Mayfield Surgery

Updated 15 June 2017

Mayfield Surgery provides primary medical services in Wandsworth to approximately 6,000 patients and is one of 44 member practices in the NHS Wandsworth Clinical Commissioning Group (CCG). The practice operates under a Personal Medical Services (PMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

The practice population is in the fourth more deprived decile with income deprivation affecting children and adults higher than national averages.

The practice operates from purpose built premises over two floors with off street car parking facilities. The practice has step free access into the ground floor which comprises reception and waiting areas, staff and patient accessible facilities including baby change facilities and space available for breast feeding mothers. The ground floor has seven clinical rooms and practice management facilities. The first floor comprises a large meeting room, offices and a staff kitchen.

The practice clinical team consists of two male and two female GP partners together providing 22 sessions per week, two female and one male salaried GPs together providing 13 sessions per week, and one female GP registrar providing 10 sessions per week. The practice employs one part time female nurse practitioner and one part time female healthcare assistant. The practice non-clinical team consists of one practice manager and six administrative and reception staff.

The practice opens between 8.00am and 6.30pm Monday to Friday. Telephone lines are operational between the hours of 8.30am and 6.30pm Monday to Friday.

Appointments are available in one morning and one afternoon session daily. Extended hours are available on Monday, Wednesday and Thursday evenings from 6.30pm until 8.00pm and on Saturday mornings from 9.00am until 11.00am for pre booked appointments.

The provider has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8.00am when the practice directs patients to seek assistance from the locally agreed out of hours provider.

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

Updated 15 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mayfield Surgery on 15 September 2016. The overall rating for the practice was good; however the safe domain was rated as requires improvement as;

• Actions identified in infection prevention and control audits had not been addressed to provide infection prevention and control training for all staff;
• Emergency medicines were not stored securely and regular checks were not thoroughly conducted or recorded;
• Patient specific directions (PSD) from a prescriber for the healthcare assistant (HCA) to administer influenza vaccines in a flu clinic were not clearly documented;
• Blank prescriptions were not managed or stored to maintain their security.

The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Mayfield Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 9 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 15 September 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had provided infection prevention and control training for all staff.
• The practice had reviewed and changed arrangements to securely store emergency medicines and blank prescription forms and had systems in place for providing and recording appropriate checks.
• The practice ensured patient specific directions for influenza vaccines include the dose, route and frequency to be administered to a named patient and a record that the prescriber has assessed the patient on an individual basis.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 19 December 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.

• Performance for diabetes related indicators was comparable to the local and national average.

• 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 19 December 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice nurse was engaged in work to prevent and support victims of female genital mutilation (FGM), including providing advice and guidance on a local and national level and working overseas. The practice supported and encouraged this work and had robust arrangements in place to identify, report, prevent from harm, and support vulnerable individuals and families at risk of FGM.

• 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 82%, which was comparable to the CCG average of 81% and the national average of 82%.

• 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.

Updated 19 December 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 patients aged over 75 years had a named GP responsible for their care.

Updated 19 December 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.

Updated 19 December 2016

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

• Performance for mental health related indicators was comparable to the local and national average.

• 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 held GP led mental health clinics monthly for patients of the practice as well as telling 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 19 December 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 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.