Station Road Surgery

Updated 12 December 2016

Station Road Surgery has been a GP practice for over fifty years. It is situated in the middle of West Wickham in a detached house with no onsite parking for patients although there are two public car parks within a short walk from the practice. There is step free access, a reception and waiting area, 8 consultation rooms, two treatment rooms and toilet facilities on the ground floor. The upstairs is only used by staff.

The practice provides primary medical services to approximately 12350 patients and is one of 48 practices in Bromley CCG. The practice is a teaching practice for final year medical students.

There are seven GP partners (four of whom are female) who make up 5.75 whole time equivalent. There is a part time nurse practitioner and three part time nurses (all female) who cover two whole time equivalent posts and a part time health care assistant who work almost full time. The clinical team are supported by a practice and reception manager, 18 part time reception and administrative staff.

The practice works under a General Medical Services contract and has signed up to provide some extra services (not normally provided under their contract): childhood vaccinations and immunisation; extended hours access; facilitating timely diagnosis and support for people with dementia; improving patient on-line access; influenza and pneumococcal immunisations; minor surgery; patient participation and rotavirus and Shingles immunisation. They are registered with CQC to provide the regulated activities diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice is open between 8.00am and 6.30pm Monday to Friday. Appointments are from 9.00am to 12noon every morning and 3.00pm or 4.00pm to 5.00pm or 6.00pm daily. Extended surgery hours are offered from 7.00am-8.00am Monday, Thursday and Friday and from 8.00am-11.15am on alternate Saturdays. Outside of these hours patients are directed to contact the out of hours provider for the local area via the 111 service or advised to go to the local urgent care centre.

The practice is in one of the least deprived areas. Life expectancy for both men and women is slightly above the local and national averages. They have below the local and national average of patients under the age of 18 and those aged 20-40 and slightly above average for patients aged over 40.

The practice has not been inspected before.

Updated 12 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Station Road Surgery on 16 March 2016. Overall the practice is rated as good.

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

• The practice had an open and transparent approach to safety and an effective system in place for reporting and recording significant events, although it was not always clear how this information was shared across the practice.
• 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 generally 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.

The areas where the provider should make improvement are:

• Continue to review patient feedback and work to improve patient experience with long waiting times.

• Continue to develop the patient participation group.

• Review how learning is shared across the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 12 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. The practice had registers of patients with the various long term conditions and had systems in place to recall patients for regular reviews. Nursing staff received regular training updates to monitor these patients appropriately.

• Performance for diabetes related indicators was generally comparable to other practices, with numbers for some indicators above and others below the CCG and national averages. For example: 80% of patients had the flu immunisation between April 2014 and March 2015. The practice had developed an action plan and had increased the number to 88% between March 2105 and February 2016; 80% had records of their cholesterol between April 2014 and March 2015 was 80%, same as the national figures. Clinical staff had completed updated training in care of patients with diabetes.

• 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 12 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.

• The practice sent new parents a congratulations letter which included an information pack with the immunisation schedule, a new baby registration form for the practice and information about breast feeding. Immunisation rates were in line or above national averages for all standard childhood immunisations.

• 75% of patients diagnosed with asthma had a review of their condition between April 2014 and March 2015 was 75%, the same as the national average.

• 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.

• 86% of female patients aged 25-64 had cervical screening test in the last five years which was above the local and national average.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with health visitors and midwives, families with children under five were routinely discussed.

Updated 12 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. All patients over the age of 75 had a named doctor.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. They maintained a list of patients who needed home visits and carried out at least annual reviews for all these patients.

• The practice had an arrangement with a local practice for patients to attend blood tests rather than travelling to the hospital for this service.

• The practice provided a weekly service to a local nursing home and fortnightly visits to a local care home and carried out home visits to patients in their own homes when they were required.

Updated 12 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. It provided early morning appointments three mornings a week and appointments on alternate Saturdays.

• The practice was proactive in offering online services including an electronic prescriptions service. There was a system for clinical staff to return patients telephone calls.

• The practice provided a full range of health promotion and screening that reflects the needs for this age group.

Updated 12 December 2016

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

• 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting between April 2014 and March 2015, which was below the national average of 84%. The practice had developed an action plan to improve this number by training the health care assistant to complete them.

• 95% of patients with schizophrenia, bipolar affected disorder and other psychoses had a review of their care plan (above the national average of 88%) and 87% had a record of their alcohol consumption which was in line with the national average.

• 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.

Updated 12 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. They had 15 patients on the learning disability register and all had received an annual health care review.

• 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.