Dr Seyan & Partners

Updated 12 May 2016

Dr Seyan & Partners provides primary medical services in Sutton to approximately 11200 patients and is one of 27 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the third least deprived decile in England.

The practice population has an average representation of income deprived children and older people. The practice population of children are above local and national averages, the practice population of those of working age is in line with local and national averages at 63%, however there are a higher number of those between the ages of 25 and 45. The number of older people registered at the practice is lower than local and national averages; 12% of patients are over the age of 65. Of patients registered with the practice, 67% are White or White British, 26% are Asian or Asian British and 7% are Black or Black British.

The practice operates from a purpose built health centre. The practice shares the health centre premises with community health services. The practice sub-lets four consultation rooms to another GP provider and both practices share the same waiting and reception area. All patient facilities are on the ground floor and are wheelchair accessible. The practice has access to eight doctors’ consultation rooms, four nurses’ consultation rooms and one treatment room. The practice team at the surgery is made up of two full time male GPs who are partners, one part time female GP who is a partner, three part time female GPs and one part time male GP. The total number of GP sessions per week is 42. The nursing team consists of a part time nurse practitioner who is a nurse prescriber, two part time female practice nurses and one part time female health care assistant. The administrative team includes a practice business manager, five administrative staff and 11 reception staff members.

The practice operates under a Personal Medical Services (PMS) 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 a training practice for trainee GPs and provides teaching for medical students.

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday. Appointments are available between 8.30am and 12pm every morning and 3pm and 6.20pm every afternoon. Extended hours surgeries are offered from 7am to 8am every Monday, Thursday and Friday morning. 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 Sutton CCG.

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

Updated 12 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Seyan & Partners on 15 March 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 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.
• The practice engaged with local commissioners and other stakeholders to ensure that services were tailored to meet the needs of the practice’s population groups. For example, a number of services offered by the practice meant that care could be provided closer to home.
• Most patients said they found it easy to make an appointment with a named GP. Patients were able to access urgent appointments on 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.

We saw several areas of outstanding practice:

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice provided an anticoagulation service led by a GP and the practice nurses. Patients from across the Clinical Commissioning Group (CCG) were able to access the ‘anticoagulation hub’ which reduced the need to attend the hospital for monitoring. The practice nurses also provided domiciliary anticoagulation visits to 30 housebound patients who were registered with the practice to provide continuity of care.

• There were innovative approaches to providing care closer to home. For example, the practice provided an in-house gynaecology service utilising a practice GP with a special interest in gynaecology, to reduce the need for patients to be referred to hospital gynaecology services. For 2014/15, the practice had only found it necessary to refer one patient to secondary care for gynaecology, which was the lowest referral rate in the CCG area for this service.

• The practice had also identified that they needed to improve access to psychological therapies for their patients. In addition to referring to local psychological support services the practice had arranged for in-house counselling services approximately three days per week. From January 2015 to December 2015 the in-house counselling team saw 48 patients with a waiting time that varied from two weeks to six weeks. The waiting time for the local psychological support service was three months, demonstrating that patients were able to access mental health support more quickly via the in-house service.

The areas where the provider should make improvement are:

• Ensure that medicines management procedures include robust monitoring of emergency medicines.

• Ensure that care planning is holistic and patient centred in order to assess and monitor patients’ needs effectively.

• Ensure that the practice has robust systems in place to be able to identify and support all patients acting as carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 12 May 2016

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

• Patients from across the Clinical Commissioning Group (CCG) were able to access the ‘anticoagulation hub’ which reduced the need to attend the hospital for monitoring. The practice nurses also provided domiciliary anticoagulation visits to 30 housebound patients who were registered with the practice, to provide continuity of care.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was mixed. For example, 68% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the CCG average of 74% and the national average of 78%. The number of patients who had received an annual review for diabetes was 91%, which was above the CCG average of 86% and national average of 88%.
• The number of patients with Chronic Obstructive Pulmonary Disease (COPD) who had received annual reviews was 93% which was above CCG average of 91% and national average of 90%.
• The practice provided a daily in-house phlebotomy service with a health care assistant.
• The practice provided a weekly diabetic clinic with a GP and practice nurse.
• 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 had worked with the Patient Participation Group (PPG) to offer health education sessions. Sessions on diabetes, dementia and heart failure had been held in the practice.
• Longer appointments and home visits were available when needed.

Updated 12 May 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 Accident and Emergency (A&E) attendances.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice provided baby clinics, midwife-led antenatal clinics and post-natal checks.
• Chlamydia screening and a range of contraceptive services were provided by GPs and nurses.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 96%, which was above the Clinical Commissioning Group (CCG) average of 83% and the national average of 82%.
• The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 75% which was in line with CCG and national averages.

Updated 12 May 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 had initiated an over 65s alert on the electronic record system to prompt clinicians to monitor patients for conditions such as dementia and atrial fibrillation.
• The practice had engaged with the Clinical Commissioning Group (CCG) and local community services and were able to invite patients to local education sessions for those over 75 to improve holistic health and well-being of patients.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line or above averages. For example, the percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 9 months is 150/90 mmHg or less was 83%, which was above the CCG average of 81% and in line with national average of 84%.
• Flu vaccination rates for 2014/15 for the over 65s were 78% which was above the national average.

Updated 12 May 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 offered extended hours on a Monday, Thursday and Friday morning to meet the needs of their working-age population who were not able to attend during normal opening hours.
• One of the GPs provided a minor surgery clinic at the practice for joint injections and skin conditions.
• There were innovative approaches to providing care closer to home. For example, the practice provided an in-house gynaecology service utilising a practice GP with a special interest in gynaecology, to reduce the need for patients to be referred to hospital gynaecology services.
• Patients were able to receive travel vaccinations available on the NHS and those available privately. The practice were a registered yellow fever centre.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice were based in a local health centre and patients were conveniently able to access a number of services within the same premises including minor surgery, chiropody, breast screening and audiology.

Updated 12 May 2016

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

• Performance for mental health related indicators was above the Clinical Commissioning Group (CCG) and national averages for the number of patients who had received an annual review at 95%; compared with CCG average of 87% and national average of 88%.
• The number of patients with dementia who had received annual reviews was 97% which was above the CCG average of 81% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• As part of a NHS England national project looking at new models of care, the local CCG and other services had applied to be a ‘vanguard site’ to enhance health in care homes and provide better joined up care, especially for patients with dementia. The practice provided a weekly GP session in a local care home as part of this project, working with a local pharmacist and the care home staff to reduce un-necessary admissions.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had identified that they needed to improve access to psychological therapies for their patients. In addition to referring to local psychological support services the practice had arranged for in-house counselling services approximately three days per week. From January 2015 to December 2015 the in-house counselling team saw 48 patients with a waiting time that varied from two weeks to six weeks. The waiting time for the local psychological support service was three months, demonstrating that patients were able to access mental health support more quickly via the in-house service.
• The practice had a system in place to follow up patients who had attended Accident and Emergency (A&E) 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 worked with the Patient Participation Group (PPG) to offer health education sessions, including a session on dementia.

Updated 12 May 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, carers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice was signed up to the enhanced service to offer physical health checks to those patients with learning disabilities and 32 out of 39 patients had received an annual review, which was 82%.
• There were translation services available for those with language barriers and the practice had a hearing loop installed. Staff spoke a range of languages.
• 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.