The Farley Road Medical Practice

Updated 16 March 2017

The Farley Road Medical Practice is situated in South Croydon. Croydon is one of the outer London boroughs on the border with Surrey. The practice is based in a converted house which has been developed to have level access for those with impaired mobility. There is also a branch practice, which is based in a converted flat. Patients can be seen at either practice.

The area is well served by public transport.

There are approximately 11, 700 patients registered at the practice. Compared to the England average, the practice has fewer young children as patients (age up to 15) and more patients aged over 50, particularly aged 50 - 69.

Life expectancy of the patients at the practice is in line with CCG and national averages. The surgery is based in an area with a deprivation score of eight out of 10 (1 being the most deprived), and has lower levels of income deprivation affecting older people and children. Compared to the England average, fewer patients are unemployed.

Seven doctors work at the practice: three male and four female. Two of the doctors are partners and there are five salaried GPs (one male and four female). Some of the GPs work part-time. The working hours added together equate to 5.8 full time roles (whole time equivalents).

The (all female) nursing team is made up of an advanced nurse practitioner, four practice nurses, a health care assistant and two phlebotomists.

The practice delivers a range of GP services, including health checks, travel health, contraceptive coils and implants and minor surgery.

The main practice is open 8am to 6.30pm Monday to Friday. The branch surgery is open 9am to 5.30pm Monday to Thursday and 9am to 12pm on Friday.

Appointments with GPs are available from 9am to 11.30am and 3.30pm to 6pm Monday to Friday.

Extended hours appointments are available on alternate Tuesdays 6.30pm to 8pm, alternate Wednesdays 6.30pm to 8pm, Thursday and Friday 6.30pm to 7.30pm (telephone consultations only) and most Saturdays 8.30am to 10.30am.

When the practice is closed cover is provided by a local service that provides out-of-hours care.

The practice offers GP services under a Personal Medical Services contract in the Croydon Clinical Commissioning Group area. The practice is registered with the CQC to provide family planning, surgical procedures, diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.

This is the first time that the CQC has inspected the practice.

Updated 16 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Farley Road Medical Practice on 18 January 2017. 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. Rates of exception reporting were generally comparable to or below local and national averages, but there were a few indicators where the practice excepted more patients than the local and national average. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.)

• Rates for some childhood immunisations for under two years old were a little below the national expectation of coverage (90%).

• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice carried out clinical audits, but most of these were not repeated to check for improvement.
• 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:

• Monitor exception rates to determine if procedures are operating effectively to identify patients who need support and those who shouldn’t be included in performance data.

• Monitor and consider ways to maintain and improve rates of childhood immunisation.

• Strengthen quality improvement, with more completed audits or other activities to check that improvement is made and sustained.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 16 March 2017

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 comparable to the national average. For example, 77% of patients with diabetes, had their HbA1c (blood sugar over time) last measured at 64 mmol/mol or less, compared to the local average of 71% and the national average of 78%.
• 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.

Updated 16 March 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 practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 82% and the national average of 82%.
• 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.

Updated 16 March 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.
• Older patients had a named GP to support their care.

Updated 16 March 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.

Updated 16 March 2017

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

• 94% 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 regularly worked with multi-disciplinary teams in 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 16 March 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 homeless people, travellers and 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.