Essex House Surgery - Flood Also known as Dr Flood and Partners

Updated 5 December 2017

Essex House Surgery provides primary medical services in the London Borough of Richmond Upon Thames to approximately 9,045 patients. 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 operates from one site. The surgery is a converted residential property over two floors. There is stepped and ramp access to the ground floor waiting area, reception desk and consulting rooms. The practice has seven consulting rooms. The second floor is comprised of consulting rooms, practice management facilities including a staff room, meeting room and offices. Patients with mobility issues are offered appointments on the ground floor or lift access to the first floor.

The practice clinical team is made up of three GP partners (male and female), four salaried GPs (two female and two male), one physician’s associate, two trainee doctors, three practice nurses, two healthcare assistant’s (HCA), one practice manger, one assistant practice manager and other non-clinical staff. The practice is a training practice, with two trainee doctors.

The practice is one of two hub practices currently operating in the locality, open every Saturday and one Sunday a month. The practice offers 52 GP sessions per week. The practice opens between 8.30am and 6.30pm Monday to Friday. Appointments are available between 8:30am to 6:30pm Monday to Friday. Extended hours are available on from 6:30pm to 7:30pm every Monday and 7:00am to 8:30am every Friday. When the practice is closed patients can call NHS 111 in an emergency or a local out of hour’s service. The practice is registered with the Care Quality Commission to provide the regulated activities of; maternity and midwifery service, treatment of disease, disorder or injury, family planning, diagnostic and screening procedures and surgical procedures.

Updated 5 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Essex House Surgery – Flood on 20 September 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. This was because the provider did not have a defibrillator available at the practice or an appropriate risk assessment to indicate how they would deal with a medical emergency.

The full comprehensive report can be found by selecting the ‘all reports’ link for Essex House Surgery – Flood on our website at www.cqc.org.uk.

This inspection was an announced desk-based follow up inspection carried out on 9 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation 12 that we identified in our previous inspection on 20 September 2016. This report covers our findings in relation to those requirements.

Overall the practice is rated as good. Specifically the practice was now found to be good for providing safe services.

Our key findings were as follows:

• The practice had access to an automated external defibrillator (AED) for use in medical emergencies.

• The practice had worked with a charity and local community organisations to secure a defibrillator that would be accessible for use by the practice and the local community.

• The practice had arranged resuscitation training sessions for November 2017 that could be attended by staff, patients and the public.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 20 February 2017

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.

• 72% of patients diagnosed with asthma had an asthma review in the last 12 months; this was comparable to the local average of 74% and national average of 75%.

• Performance for diabetes related indicators was comparable to the local and national average, for example:

• 84% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 77%, national average 77%).
• 83% of patients with diabetes on the register had their cholesterol recorded as well controlled (local average 79%, national average 81%).
• 96% of patients with diabetes on the register had a recorded foot examination and risk classification (local average 91%, national average 88%).

• 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 20 February 2017

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.
• 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.
• 84% of women aged 25-64 had it recorded on their notes that a cervical screening test has been performed in the preceding five years; this was comparable to the local average of 84% and 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 and health visitors.

Updated 20 February 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 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.

• 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 20 February 2017

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 opening hours on Monday evenings and Friday mornings.

Updated 20 February 2017

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:

• 78% of patients diagnosed with dementia had a recorded review in a face to face meeting in the last 12 months (local average 86%, national average 84%).

• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 92%, national average 90%).

• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months (local average 94%, national average 88%).

• 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 20 February 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.

• 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.For example, all care plans produced by the practice included links and contact details for local support services, for example FISH (Friendship, Independence, Support, Help), CILS (Community Independent Living Service) and The local CMHT, Richmond Carers Centre.The practice felt that these care plans, are more than a requirement as part of the enhanced service, they should also provide patients with useful advice and details of support agencies.Not only details on how to contact the surgery and other health agencies (which the care plans do include) but also local support services that can support independent living beyond the care that the health service can provide.The documents are considered to be useful, rather than just a tick box exercise. This care plan template has also been rolled-out within other local practices.

• 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.