Archived: Bexley Group Practice

Updated 15 October 2015

Bexley Group Practice provides primary medical services in Bexley across four locations to approximately 11000 patients and is one of 28 practices in Bexley clinical commissioning group (CCG). The practice site located at Nuxley Road provides services to 950 patients, although patients can attend any of the four practice sites. The practice at Nuxley Road was the only Bexley Group Practice location that was inspected on 25 August 2015, as all four locations are registered separately with the Care Quality Commission. This report refers specifically to services provided from the Nuxley Road location; however the intelligence data we hold and the national GP patient survey data are combined for all the locations.

The practice population is in the fourth least deprived decile in England. They have a lower than national average representation of income deprived children and older people. The practice has a comparable representation to the national average of working age patients, patients over 65 and children. Of patients registered with the practice, 66% are White British and 9% are of Black African origin.

Bexley Group Practice has two senior partners; with one partner being on long-term sick leave and the practice employs one salaried GP and two self-employed GPs. The practice also uses regular locum GPs. The practice has a full time practice manager who works across all four sites; the rest of the practice team consists of two practice nurses, two advanced nurse practitioners, one health care assistant, one care co-ordinator and 23 reception and administrative staff members.

All four practices operate on a rotational basis and most clinical staff work across all sites if required, however the Nuxley Road practice routinely offers medical consultations with an advanced nurse practitioner on a daily basis and GP sessions one day per week. Four reception and administrative staff members work at the Nuxley Road site, with one being on duty at any one time. The premises are ground floor accessible in an adapted residential property.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of enhanced services including minor surgery (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice telephone lines are open from 8am to 6.30pm Monday, Tuesday, Wednesday and Friday; and from 8am to 2pm on Thursdays. All telephone calls are handled via staff in the telephone call centre which is located at the main Bexley Group Practice location. The Nuxley Road practice reception is open from 8.30am to 6.30pm Monday, Tuesday, Wednesday and Friday; and from 8.30am to 2pm on Thursday.

Appointments with a GP or advanced nurse practitioner are available between 9am and 10am Monday to Friday, 3pm to 4pm Monday, Wednesday, Thursday and Friday and 6pm to 8pm on Tuesday. Appointments with a nurse and health care assistant are also available on Tuesday, Wednesday and Friday. Appointments are offered at the three other sites for practice patients if required.

The practice has opted out of providing out-of-hours (OOH) services to their own patients and directs patients to the out-of-hours provider for Bexley CCG.

Updated 15 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bexley Group Practice on 25 August 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Most information about safety was recorded, monitored, appropriately reviewed and addressed.
• Some risks to patients and staff were assessed and well managed, with the exception of those relating to lone working and responding to emergencies.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Most staff had received training appropriate to their roles, however not all staff had received mandatory training.

• Data showed patient outcomes were average or above for the locality. Clinical audits had been carried out, with evidence that audits were driving improvement in performance to improve patient outcomes.
• 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.
• Patients said they found it easy to make an appointment with a named GP or nurse and that there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and was well equipped to treat patients and meet their needs; however not all areas of the practice were wheelchair accessible.
• 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, although the patient participation group was less actively involved at the Nuxley Road location.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must

• Review the arrangements for the practice to be able to appropriately respond to emergencies; including access to a defibrillator.
• Ensure that staff are adequately trained and updated in fire safety, infection control and mandatory safeguarding children’s training.
• Ensure that the risks of lone working have been thoroughly assessed, with mitigating actions put in place.
• Ensure there are clear and effective systems in place to govern activity at the Nuxley Road practice, to include assessing, managing and responding to risks, safety alerts, incidents and complaints; and adequate monitoring and recording of staff information including recruitment and training.
• Ensure that recruitment arrangements include all necessary employment checks for staff.

Importantly the provider should

• Ensure that prescription pads are tracked and monitored in the practice.
• Ensure that translation services are advertised in the practice.
• Ensure that the practice environment is suitable for wheelchair users and those with mobility difficulties.
• Ensure that systems to promote confidentiality and privacy at the practice are reviewed.
• Ensure that the Patient Participation Group (PPG) is actively involved in improving services at the Nuxley Road practice site.
• Ensure that all clinicians have a clear understanding of the consent and decision-making requirements of the Mental Capacity Act 2005.
• Ensure all staff have easy access to policies, procedures and guidance to carry out their role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 October 2015

The practice is rated as requires improvement for the care of people with long-term conditions. The practice was rated as requires improvement for safe and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice had a dedicated care co-ordinator to work with those with the most complex needs and the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. 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 that their health and medication needs were being met. For 2013/14 91% of diabetic patients had received an annual review and the practice was a tier two practice for diabetic care.

Updated 15 October 2015

The practice is rated as requires improvement for the care of families, children and young people. The practice was rated as requires improvement for safe and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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. Immunisation rates were slightly low for some 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. Appointments were available outside of school hours.

Updated 15 October 2015

The practice is rated as requires improvement for the care of older people. The practice was rated as requires improvement for safe and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nationally reported data showed that most outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia, social prescribing and avoiding unplanned admissions. The practice had a dedicated care co-ordinator to work with those with the most complex needs. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. Over 75s health checks were provided annually.

Updated 15 October 2015

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The practice was rated as requires improvement for safe and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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, such as the availability of an evening surgery . 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 15 October 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).The practice was rated as requires improvement for safe and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Ninety two per cent of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia and identified those at risk of dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It 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.

Updated 15 October 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice was rated as requires improvement for safe and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice held a register of patients living in vulnerable circumstances including homeless people, carers and those with a learning disability. It had carried out annual health checks for people with a learning disability and 50% of 48 patients on the register had received a review in 2014/15. It offered longer appointments for people with a learning disability and the practice also visited a local learning disabilities home to carry out flu vaccinations. Flu vaccinations were provided to those who were carers.

The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. It had told 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. Not all staff had completed mandatory safeguarding children's training.