Shotfield Medical Practice (formerly Dr Lings & Partners)

Updated 4 October 2016

Shotfield Medical Practice provides primary medical services in Wallington to approximately 11000 patients and is one of 27 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the third less deprived decile in England.

The practice population has a lower than CCG and national average representation of income deprived children and older people. The practice population of children is in line with the CCG and national average and the practice population of working age people is also in line with the CCG and national averages; the practice population of older people is higher than the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded 52% are white British or mixed British, 6% are other white and 4% are other Asian.

The practice operates in purpose built premises and it is shared with another practice. All patient facilities are wheelchair accessible with lift access to the first floor. The practice has access to nine doctors’ consultation rooms and two nurse/healthcare assistant consultation rooms on the ground floor and two doctors’ consultation rooms and one nurse consultation room on the first floor.

The clinical team at the surgery is made up of four full-time GPs (two male and two female) who are partners, two part-time salaried GPs (one male and one female), one physician associate, one full-time practice nurse and three part-time female practice nurses and one part-time female healthcare assistant. The non-clinical practice team consists of practice manager, deputy practice manager and 24 administrative and reception staff members. The practice provides a total of 45 GP sessions per week.

The practice is merging with Beddington Medical Centre on 30 September 2016 during which all staff and patients from Beddington Medical Centre will move to Shotfield Medical Centre.

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 a training practice for trainee doctors and physician associates (Physician associates are trained to conduct physical examinations, diagnose and treat illness, order and interpret tests and counsel on preventive health care; they worked under the supervision of GPs).

The practice reception and telephone lines are open from 8:00am till 6:30pm Monday to Friday. Appointments are available from 8:30am to 12:00pm and 4:00pm to 6:00pm every day. Extended hours surgeries are offered on Mondays and Wednesdays from 6:30pm to 7:30pm and on Tuesdays and Thursdays from 7:30am to 8:00am.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8am and directs patients to the out-of-hours provider for Sutton CCG.

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

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shotfield Medical Practice on 01 September 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

There were areas of practice where the provider should make improvements:

• Review practice procedures to ensure there is a system in place to monitor implementation of medicines and safety alerts.
• Review practice procedures to ensure all staff receive annual basic life support training.
• Review patients’ access to routine appointments.
• Ensure that patients are made aware of how to make a complaint.
• Review systems in place to ensure that patients with a learning disability are regularly reviewed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 4 October 2016

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. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
• The national Quality and Outcomes Framework (QOF) data showed that 84% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 78%. The number of patients who had received an annual review for diabetes was 96% which was above the CCG average of 86% and in line with the national average of 88%.
• The national QOF data showed that 80% of patients with asthma in the register had an annual review, compared to the CCG average of 73% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice offered 24 hour blood pressure monitoring for patients.

Updated 4 October 2016

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 urgent care and 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.
• The practice’s uptake for the cervical screening programme was 83%, which was in line with the Clinical Commissioning Group (CCG) average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice patients had access to antenatal care through midwife led clinics and postnatal care through GP clinics.

Updated 4 October 2016

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.
• Longer appointments and home visits were available for older people with long term conditions when needed.
• The practice had alerts set up for patients with visual and hearing impairments who may need extra support.

Updated 4 October 2016

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 offered extended hours appointments with GPs, physician associate, nurses and healthcare assistant which were suitable for working people.

Updated 4 October 2016

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

• 94% of 103 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 87% and national average of 88%.
• One of the practice GPs worked a session as a GP advisor with the local mental health trust which enabled closer working relationship with the trust. The practice was piloting a new initiative with pharmacists reviewing practice patients who were on medicines for their mental health. The practice had also engaged in a project which offered physical health reviews for patients with serious mental health issues with cardiovascular risk factors.
• The number of patients with dementia who had received annual reviews was 82% which was in line with the Clinical Commissioning Group (CCG) average of 81% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• The practice patients had access to an in-house counsellor which made it easier for local patients to attend; the practice had a detailed information sheet for patients regarding this service.

Updated 4 October 2016

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, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; only 39% (30 patients) out of 77 patients with learning disability had received a health check in the last year. The practice clinical staff had specific training in reviewing patients with learning disabilities from the local learning disability team.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.