The Fulham Medical Centre

Updated 16 November 2017

Fulham Medical Centre provides GP primary care services to approximately 8000 people living in the London Borough of Kensington and Chelsea in West London. The practice is staffed by four GPs, two male and two female who work a combination of full and part time hours totalling 30 sessions. The practice employs one nurse, an HCA, a practice manager and four administrative staff. The practice holds a General Medical Services (GMS) contract and was commissioned by NHSE London. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury, surgical procedures, family planning and maternity and midwifery services.

The practice was open between 8.30am to 5.30pm Monday to Friday and extended hours were appointments were available Tuesday morning 7am to 8.30am. The telephones were staffed throughout working hours and a recorded message was available at all other times. Appointment slots were available throughout the opening hours. Longer appointments were available for patients who needed them and those with long-term conditions. In addition to pre-bookable appointments that could be booked up to two weeks in advance, urgent appointments were also available for people that needed them. If patients wised to speak to a doctor there was a telephone advice slot each morning after surgery. Out of hours primary care is contracted to a local out of hours care provider. The practice provides patients with information about how to access urgent care when the practice is closed on its website, answerphone and on the practice door, primarily informing patients to telephone the 111 service. Patients are also provided with details on a number of local GP practices where patients could walk in or book a same day appointment between 9am and 4pm on Saturday and Sunday.

The practice provides a wide range of services for child health care and smoking cessation. The practice also provides health promotion services including a flu vaccination programme, travel vaccinations and cervical screening.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fulham Medical Centre on 3 December 2015. The practice was rated requires improvement for safe, with the overall rating for the practice being good. The full comprehensive report can be found by selecting the ‘all reports’ link for Fulham Medical Centre on our website at www.cqc.org.uk.

We carried out this announced follow up comprehensive inspection on 12 September 2017. Overall the practice is now rated as good in all domains.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. .
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the practice should make improvements are:

• Review the patient feedback including the results of the national GP patient survey in relation to the practices opening hours and getting through to the practice by phone, with a view to improving the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2017

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

• Nursing staff had lead roles in long-term disease management of patients with long term conditions.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for 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.
• Performance for diabetes related indicators was 94%, which was 13% above the CCG average and 4% above national averages

Updated 16 November 2017

The practice is rated as good for the care of families, children and young people.

• Systems were 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 slightly lower than the CCG rates for some childhood immunisations. However, the practice had implemented a strategy to improve these.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. 

Updated 16 November 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 patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• Older vulnerable patients were referred to the older person’s rapid access clinic (OPRAC) team to help manage their care in their own homes.

Updated 16 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.
• 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 November 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average.
• The practice had a register of patients experiencing poor mental health. These patients were invited to attend annual physical health checks and 85 out of 97 had been reviewed in the last 12 months.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 November 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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.