart disease (CHD) and provided a search of patients prescribed clopidogrel (medication given to patients who have had a heart attack) where there was no diagnosis of CHD noted on their records.

• The practice provided evidence of improved clinical performance assessed against key performance indicators set by the Clinical Commissioning Group (CCG) in respect of administration of flu vaccinations and management of long term conditions. All areas assessed showed improvement between 2015/16 and 2016/17 For example patients with hypertension who had blood pressure readings within target range had increased by 7% and the numbers of pregnant women who received a seasonal flu vaccination had increased by 25%. The practice had improved performance in these areas by employing a pharmacist to assist with management of patients with long term conditions and upskilling a receptionist to become a healthcare assistant who delivered 349 flu vaccinations in the last flu season.

• The practice informed us that they had increased the number of patients on their carers register by 15 patients to 52 (0.8%). The practice had used their seasonal flu campaign to identify patients who act as carers and held an open day in October 2016 which was attended by a local carers support organisation.

• The practice provided evidence that internal appraisals were being undertaken for salaried clinical staff working at the practice.

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

The provider should:

• Continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Continue work to improve uptake of breast screening.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 November 2016

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

• The practice nurse led in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice also employed a pharmacist who undertook the management of medication for chronic disease patients.

• Performance related to the management of patients with diabetes was comparable to local and national averages.

• 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 held virtual clinics with consultant input for complex patients with respiratory illnesses and diabetes.

Updated 25 November 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 relatively high for all standard childhood immunisations. The practice hosted quarterly safeguarding meetings and the health visitor was usually in attendance.

• We saw evidence to confirm that children were treated in an age appropriate way.

• The percentage of female patients who had received cervical screening was comparable to local and national averages.

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

Updated 25 November 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.

• The practice provided GP services to 13 residents at a local residential care home.

• One of the non-clinical staff within the practice had recently been appointed to the role of primary care navigator; working to address social isolation amongst patients within the practice.

• The practice had recently signed up to a pilot whereby the practice would have access to a geratologist for urgent referral and assessment of elderly people avoiding the need for admission.

Updated 25 November 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 25 November 2016

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

• 92% 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.

• Performance indicators for the management of patients with mental health conditions were in line with local and national averages.

• 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 and provided longer appointments where appropriate.

• 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 had a serious of short films that AT Medics staff had produced about mental health awareness. These films were translated into Somali, Urdu and Bengali as the organisation had identified high prevalence of mental illness among this population.

Updated 25 November 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 including homeless people those with a learning disability and told us that they were conscious of those who may be isolated due to cultural reasons, unpaid carers and those with substance abuse issues.
• The practice offered longer appointments for patients with a learning disability and their carers to attend in order for them to offer carer health checks.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.