Hetherington Group Practice

Updated 10 April 2017

Hetherington Group Practice is part of Lambeth CCG and serves approximately 8600 patients. The practice is registered with the CQC for the following regulated activities Diagnostic and Screening Procedures, Family Planning, Maternity and Midwifery Services, Surgical Procedures

And Treatment of Disease, Disorder or Injury.

The practice population is in the fourth most deprived decile on the index of multiple deprivation. The practice has a significantly higher proportion of working age people. The practice has a slightly lower than the national average proportion of older people and children.

The practice is run by three male partners and five salaried GPs of mixed gender. The practice is a training practice and currently has two trainee GPs. There are six nurses; two of which do work exclusively in the community.

The practice is open between 8 am and 6.30 pm Monday to Friday except Tuesdays when the practice stays open till 8 pm. The practice is also open on Saturdays 9 am till 12 pm. Appointments are available 8 am and 12 pm and 3 pm till 6 pm Monday to Friday except Tuesdays when surgery commences at 9 am till 12 pm and then resumes from 5 pm till 8 pm. The practice offers 47 sessions per week with booked and emergency appointments five days per week. Only pre booked appointments are available between 9 am and 12 pm on Saturdays.

Hetherington Group Practice operates from 18 Hetherington Road, Clapham, London, SW4 7NU in purpose built premises which are rented from NHS Property Services. The service is accessible for people with mobility difficulties. The practice is based over three floors and there is a lift. We were told that patients with mobility difficulties tended to be seen on the ground floor only.

Practice patients are directed to contact the local out of hours provider 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: 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, Learning Disabilities, Minor Surgery, Rotavirus and Shingles Immunisations and Unplanned Admissions.

The practice is part of a GP federation.

Updated 10 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hetherington Group Practice on 30 March 2016. The overall rating for the practice was good. However, we identified breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which led to the practice being rated as requires improvement for being well led.

Specifically:

• The systems for analysing significant events were not effective in that learning was not clearly documented or communicated to staff.

• Recruitment policies and processes were not effective in that there was no system in place for monitoring the professional registrations of clinical staff.

• The practice did not have a full supply of emergency medicines including rectal diazepam and diclofenac and there was no risk assessment in place to justify the absence of these medicines.

In addition to the breaches of legislation identified we found several areas where we suggested the provider should make improvements:

• Ensure complaints policy and responses comply with requirements of The Local Authority Social Services and NHS Complaints (England) Regulations 2009.

• Ensure that all staff have received required mandatory training including fire safety, information governance and infection control.

• Continue to review and monitor telephone and appointment access.

• Consider drafting a formal strategic business plan.

• Consider undertaking regular internal appraisals for salaried GPs and review the appraisal process for all staff.

• Review patients with mental health concerns and put strategies in place to ensure that their alcohol consumption is discussed and recorded.

• Continue to review patients to ensure that people with Coronary Heart Disease are identified.

• Review the process of internal audit, clearly documenting the action taken to improve outcomes and consider putting this information into a structured written format.

The full comprehensive report from the 30 March 2016 inspection can be found by selecting the ‘all reports’ link for Hetherington Group Practice on our website at www.cqc.org.uk.

This inspection was a desk-based focused review carried out on 13 February 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 30 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice rating for well led is now good. The practice remains rated good overall.

Our key findings in respect of the breaches of regulation were as follows:

• The practice had a full supply of emergency medicines.

• The practice had an effective system in place for documenting, discussing and learning from significant events.

• The practice had systems in place to monitor the professional registrations of clinical staff.

The practice had also taken action to address the areas where we suggested that improvement should be made:

• The practice detailed information about advocacy organisations patients could contact if they were unhappy with the practice’s response in their complaint acknowledgement letter.

• The practice had systems in place to ensure that staff completed required training in accordance with current legislation and guidance.

• The practice had started drafting a business plan which had involved analysis of practice strengths, weaknesses, opportunities and threats.

• The practice told us that they had held two training sessions with patients to try and increase or improve access to online services thereby easing congestion on the practice’s telephone appointment system. This was in response to a patient survey which indicated that patients were having difficulties using the online appointment system.

• We were provided with an appraisal schedule which indicated that all staff, including salaried GPs, had been appraised after our previous inspection.

• We saw that the practice was taking steps to improve outcomes for mental health patients. Reminders were sent to staff about the importance of undertaking health checks and the practice had planned a clinic for patients suffering from mental illness who resided at a local hostel. In addition the percentage of patients with mental illness who had their alcohol consumption recorded had increased from 63% in the 2014/15 Quality and Outcomes Framework (QOF) year to 72% in 2015/16. However, this was still below the national average of 89% and local performance of 73%. (QOF is a system intended to improve the quality of general practice and reward good practice)

• The practice provided us with evidence to show that the low prevalence of Coronary Heart Disease (CHD) amongst their patient list was in line with local averages. The document provided showed that, while nationally prevalence was 3.4%, the prevalence in south London was 1.97% and in Lambeth this was 1.3% which was similar to the practice prevalence rate of 1.2%. As CHD is generally a disease associated with older people, the lower prevalence was attributed to the practice population which has a higher proportion of younger patients than the national average.The practice informed us that they would continue to make efforts to ensure their CHD prevalence data was accurate by coding patients with this disease on receipt of information from newly registered patients and diagnostic information from secondary care. In addition one of the partners told us that they would undertake regular searches of patients on medicines that were indicative of CHD to ensure coding was accurate.

• The practice provided us with a review of abnormal potassium results. Although the practice identified a potential cause of the abnormal results it was not clear what action the practice had taken in response to their findings and there was no evidence of reviewing this action in order to see if improvements could be made.

Action the practice should take:

• Continue to work to improve the practice’s vision and strategy.

• Continue to work on improving the quality of service provided including work to improve patient outcomes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 20 June 2016

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.

• Performance for diabetes related indicators was in line with the national average. The practice had established formal links with local diabetic specialists.

• Longer appointments and home visits were available when needed.

• The practice supported patients to manage their own long term conditions.

• 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 told us that 12.2% of the practice population had a care plan in place which addressed long term conditions.

• Patients who were at risk of a long term condition were regularly reviewed and identified using factors such as age, number of co-morbidities and unexpected admissions to hospital.

Updated 20 June 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 percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months which included an assessment of asthma control using the 3 Royal College of Physician questions, was in line with the national average.

• 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 percentage of eligible women whose notes recorded a cervical screen having been completed in the last five years was comparable to the 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, health visitors and school nurses.

• The practice held 8 week baby clinic and a child asthma clinic.

Updated 20 June 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 held a “Yak and yarn” knitting group in conjunction with age concern for older people and carers.

• The practice’s outreach nursing team undertook holistic health assessments for patients over 65 who were housebound and those over 80 years old; ensuring that these patients had packages of care that addressed their health and social care needs.

• The practice ran a flu immunisation clinic.

Updated 20 June 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 of this age group.

• The practice offered extended hours access for working people on Tuesdays and Saturdays.

Updated 20 June 2016

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

• 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• The practice were in line with national targets for mental health and dementia patients except in respect of recording the alcohol consumption of mental health patients which was 62.62% compared with a national average of 89.55% and a CCG average of 86.7%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 hosted a counsellor and psychologist.

• The practice had identified 5% of their population as having schizophrenia and 5% as having depression. The practice registered challenging patients that other practices in the area had been unable to support.

• The practice ran a reading group for mental health patients as part of a study which aimed to assess the therapeutic benefit of group reading.

Updated 20 June 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 and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• 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.

• The practice ran a clinic to review learning disabled patients.

• The practice supported a number of community organisations that cared for patients in vulnerable circumstances. We spoke with the manager of one community service that temporarily supported people in vulnerable circumstances with complex health and social problems which was located out with the practice’s catchment area. They told us that the practice had provided excellent care overall; agreeing to register all of their residents which no other GP surgery had been willing to do. The manager informed us that the residents thought highly of the service received from the practice with one patient recently telling her that they were considering moving to the area to ensure that they did not lose the support offered by the practice.