Putneymead Group Medical Practice Also known as Putneymead Group Medical Practice

Updated 28 April 2017

Putneymead Medical Centre is part of Wandsworth Clinical Commissioning Group (CCG) and serves approximately 25,500 patients. The practice is registered with the Care Quality Commission (CQC) for the following regulated activities; diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury. The practice is linked with another site called Student Medical Centre which caters to 2,600 of the patient list who are students of Roehampton University. Patients from the Student Medical Centre are able to make appointments at Putneymead Medical Centre if they require appointments outside The Student Medical Centre’s stated opening times. The practice is registered with the CQC for the following regulated activities; maternity and midwifery services; family planning; treatment of disease, disorder or injury; surgical procedures and diagnostic and screening procedures.

Much of the practice’s performance data is connected with the Student Medical Centre. For example, national patient survey data and information from the Quality and Outcomes Framework (QOF) (QOF is a system intended to improve the quality of general practice and reward good practice). The practice has joint lists of patients who act as carers, and those who have long term conditions and learning disabilities.

The practice is located within an area ranked as the third least deprived decile on the index of multiple deprivation. The practice has a higher proportion of working age people compared to the national average and lower proportion of patients aged over 65. The percentage of those with a long standing health condition and levels of unemployment are lower than national averages.

The practice is currently run by eight partners (five female and three male), thirteen salaried GPs (12 female and one male), two physician associates, seven female nurses and two female healthcare assistants. The practice is a teaching practice and there are currently two trainee GPs. The practice has 16 full time equivalent GPs.

The practice is open between 8.00 am until 8.00 pm Monday to Thursday and 8.00 to 6.30pm on Fridays. The practice provides a Saturday surgery from 8.00 am until 11.30 pm for patients with pre-booked appointments. The practice offers emergency appointments and pre-bookable appointments are available four weeks in advance.

Putneymead Medical Centre operates from 266 Upper Richmond Road, London, Wandsworth SW15 6TQ which is a purpose built health centre. The service is accessible for to those with mobility problems.

Practice patients are directed to contact the local out of hours provider when the surgery is closed.

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). These are: meningitis provision, alcohol support services, childhood vaccination and immunisation scheme, extended hours access, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, learning disabilities, minor surgery, patient participation, rotavirus and shingles immunisation, unplanned admissions and out of area provision.

The practice is part of Wandsworth GP federation which is an organisation of local GP practice that aims to pool and better utilise resources for the benefit of patients in the community.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roberts, McKenzie, Plumley, Hassas, Kirkland, Allen, Rose & Helm (Putneymead Medical Centre) on 24 November 2016. Due to unforeseen circumstances related to Care Quality Commission staffing we extended the inspection to a second visit on 6 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.
• Most risks to patients were assessed and well managed. However we noted that some equipment used to respond in an emergency had expired.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the clinical 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.
• 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 was outward facing and supported other practices to provide services that benefited their local population.
• 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 two examples of outstanding practice:

• The practice ran an in-house counselling service. A minimum of between six and 10 counselling sessions were provided per week. The three counselling rooms within the practice were operational 12 hours per day five days per week with additional sessions on Saturdays. The practice told us that between 110 and 120 patients were seen at the counselling service every week. The practice had collated information in respect of assessing the impact of counselling by comparing patient scoring on the Patient Health Questionnaire (PHQ – test used to assess severity of depression) and the Generalised Anxiety Disorder Assessment (GAD – test used to assess severity of anxiety symptoms) both before and after they had undertaken counselling. Of the 62 patients reviewed the practice identified a 73% of these patients showed an improvement in PHQ scoring while 82% had improved GAD scores. The practice had also conducted a survey of patients using the counselling service featuring six questions. Ninety seven percent of the 170 patients asked stated that their counsellor listened to them and treated their concerns seriously and 90% had confidence in their counsellor’s skills and techniques.
• The practice supported four practices in parts of the Clinical Commissioning Group which did not have sufficient numbers of staff to complete NHS health checks during 2014 and 2015. The number of health checks had increased in three of the practices, where comparative data from 2013/14 was available, in 2014/15 by 37%, 113% and 257%. In 2015/16 one of the practices declined the practice’s continuing support as they felt sufficiently resourced to provide the checks independently. The other two practices increased the number of health checks in 2015/16 comparative to 2013/14 by 382% and 886%. It was estimated that the support from the practice’s healthcare assistants enabled an additional 1290 health checks to be undertaken in these practices between 2014 and 2016.

The areas where the provider should make improvement are:

• Review systems and process for checking the expiry dates of equipment used in an emergency.
• Provide appropriate escalation and support contact details in all complaint responses.
• Improve the identification of patients with caring responsibilities to be able to provide appropriate support and signposting

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as good for the care of people with long-term conditions.

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice used a computer system to access advice from secondary care to prevent admissions for patients with long term conditions.

• Performance for diabetes was comparable to local and national averages.

• Longer appointments and home visits were available when needed.

• The Clinical Commissioning Group pharmacist ran a clinic for patients with asthma and chronic obstructive pulmonary disease at the practice.

• 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.

• In order to maintain continuity of care for these patients the practice had divided GPs into four teams and appointed an administrator for each time to act as care co-ordinator focusing on patients who were on the practice’s secondary care admission avoidance register. The care co-ordinator was introduced on the basis of feedback provided by a local adult care centre.

• The practice provided phlebotomy, electro cardiograms (ECGs), 24 hour blood pressure monitoring, spirometry and weight management clinics

Updated 28 April 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 high for all standard childhood immunisations. The lead GP for safeguarding held an open door non clinical session each week for safeguarding work.

• 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 percentage of women who had received cervical screening was comparable to local and national averages. The practice held evening clinics during extended hours to promote uptake.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice reserved appointments slots for children who needed to be seen on the day.

• We saw positive examples of joint working with midwives and health visitors.

Updated 28 April 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 worked with

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• All patients over the age of 75 had a named GP.

Updated 28 April 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.

• The practice provided support to other practices in the locality which enabled them to undertake NHS health checks. The assistance provided by the practice resulted in an additional 1290 health checks to be undertaken in these practices between 2014 and 2016.

Updated 28 April 2017

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

• 98% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.

• The practice had a designated clinical lead for this population.

• The practice ran an in-house counselling service. A minimum of between six and 10 counselling sessions were provided per week. The three counselling rooms within the practice were operational 12 hours per day five days per week with additional sessions on Saturdays. The practice told us that between 110 and 120 patients were seen at the counselling service every week. The practice had collated information in respect of assessing the impact of counselling by comparing patient scoring on the Patient Health Questionnaire (PHQ – test used to assess severity of depression) and the Generalised Anxiety Disorder Assessment (GAD – test used to assess severity of anxiety symptoms) both before and after they had undertaken counselling. Of the 62 patients reviewed the practice identified a 73% of these patients showed an improvement in PHQ scoring while 82% had improved GAD scores. The practice had also conducted a survey of patients using the counselling service featuring six questions. Ninety seven percent of the 170 patients asked stated that their counsellor listened to them and treated their concerns seriously and 90% had confidence in their counsellor’s skills and techniques.

• In addition to the in-house counselling service the practice also told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice provided a mindfulness course annually for groups of between 15 and 20 patients.

• Performance for mental health related indicators was higher when compared to the national average. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94% compared with 90% in the Clinical Commissioning Group and 89% nationally.

• The practice quarterly meetings with the community mental health team and monthly meetings with their in house counsellors to discuss patients experiencing poor mental health.

• The practice carried out advance care planning for patients with dementia.

• 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 28 April 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 those with a learning disability. The practice had a clinical and administrative lead for patients with learning disabilities. Those with learning disabilities had direct telephone line access to a designated administrator.

• Homeless patients were able register at the practice.

• There were 42 patients on joint the learning disabilities register for Putneymead Medical Centre and Student Medical Centre. Thirty six of these patients had received an annual health check. Patients were reviewed annually with a community learning disabilities team.

• The practice offered 40 minute appointments for patients with a learning disability. Annual health checks could be undertaken in patient’s homes if necessary.

• 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.