Tadworth Medical Centre

Updated 29 December 2016

Tadworth Medical Centre provides general medical services to the population living in the catchment areas of Tadworth, Epsom Downs, Langley Vale, Kingswood, Lower Kingswood, Burgh Heath, Tattenham Corner, Walton-on-the-Hill, Nork and part of Banstead. There are approximately 9,265 registered patients.

Tadworth Medical Centre is purpose built and has disabled access. There is a seated waiting area situated near the reception desk. All of the GP consulting rooms and nurse treatment rooms are located on the ground floor. There is a toilet for patients with disabilities and baby changing facilities. Staff offices and facilities are located on the first floor.

Tadworth Medical Centre is run by three partners GPs (two male and one female). The practice is also supported by four salaried GPs (three female and one male), three practice nurses and two healthcare assistants. The practice also has a team of receptionists, administrators, secretaries and a practice manager.

The practice is a GP training practice and supports undergraduates and new registrar doctors in training.

The practice runs a number of services for its patients including asthma reviews, child immunisation, diabetes reviews, new patient checks and holiday vaccines and advice.

Services are provided from:

1 Troy Close, Tadworth, Surrey, KT20 5JE

The practice is open from 8am to 6.30pm on weekdays.

Extended hours appointments were offered at the practice on Tuesdays and Thursday 7.30am to 8am and Monday and Wednesday 6.30pm to 7.30pm

The practice is part of a hub of GP practices offering evening weekday appointments 6.30pm to 9.30pm and weekend appointments 9.30am to 1.30pm. Appointments are available from four locations (Epsom, Nork, Leatherhead and from Tadworth Medical Centre).

During the times when the practice is closed, the practice has arrangements for patients to access care from an Out of Hours provider.

The practice delivers services to a slightly higher number of patients who are aged 65 years and over, when compared with the national average. Care is provided to patients living in residential and nursing home facilities and a local hospice. Data available to the Care Quality Commission (CQC) shows the number of registered patients suffering income deprivation is lower than the national average. The practice told us they provided care to patients in an area of high deprivation when compared with the local clinical commissioning group (CCG) average.

Updated 29 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tadworth Medical Centre on 3 November 2016. Overall the practice is rated as Good.

Tadworth Medical Centre was subject to a previous comprehensive inspection in July 2015 where the practice was rated overall as Requires Improvement but more specifically Inadequate for providing safe services. We re-inspected the practice in March 2016 and found that it had not addressed all of the issues previously found. As a result the practice was rated overall as Inadequate and was placed into Special Measures. (The practice had been rated in March 2016 as Inadequate for providing safe and well led services, as Requires Improvement for providing effective, responsive services and as Good for providing caring services).

Following our inspection of the practice in March 2016, the practice sent us an action plan detailing what they would do to meet the regulations. We undertook this comprehensive inspection on 3 November 2016 to check that the provider had followed their action plan and to confirm they now met the regulations. We found the practice had made significant improvement since our previous inspection. The practice is now rated as Good overall.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Governance processes were well planned and implemented.
• Continuous improvement was planned and reviewed to ensure improvement within the practice. For example, the practice had reviewed performance for diabetes related indicators which were significantly below the national average and had put in place patient audits, additionally trained staff and additional nursing hours to improve results.
• Risks to staff, patients and visitors were formally assessed and monitored. For example, the practice had processes in place for identifying, recording and managing risks for legionella, fire safety and infection control.
• The infection control lead had undertaken additional training and up-to-date infection control audits had been carried out. Findings had been reviewed and appropriate action taken to address any concerns.
• Staff had received training appropriate to their roles and further training needs had been identified and planned. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff had received an appraisal of their performance which was recorded and well managed. Performance management processes were well defined.
• Urgent appointments were usually available on the day they were requested. However, patients rated the practice significantly below average for several aspects of their ability to access services. In response to this the practice had added extended hours appointments at the practice on Tuesday and Thursday from 7.30am to 8am, and on Monday and Wednesday from 6.30pm to 7.30pm. The practice’s own patient survey results showed a significant improvement in how patients rated access to services.
• The practice participated in a locality initiative which enabled patients to access appointments from 6.30pm to 9.30pm Monday to Friday and from 9.30am to 1.30pm on Saturdays and Sundays at four different locations (Epsom, Nork, Leatherhead and from Tadworth Medical Centre).
• The practice was an accredited practice with Epsom and Ewell Foodbank (the Trussell Trust) to provide food vouchers to those in urgent need.
• 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.
• 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:

• Continue to monitor the national patient survey results and ensure that measures are put in place to secure improvements where scores are below average.
• Continue to monitor QOF indicators and ensure that measures are put in place to secure improvements in relation to scores which are below the national average.
• The provider should continue to identify a greater proportion of carers from its patient list, to better support the population it serves.

I am taking Tadworth Medical Centre out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 December 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.
• The practice offered diabetic foot screening. CQC data indicated that the practice achieved 44% for annual foot checks in patients with diabetes compared to the CCG average of 84% and the national average of 88%. However, we viewed unverified data that showed the most recent figures for the practice. This data showed that the practice was performing at 64% with five months of the QOF year to achieve their target figures.
• A specialist diabetic nurse visited the practice fortnightly for those patients who needed additional support.
• 90% of patients with chronic obstructive pulmonary disease(COPD) had a review undertaken including an assessment of breathlessness, which was the same as the national average of 90%
• Longer appointments and home visits were available when needed.
• 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.
• Patients were supported to self manage their long-term condition by using agreed plans of care and were encouraged to attend self-help groups

Updated 29 December 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.
• 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.
• 73% of patients with asthma had an asthma review in the last 12 months that included an assessment of asthma control. This compared to a CCG average of 74% and a national average of 75%.
• 74% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 80% and a national average of 82%.
• The practice held weekly antenatal clinics which were run by midwifes.
• The practice ensured that children needing emergency appointments would be seen on the same day.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Appointments were available at the practice with a GP until 6.30pm and there were pre-bookable appointments on Tuesday and Thursday 7.30am to 8am and Monday and Wednesday 6.30pm to 7.30pm

Updated 29 December 2016

The practice is rated as good for the care of older people.

• Patients over 65 years of age made up 25% of the practice population. The practice provided care to patients within eight local residential and nursing homes. Weekly GP visits were made to residents within those homes.
• The practice worked closely with district nurses and the community matron to share information regarding older housebound patients and ensure their access to appropriate support and care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Older patients with complex care needs and those at risk of hospital admission all had personalised care plans that were appropriately shared with local organisations to facilitate communication and the continuity of care.
• The practice was working to the Gold Standards Framework for those patients with end of life care needs. (The Gold Standards Framework is a framework to enable an expected standard of care for all people nearing the end of their lives. The aim of the Gold Standards Framework is to develop a locally-based system to improve and optimise the organisation and quality of care for patients and their carers in the last year of life).
• The practice offered flu, pneumonia and shingles vaccine programmes.

Updated 29 December 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 for this age group.
• Appointments were available at the practice with a GP until 6.30pm and their were pre-bookable appointments on Tuesday and Thursday 7.30am to 8am and Monday and Wednesday 6.30pm to 7.30pm
• The practice was part of a group of GP practices offering evening appointments until 9:30pm as well as weekend appointments, from four locations (Epsom, Nork, Leatherhead and Tadworth Medical Centre).
• Telephone consultations with a GP were available during working hours.
• Electronic Prescription Services (EPS) and a repeat dispensing service helped patients to get their prescriptions easily.
• Travel health and vaccination appointments were available.
• The practice offered Saturday flu clinic appointments to fit in around working patients.

Updated 29 December 2016

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

• Patients were monitored as part of the Quality and Outcomes Framework (QOF) to check that they had an up-to-date care plan. 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This compared to a CCG average of 91% and a national average of 89%.
• 75% of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This compared with the CCG average of 80% and was slightly below the national average of 83%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice looked after a care home for patients with severe mental illness and undertook weekly GP reviews.
• The practice provided a service to patients with a severe mental illness. The practice was in the process of setting up a Quality Improvement Project to improve health outcomes for this patient group.
• 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. GPs were trained in the Mental Capacity Act 2005 and the appropriate use of Deprivation of Liberty Safeguards (DOLS).

Updated 29 December 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.
• 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 provided a service to patients with a learning disability. The practice had set up a Quality Improvement Project to improve health outcomes for this patient group.
• The practice was an accredited practice with Epsom and Ewell Foodbank (the Trussell Trust) to provide food vouchers to those in urgent need.
• The practice could accommodate those patients with limited mobility or who used wheelchairs.
• Carers and those patients who had carers, were flagged on the practice computer system and were signposted to the local carers support team.