Park Road Medical Centre

Updated 21 March 2017

Park Road Medical Centre has approximately 4000 patients and is in Wallington, in the south London borough of Sutton . The surgery is in purpose built premises. The is no patient parking, but the area is well served by public transport.

Compared to the England average, the practice has more young children as patients (age up to 14) and fewer young adults (age 15 – 29). There are more patients aged 30 – 49, and fewer patients aged 50+ than at an average GP practice in England.

The surgery is based in an area with a deprivation score of eight out of 10 (one being the most deprived), and has a lower levels of income deprivation affecting older people and children. Compared to the English average, more patients are unemployed. Life expectancy (for men and women) is slightly above the national average.

Three doctors work at the practice: two male and one female. Two of the doctors are partners and there is one salaried GP. The practice provides 13 GP sessions per week. There are two practice nurses, who provide five sessions per week.

The practice is open 8am and 6.30pm Monday to Friday, and until 8.30pm on Tuesday. Appointments are available from 8.30am to 11.40am and 4pm and 18.10pm on Monday, Thursday and Friday, 8.30am to 12pm and 5.20pm to 8.30pm on Tuesday and 9am to 11.40 to 4pm to 6.10pm on Wednsday. When the practice is closed cover is provided by a local service that provides out-of-hours care.

The practice offers GP services under a Personal Medical Services contract in the Croydon Clinical Commissioning Group area. The practice is registered with the CQC to provide family planning, diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.

This is the first time that the CQC has inspected the practice.

Updated 21 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Road Medical Centre on 30 November 2016. Overall the practice is rated as good.

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

• There was a system in place for reporting and recording significant events, although analysis and recording was not always detailed enough to show that all of the risks had been addressed.
• Generally, risks to patients were assessed and well managed, although some had not been addressed comprehensively. For example, although the premises were clean, there was no clear lead for infection prevention and control and although appropriate recruitments checks had been madenot all the checks had been made and fully documented for one member of staff before they started in post.
• 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.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes on most indicators were at or above average compared to the national average. The practice was an outlier for diabetes indicators in 2014/15 and took action to improve – results in 2015/16 were generally in line with averages. The percentage of patients diagnosed with dementia who had a face-to-face review of their care was below average in 2015/16. We saw evidence that action had been taken, and results were likely to be in line with average in 2016/17.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care. Satisfaction with nursing care was below average in the survey data published in July 2016. The practice had taken action to improve the nursing service, including employing an additional nurse and providing more support and training.
• 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 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:

• Consider the level of detail recorded for significant events, so that all of the analysis is evident.

• Ensure that risks are comprehensively assessed and managed. Strengthen arrangements for infection prevention and control and ensure that recruitment checks are carried out and fully documented before staff begin in post.

• Continue to monitor and take action to improve care of patients with long term conditions, particularly diabetes and dementia.

• Continue to monitor and take action to improve patient satisfaction with the nursing service.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 21 March 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.
• Performance for diabetes related indicators was comparable to the national average in 2015/16. The practice performed below average in 2014/15, and took action to improve.
• The practice referred patients with borderline results for diabetes (who had a borderline HBA1C, a test of blood sugar over time) to a local diabetes prevention programme.
• Flu vaccination clinics were run on weekends, in addition to flu vaccinations being given during normal working hours. Invitations to attend for a flu vaccination included an advice leaflet about keeping warm in the winter months, to reduce the risk of complications for patients with long-term health conditions.
• 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 21 March 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.
• The practice’s uptake for the cervical screening programme was 78%, which was comparable to the CCG average of 82% 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 21 March 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.
• Older patients had a named GP to support their care.

Updated 21 March 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 website had a tool that allowed patients to contact their GP directly online, and had arranged Skype consultations. Telephone consultations were arranged out of normal hours where this was more convenient for patients.

Updated 21 March 2017

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

• 68% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the national average. We saw evidence that more patients with dementia had received face to face reviews in 2016/17.
• Performance for other mental health related indicators was comparable to the 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 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 21 March 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.
• 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.