Elm House Surgery

Updated 25 November 2016

Elm House Surgery is a large practice based in Bromley. The practice list size is approximately 17,642. The practice population is diverse. Life expectancy for males in the practice is 81 years and for females 86 years. Both of these are in line with the CCG and national averages for life expectancy. The practice has a higher than average number of female and male patients aged between 34 and 54 years.

The practice facilities include 10 GP consulting room, four nurse/ treatment rooms, two minor surgery rooms, two patient waiting rooms and seven staff and administration offices. The premises are wheelchair accessible and there are facilities for wheelchair users including a lift and disabled toilets and a hearing loop. Other facilities include baby changing facilities and wheelchair accessible toilets. There are lowered reception desks to enable wheelchair users to speak with staff at the reception.

The staff team compromises of five GP partners three male and two female. All partners worked eight sessions a week. There were five salaried GPs one male and four female. Two of the salaried GP worked seven sessions per week, one worked eight and two worked four sessions. The practice was a training practice. The practice had two health care assistant one male and one female. One business manager, one practice manager, eleven receptionists, eight administration staff, a summariser, and five secretaries.

The practice is open between 8.00am to 6.30pm Monday and Friday, Tuesday to Thursday 8.00am to 7.30pm and on Saturdays 8.00am to 10.30. They offer extended hours from 6.30pm to 7.30pm Tuesdays to Thursday and Saturday morning. Appointments are available to patients from 8.00am to 6.30pm. Appointments are also available during the extended hours from 6.30pm to 7.30pm. When the practice is closed patients are directed (through a recorded message on the practice answer machine) to contact the local out of hour’s service. Information relating to out of hour’s services is also available on the practice website. The practice is based in the same building at the local urgent care centre. Posters are available to make patients aware of this as well.

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 maternity and midwifery services, surgical procedures, diagnostic and screening procedures.

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elm House Surgery on 4 August 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.
• 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.
• 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.

The areas where the provider should make improvement are:

• Ensure systems are in place to monitor the use of blank prescription pads.

• Ensure systems are put in place to ensure appropriate testing of portable appliances is carried out.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 25 November 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.

• There were 592 patients on the diabetes register.

• 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 73%, which was 2% below the CCG average and 4% below the national average. The exception rate for the practice was 8%, CCG was 10% and national was 12%.

• Staff managing patients with long term conditions had completed the Warwick Certificate for Optimizing Glycaemic control.

• 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).

• Longer appointments and home visits were available when needed.

• Most patients received structured annual review to check the 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 25 November 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 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.

• 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, health visitors and school nurses.

• Same day appointments were always offered to children.

• GP and midwife appointments were offered for antenatal care.

• The practice had a dedicated administrator who co-ordinated post-natal checks for all new mothers, six week developmental checks and also arranged childhood immunisations.

Updated 25 November 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.

• All older people had a named GP. The named GP is responsible for repeat prescribing, dealing with paperwork and leading on home visits for all their allocated patients.

• The practice participated in the unplanned admissions direct enhanced service and 303 older patients had a current care plan in place. There was a dedicated patient liaison office for patients on a care plan.

• The practice provided medical care to three nursing homes. They had protocols in place outlining how and when registered patients could access GP care.

• The practice held quarterly multidisciplinary meetings which included discussions of the support needs for older population at home.

• Flu vaccinations were offered to all over 65s. The percentage of uptake was in line with the CCG rates.

Updated 25 November 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.

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

• Telephone appointments were available throughout the day.

• Pre-bookable phlebotomy appointments were available from 8.00am to accommodate the working population.

• Health checks were offered to patients aged 40-74 years old.

Updated 25 November 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.

Updated 25 November 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. The practice had 23 patients on its learning disability register.

• 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.