Bursted Wood Surgery

Updated 29 September 2016

Bursted Wood Surgery is situated in the London Borough of Bexley. Services are provided from one location at 219 Erith Road, Bexleyheath, Kent DA7 6HZ. Bexley Clinical Commissioning Group (CCG) is responsible for commissioning health services for the locality.

Bursted Wood Surgery is located in purpose-built premises opened in 1986. The premises comprises of four consulting rooms and a treatment room on the ground floor with a meeting room on the first floor. The surgery hosts several services including a weekly anticoagulation clinic and a counselling service (three days per week). Office space on the first floor is used to host the local Community Education Providers Network (CEPN) service.

The practice has 4748 registered patients. The practice age distribution is similar to the national average. The surgery is based in an area with a deprivation score of 8 out of 10 (10 being the least deprived).

The practice has operated under an Alternative Provider Medical Services (APMS) contract since 2012 under which they are required to report quarterly on 15 key performance indicators (KPIs). The current contract is due to expire in 2019.

The practice is required to provide 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 registered as an Organisation (Clocktower Healthcare Ltd) with the Care Quality Commission and is registered to provide the regulated activities of diagnostic and screening services, maternity and midwifery services, treatment of disease, disorder or injury and surgical procedures.

The practice provides 14 regular GP sessions per week. These include, 4 sessions by the female salaried GP and 10 sessions by three locum GPs (two female GPs and one male GP).

Clinical services are also provided by four locum Nurse Practitioners (10 sessions per week): one Practice Nurse (0.53 wte) and one Health Care Assistant (HCA) (0.53 wte).

Administrative services are provided by a Practice Manager (1.0 wte); a Deputy Practice Manager (0.88); two Senior Administrators (1.32 wte) and five administrative/reception staff (2.56 wte).

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday with extended hours on Tuesday until 8.15pm and Thursday from 7.30am to 8am (telephone lines close at 6.30pm).

Booked appointments are available with the GP or Nurse Practitioner from 8.30am to 09.50am and 3pm to 5.50pm on Monday and Wednesday; from 9am to 9.50am and from 3pm to 7.50pm on Tuesday; from 8.30am to 9.50am and from 2pm to 5.40pm on Thursday and from 8.30am to 11.20am and from 2.30pm to 5.50pm on Friday. A ‘Sit and Wait’ surgery is held daily between 10am and 11am for patients who need to be seen urgently.

Practice Nurse appointments were available between 8.30am and 12.45pm Monday and Thursday; between 2.30pm and 5.45pm on Tuesday; between 8.30am and 11.45am on Wednesday and between 9am and 12.45pm on Friday.

HCA appointments are available from 2.30pm to 6pm on Tuesday; from 8am to 10.45am and 1pm to 2.15pm on Thursday and from 9am to 11.45am and 1pm to 2.15pm on Friday.

A practice leaflet was available and the practice website included details of services provided by the surgery and within the local area.

Updated 29 September 2016

We carried out an announced comprehensive inspection at Bursted Wood Surgery on 21 July 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. 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 generally found it easy to make an appointment but that there was a lack of continuity of care due to the absence of permanent medical staff. Urgent consultations were 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The provider should continue to make every effort to recruit permanent GP staff.

• The provider should review the management of long-term conditions to improve outcomes for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 September 2016

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

• Some nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance data for the management of patients with diabetes was comparable with local and national averages.

• Performance data for the management of patients with long-term respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD), were below local and national averages.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions were offered a structured annual review to check that their health and medicines needs were being met. For those patients with the most complex needs theGP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 September 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 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.

• 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.

• The practice’s uptake for the cervical screening programme was comparable with the local and national average.

• 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.

Updated 29 September 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 (9% of the practice population was over 75 years, which is slighter higher than local and national averages).

• The practice offered home visits and urgent appointments for those with enhanced needs. Housebound patients are highlighted on the patient record system.

• The 2% of patients placed on the practice admission prevention register were monitored regularly and given priority access to clinicians.

Updated 29 September 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 had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Extended hours appointments are available on two days a week.

• The practice was proactive in offering online services and patients are sent text reminders for booked appointments.

• A full range of health promotion and screening was available which reflected the needs for this age group.

Updated 29 September 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had a higher than average prevalence of patients with dementia compared to local and national averages.

• The practice carried out advance care planning for patients with dementia. The practice was responsible for 52 patients resident in a local care home for patients with dementia. Verbal and written consent was obtained from patients to enable the practice to communicate with named relatives when appropriate.

• Performance data for the management of patients with dementia was below local and national averages. However, 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months, this was above the CCG average of 81% and national average 84%.

• Performance data for the management of patients with a diagnosed mental health disorder was comparable to local and national averages.

• The practice told patients experiencing poor mental health 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.

Updated 29 September 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability and patients who required them.

• 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.