The Morden Hill Surgery

Updated 24 October 2016

Dr Abrahams & Partners run the GP practice known as Morden Hill Surgery. The practice is based in a conversion of two houses in a residential area of Lewisham area, in south London, and works within Lewisham Clinical Commissioning Group (CCG). Parking near the practice is very limited but the area is well served by public transport.

There are approximately 8829 patients at the practice. Compared to the England average, the practice has more patients aged 25 to 49, young children as patients (age up to nine) and fewer older children (age 10 – 19). There are more patients aged 20 – 49, and many fewer patients aged 50+ than at an average GP practice in England.

Life expectancy of the patients at the practice is in line with CCG and national averages. The practice population scores relatively highly on a national measure of deprivation: with a score of four out of ten (with one being the most deprived) and on measurements of deprivation affecting older people and children. Compared to the English average, more patients are unemployed.

Six doctors work at the practice: two male and four female. Four of the doctors are partners (two male and two female) and there are two salaried GPs. Some of the GPs work part-time. Full time doctors work 8 sessions per week. The practice has 39 GP sessions per week.

There are three female practice nurses. They all work part-time, with all of the nursing hours adding up to 1.7 whole time equivalents.

The practice is a training practice for junior doctors training to be GPs.

The practice is open 7am to 6.30pm Monday to Friday.

Appointments are available from 7am to 11.30 am and 1pm to 6pm on Monday, 8am to 12pm and 3.30pm to 6pm on Tuesday, 8.10am to 12pm and 2.30pm to 8.30pm on Wednesday, 8am to 11.30 am and 1pm to 6pm on Thursday, and 8am to 11.40 am and 2.50pm to 6pm on Friday.

When the practice is closed cover is provided by a local out-of-hours care service.

The practice provides works under a Personal Medical Services contract with the NHS, and is registered with the Care Quality Commission to provide treatment of disease, disorder or injury, surgical procedures, diagnostic and screening procedures, family planning and maternity and midwifery services.

Updated 24 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Abrahams & Partners (Morden Hill) on 25 May 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 that complete records are maintained of all training, including child safeguarding training appropriate to staff members’ roles.

• Ensure that ‘near miss’ events are managed using the practice’s significant event process, so that learning can be recorded and assessed.
• Ensure that recruitment checks are carried out in line with guidance and the practice policy and that a personal development plan is completed for all staff as part of the annual appraisal process.
• Continue to improve patient outcomes as measured by the Quality and Outcomes Framework (QOF) and consider how to improve take up of annual health checks by patients with a learning disability.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 October 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 generally below the national average in 2014/15. The practice showed us data that showed that their performance had improved in 2015/16 (although this data had not been published or independently verified at the time of our inspection), and we heard of new arrangements put in place to make further improvements.
• Two of the practice nurses were trained educators for a specific self-management course for people with, or at risk of, type 2 diabetes. One of the GPs had led on the local education programme for people with type 1 diabetes.
• To better meet the needs of patients with long term medical conditions, all clinical staff were trained in collaborative care planning. We saw evidence that the care plans of people with complex needs were reviewed every six months, with extra time and support given to engage patients to help them engage with plans to improve their health and wellbeing. This scheme was supported by the Clinical Commissioning Group.
• 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 24 October 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 attendances. Immunisation rates were in line with local averages 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 80%, which was comparable to 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 24 October 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.
• One of the GPs was designated as the ‘end of life’ care lead. Their role included working with patients and families to create holistic care plans and encouraging discussions about patient’s wishes for end of life care and place of death. The practice worked with others in the multidisciplinary team to try to ensure these wishes were met. The practice told us that (over a 9 month period checked in 2015) 50% of these patients died in their preferred location, which was above the national average of 25%.
• We saw examples of extra efforts being made to limit the disruption to very vulnerable or frail patients from medical treatment, for example tests being arranged in a patient’s home that would normally take place in hospital.

Updated 24 October 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 24 October 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 mixed, with some below the national average. For example, 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 88%. The practice showed us data that demonstrated their performance had improved, and we heard of new arrangements put in place to make further improvements.
• 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 24 October 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, but no easy-read materials. The take up of annual health checks for patients with a learning disability was low.
• 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.