Tamworth House Medical Centre

Updated 7 July 2017

Drs’ Hollier, Williams, Wong and La Porta (Tamworth House Medical Centre) is part of Merton CCG and serves approximately 9400 patients. The practice is registered with the CQC for the following regulated activities: Diagnostic And Screening Procedures, Surgical Procedures, Maternity And Midwifery Services, Treatment Of Disease, Disorder or Injury and Family Planning.

The practice is rated within the fifth most deprived areas in the country on the Index of Multiple Deprivation.

The practice is run by five GP partners of mixed gender, two advanced nurse practitioners and two nurses all of whom are female. The practice is a teaching and training practice hosting registrars and F2 doctors, medical students and nurses in training. The practice offers 34 GP sessions per week and the two nurse practitioners work 1.6 whole time equivalent.

The practice is open between 8 am to 6.30 pm Monday to Friday with extended hours access appointments available between 7 am and 8.40 am on Tuesdays and 6.30 pm and 7.50 pm on Wednesdays. Booked and emergency appointments are available five days per week.

The Drs’ Hollier, Williams, Wong and La Porta (Tamworth House Medical Centre) operates from rented purpose built premises based over two floors. The practice is accessible through manual double doors and a manual door at the car park. Those who would have difficulty accessing the surgery through these doors could call staff using a call bell. Patients with mobility problems could be accommodated in one of the consulting rooms on the ground floor.

Practice patients are directed to contact 111 when the surgery is closed. 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). These are: extended

Hours access, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, learning disabilities, risk profiling and case management, rotavirus and shingles immunisation and unplanned admissions.

The practice is part of GP federation Merton Health Services.

Updated 7 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr’s Hollier, Williams, Wong and La Porta on 4 October 2016. The practice was rated good overall and requires improvement for safe. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Dr’s Hollier, Williams, Wong and La Porta on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 9 June 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 4 October 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 4 October 2016, we rated the practice as requires improvement for providing safe services as:

• There were not effective processes in place to monitor the expiry date of emergency medical equipment.

• There were not adequate processes in place to identify and mitigate against risks associated with fire and infection control.

• The practice did not have valid Patient Group Directions in place to enable the practice nursing staff to administer medicines.

In addition to the breaches in regulation we suggested that the practice should take action to:

• Ensure that all complaint responses adhere to current legislation and guidance.

• Review vaccine storage procedures.

• Put systems in place to store patient safety alerts and document the actions taken in response to safety alerts.

• Continue with strategies to encourage uptake of health reviews to reduce the practice’s exception reporting rate in areas where this is significantly higher than local and national averages.

• Take steps to improve the management of confidentiality in the practice reception area.

• Continue to work on improving patient satisfaction with telephone access and access to routine appointments.

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

Our key findings were as follows:

• The practice had implemented a system to check the expiry of emergency medical equipment and checks were being undertaken on a regular basis.

• The practice had taken the necessary steps to ensure that risks associated with infection control had been addressed, there were system in place to record and monitor the immunity status of clinical staff to common communicable diseases and there was a contract in place to reupholster the chairs in the reception area.

• Systems were in place to check Patient Group Directions (PGDs) to ensure that they were valid.

We also saw evidence the practice had:

• The practice now included the contact information for external organisations where complaints could be escalated to in accordance with current legislation and guidance.

• The practice had a new system in place to centrally store all patient safety alerts on one of their IT systems. We saw screen prints from this system which showed the date of action taken in response to a recent alert regarding faulty defibrillators.

• The practice were in discussions with an organisation to upgrade the telephone systems and were actively promoting online access The practice told us that from 1st January to 31st March 2017, practice registrations for online access increased from 5.2% to 19.4%.

The practice should:

• Consider the risks to non-clinical staff from common communicable diseases and take action to mitigate any risks identified.

• Continue with strategies to encourage uptake of health reviews to reduce the practice’s exception reporting rate in areas where this is significantly higher than local and national averages.

• Continue to work on improving patient satisfaction with telephone access and access to routine appointments.

• Review vaccine storage procedures.

• Take steps to improve the management of confidentiality in the practice reception area.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 19 January 2017

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

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

• Practice performance for management of diabetic patients was in line with national averages; however, the number of patients with diabetes who had been exception reported was significantly higher than local and national averages.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered 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 ran a twice weekly anticoagulation clinic which could be used by patients from one of the neighbouring practices. The practice also held diabetic clinics three times per week.

Updated 19 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 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 number of women who had received a cervical screening test was comparable to local and national averages.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice held annual flu clinics for under 5s.

• We saw positive examples of joint working with midwives and health visitors.

Updated 19 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 produced comprehensive care plans for those patients over 75 who resided in a care home or were housebound.

• The practice provided support to a number of patients in a local care home which accommodated elderly patients.

Updated 19 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 held an annual Saturday flu clinic.

Updated 19 January 2017

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

• 84% 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 for other mental health indicators was comparable to local and national averages.

• The practice met quarterly with a specialist mental health consultant to discuss 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.

Updated 19 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 those with a learning disability. The practice told us that they currently had two homeless patients registered at the practice.

• The practice offered longer appointments for patients with a learning disability. The practice provided evidence that they had completed checks for all 40 of their learning disabled patients in 2014/15.

• 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.

• The practice had undertaken a review of patients on their unplanned admissions register and provided the CCG with a report on the most common reasons for patients unexpectedly attending secondary care.