Holmwood Corner Surgery

Updated 7 March 2017

Holmwood Corner Surgery provides primary medical services in New Malden to approximately 12,500 patients and is one of 23 practices in Kingston Clinical Commissioning Group (CCG).

The practice population is in the second least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 13%, which is higher than the CCG average of 12%; and for older people the practice value is 14%, which is higher than the CCG average of 13%. The age range of the practice’s patients largely follows the same pattern as the local average. Of patients registered with the practice, the largest group by ethnicity are white (79%), followed by Asian (13%), mixed (4%), black (2%) and other non-white ethnic groups (2%).

The practice operates from a three-storey purpose built premises. A small amount of car parking is available at the practice, and there is space to park in the surrounding streets. The reception desk, main waiting area, three treatment rooms and three consultation rooms are situated on the ground floor. An additional waiting area and six further consultation rooms are on the first floor, which is accessible via both stairs and a lift. The second floor is for administration and includes a staff kitchen and dining room and a meeting room.

The practice team at the surgery is made up of one part time female GP and two full time female GPs, one part time male GP and three full time male GPs; these are all GP partners. In addition, one part time female salaried GP is employed by the practice. The practice is a training practice and has two less than full time trainee GPs placed with them. In total 61 GP sessions are available per week and an additional 10 sessions are provided by the two GP Registrars. The practice also employs four part time female nurses and two part time healthcare assistants. The clinical team are supported by a practice manager, deputy practice manager, two secretaries, five administrators, eight receptionists and an apprentice receptionist.

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).

The practice is open between 8:30am and 6:30pm Monday to Friday and from 9am to 10:30am on Saturdays. Appointments are from 8.30am to 11.30am every morning apart from Friday when appointments start at 8:50am and Saturday when appointments are available from 9am to 10:30am. Afternoon appointments are available from 4pm to 6pm on Mondays, 3pm to 7:30pm on Tuesdays and Thursdays, 2pm to 5:30pm on Wednesdays and 3pm to 6pm on Fridays, and 2:30pm to 6pm every afternoon. Extended hours surgeries are offered on Tuesday and Thursday evenings and Saturday mornings.

When the practice is closed patients are directed to contact the local out of hours service.

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

Updated 7 March 2017

Letter from the Chief Inspector of General Practic

We carried out an announced comprehensive inspection at Holmwood Corner Surgery on 15 November 2016. 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.
• 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.
• Most patients said they found it easy to make an appointment with a named GP; however, following some negative feedback about accessing the practice by telephone, the practice had reviewed their phone and appointments system and made changes to improve access; they were awaiting the release of further patient satisfaction data following these improvements in order to establish whether the problem had been resolved. 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.
• 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.

We saw three areas of outstanding practice:

The practice had a lower than expected rate of unplanned hospital admission, which was achieved as a result of their approach to collaborative working and tailoring their service to meet the needs of the population. They held fortnightly multi-disciplinary team (MDT) meetings which were attended by all GPs, practice nurses, district nurses, the palliative care nurse, health visitors and social workers, but also held six-weekly enhanced MDT meetings, which included a consultant psychiatrist, consultant geriatrician, Head of Social Care from the local authority, and representative from a local support charity for elderly people. The practice’s arrangements for working collaboratively with the MDT were being used by the CCG as a model for other practices in the locality. They also ensured that all patients received the care they needed, for example, by providing home visits by nurses to deliver long-term condition reviews.

The practice had a large proportion of Korean patients and worked closely with several organisations to develop the services provided to these patients. One of the GPs, who spoke Korean, worked with the local council to provide information sessions to members of the local Korean population, for example, sessions were provided to people who had recently moved to the UK about how the health system works and how to access health services, and topical sessions on subjects such as winter health. This GP had founded the Korean UK Medical Association, an organisation aimed at bringing together and providing mentorship to Korean speaking doctors in the UK to allow them to effectively serve the Korean community. The practice provided consultations in Korean and had written information available in Korean, such as information about fasting for blood tests and invitations to attend for cervical screening.

The practice had introduced an intranet system which had a messaging and announcement facility and was linked to the patient records system. This system was used extensively by both clinical and non-clinical staff for passing messages relating to specific patients and the practice generally, for asking clinical questions and seeking views of colleagues, and for disseminating information to staff.

The areas where the provider should make improvement are:

• Continue to monitor patient feedback to ensure changes made to the service are effective
• Review how patients with caring responsibilities are identified to ensure that these patients can be provided with information, advice and support.
• Ensure that arrangements are in place to record action taken in response to safety alerts and updates.
• Review their recruitment policy to ensure that it accurately reflects their recruitment arrangements.
• Review and address areas where their exception reporting rate is above average.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 7 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.
• Nurses visited patients at home to carry out long-term condition reviews for those who were unable to attend the surgery. Approximately 40 patients received an annual review in their own home per year, and nursing staff also visited these patients in between reviews when needed.
• Overall, performance for diabetes related indicators was better than the Clinical Commissioning Group and national average. The practice achieved 100% of the total Quality and Outcomes Framework points available, compared with an average of 98% locally and 95% nationally.
• 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 7 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.
• Cervical screening had been carried out for 92% of women registered at the practice aged 25-64, which was above the Clinical Commissioning Group average of 83% and national average of 82%; their exception rate for this area was 15%, compared to a CCG average of 11% and national average of 7%; however, the practice explained that they sent up to three letters, including information leaflets, to patients who had not booked a cervical screening appointment following the two letters sent centrally (including letters in written in Korean where appropriate), and they were therefore confident that patients who were excepted did not wish to participate in screening.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided extended appointments for new mothers when they attended with their babies for the new baby check, as this allowed the opportunity to fully assess the health and wellbeing of new mothers.
• We saw positive examples of joint working with midwives and health visitors.

Updated 7 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 had a higher than CCG average proportion of older people and a higher than average proportion of these patients lived independently. The practice used an enhanced model of multi-disciplinary working and as a result had a lower proportion of unplanned admission to hospital than would be expected.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had patients living in several local nursing homes; they provided a weekly ward round to one home where the majority of residents were their patients, and visited residents in the other homes when needed.
• The practice’s Patient Participation Group provided a volunteer-run transport service to and from the practice for people who found it difficult to attend independently.

Updated 7 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. They had introduced social media accounts to help facilitate interaction with younger patients.
• The practice had consulted with its patients about the times of day that would be most convenient for them to attend appointments and had structured its extended hours appointments accordingly, including offering appointments on Saturday mornings.

Updated 7 March 2017

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

• The practice had 80 patients diagnosed with dementia and 73% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was below the Clinical Commissioning Group (CCG) and national average of 84%.
• The practice had 157 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 97% of these patients, compared to a CCG average of 96% and national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. They were part of a pilot which explored improved ways to refer patients to mental health services.
• 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 7 March 2017

The practice is rated as outstanding 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 had 79 patients registered who were either asylum seekers or refugees, and a high proportion of these patients were North Korean. A local refugee charity directed these patients to register at the practice due to their specialist knowledge and provision for Korean-speakers.
• The practice had a large proportion of Korean patients and provided translated written information for these patients, such as information about fasting for blood tests and invitations to attend for cervical screening. One of the GPs provided consultations in Korean and also provided talks to members of the local Korean population who had recently moved to the UK about how the health system works and how to access health services.
• The practice was one of four practices in the Clinical Commissioning Group who had volunteered to temporarily register patients who were travellers, should the need arise.
• 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.