Thornton Heath Medical Practice

Updated 9 October 2017

Dr Barretto & Partners, Thornton Heath Health Centre, shares its premises with community staff and Kings Dental Services . The practice list size is approximately 7000. The practice population is diverse, with a predominantly young working population. Eighty five percent of the patient population is less than 50 years old. Life expectancy for males in the practice is 78 years and for females 83 years. Both of these are in line with the Croydon Clinical Commissioning Group (CCG) and national averages for life expectancy.

The practice facilities include six consultation and treatment rooms and a patient waiting room. The consultation rooms are on the ground floor. The premises are wheelchair accessible and there are facilities for wheelchair users including an accessible toilet. There is a hearing loop for patients with hearing impairments. Baby changing facilities are available.

The staff team compromises two GP partners male and female and two salaried GPs (male and female) working a total of 26 sessions a week. Other staff include two female practice nurses, two female health care assistants, six receptionists/administration staff, a finance manager and a practice manager.

The practice is open between 8am and 6.30pm Monday to Friday. It offers extended hours from 9am to 11.30am on Saturday. When the practice is closed patients are directed (through a recorded message on the practice answer machine) to contact the local out of hours service.

The practice provides GP services to a nursing home and a mental health residential unit.

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of treatment of disease, disorder or injury; diagnostic and screening; family planning; maternity and midwifery services, and surgical procedures.

Updated 9 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Barretto & Partners, Thornton Heath Health Centre on 7 December 2016. The overall rating for the practice was good with requires improvement in Safe. Breaches of legal requirements were found relating to the Safe domain. The provider did not ensure that sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed: For example, not all staff had received appropriate training including fire safety, infection control and information governance. Also the provider did not have processes in place to ensure references were followed up.

After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report can be found by selecting the ‘all reports’ link for Dr Barretto & Partners, Thornton Heath Health Centre on our website at www.cqc.org.uk.

This inspection was a document-based review carried out on 8 September 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 7 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as Good for providing Safe services, and overall the practice remains rated as Good

Our key findings were as follows:

• The practice had reviewed its policy on obtaining references for new staff. We saw a revised policy, a reference and a completed induction checklist, as one new member of staff had been recruited since the last inspection.

• The practice had reviewed its policy on training; we saw a copy.

• All staff had completed role appropriate training including fire safety training, infection control and information governance; we saw certificates for all staff members to demonstrate this.

• Comprehensive meeting minutes were taken, detailing mandatory training including basic life support, safeguarding, information governance, infection control and when staff should have this training completed by.

• An updated business plan had been drafted which had been reviewed in March 2017, which included all staff contact details: we saw a copy of this.

• The practice had discussed their mission statement with all staff; we saw an agenda and meeting minutes of this discussion.

• We saw copies of the updated complaints policy and complaints leaflet.

• An updated recruitment selection and interview policy had been had been reviewed in January 2017, we saw a copy of this.

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 and GP’s had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 78%, which was 3% above the CCG average and 2% below the national average. The exception rate for the practice was 13%, CCG 9% and national 12%.

• 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 medicine 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 had specialised clinics for some long-term conditions, for example, a weekly diabetic clinic, weekly COPD (chronic obstructive pulmonary disease) and an asthma clinic.

• In-house spirometry was offered. (Spirometry is the most common lung function test, it looks at how well your lungs work and shows how well you breathe in and out).

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 Accident and Emergency (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.

• Cervical screening had been carried out for 85% of women registered at the practice aged 25-64, which was comparable to the CCG average of 82% and 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, and health visitors.

• The practice held weekly baby clinics for eight week checks, immunisation and preschool boosters.

• Patients had access to weekly antenatal and postnatal clinics.

• Double appointments for parents with young children were offered.

• The practice offered a healthy living and weight advice service.

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.

• Influenza and pneumococcal vaccines were offered to patients aged 65 years and over. The percentage of uptake was 71% for 2015/2016.

• The practice looked after one nursing home with weekly ward rounds.

• Dementia screening was offered for older patients.

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.

• Extended hours were provided on Saturday mornings from 9am-11.30am.

• On-line access was available to patients to book appointments and request repeat prescriptions.

• Pre-bookable phlebotomy appointments were available Monday to Friday from 8.30am to accommodate the working population.

• Telephone consultations were offered.

Updated 16 March 2017

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

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months,

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• Mental health checks were done.

• 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 looked after a home for mentally ill patients.

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 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 had 48 patients on its learning disability register 81% had an annual health check in the last 12 months.

• 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.

• Translation services were available by telephone or face to face.