Background to this inspection
Updated
15 March 2018
Queenhill Medical Practice is located in Selsdon, South Croydon. At the time of our inspection, the practice had approximately 7300 registered patients. Compared to the local and national average, the practice has more patients aged 65 years old, and over 75 years old.
Life expectancy of the patients at the practice is slightly above CCG and national averages. The surgery is based in an area with a deprivation score of nine out of 10 (1 being the most deprived), and with lower levels of income deprivation affecting older people and children. Compared to the English average, slightly more patients are unemployed and slightly fewer have a long-standing health condition.
The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of treatment of disease, disorder or injury, family planning services, maternity and midwifery services, surgical procedures, and diagnostic and screening procedures at one location.
The practice has a PMS contract. (Personal Medical Services(PMS) agreements are locally agreed contracts between NHS England and a GP practice) and provides a range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning clinic, contraception services, minor surgery and substance misuse management.
The practice is currently open five days a week, Monday to Friday from 8.00am to 6.30pm. In addition, the practice offers extended opening hours from 6.30pm to 8.00pm every Tuesday and Wednesday. From 6.30pm the practice telephone lines will be switched over to their Out of Hours service provider.
Queenhill Medical Practice has two GP partners, four salaried GPs, four practice nurses and two healthcare assistants (one of whom is a phlebotomist). The practice staff team also included a practice manager, a reception supervisor and a team of reception and administrative staff.
Queenhill Medical Practice is an accredited training practice for doctors training to become GPs.
Updated
15 March 2018
Letter from the Chief Inspector of General Practice
This practice is rated as Good overall. (Previous inspection September 2015 – Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Queenhill Medical Practice on 9 January 2018, as part of our inspection programme.
At this inspection we found:
- The practice had clear systems to keep patients safe and safeguarded from abuse.
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, we found that there were some incidents that the practice had not reviewed as significant events when it might have been beneficial to do so.
- There were established safety systems. Most of the safety systems that had been established were monitored and were working well, leading to improvements were required. There were some systems that were not working as effectively. When we raised these with the practice, we were told of action taken to ensure that these safety systems were effective.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. The practice generally performed well against local and national averages and targets.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider
should
make improvements are:
- Review monitoring of all safety systems to ensure they are effective.
- Review how to ensure that all incidents that would benefit from review as significant events are identified.
- Consider how to improve uptake of cervical screening.
- 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 FRCGPChief Inspector of General Practice
People with long term conditions
Updated
17 December 2015
The practice is rated as good for the care of people with long-term conditions. It had nurse led clinics for asthma, Chronic obstructive pulmonary disease (COPD) and Ischaemic Heart Disease (IHD). Longer appointments and home visits were available when needed. Patients with long term conditions were provided with structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the clinical team worked with relevant health and care professionals to deliver a multidisciplinary package of care.
The practice led in the development of a prostate monitoring service in the local area that enables low risk patients to be followed up in primary care. The practice has also led in the use of GP follow up for some other disease areas that had previously been followed out in hospital outpatient services: Coeliac Disease, Barrett’s oesophagus, Monoclonal Gammopathy of Undetermined Significance, and chronic lymphocytic leukaemia.
Families, children and young people
Updated
17 December 2015
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.
Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. The practice ran weekly antenatal and baby clinics. The nursing team ran ad hoc family planning support with sexual health advice and chlamydia testing. Through their PPG, the practice offered first aid courses for parents.
Updated
17 December 2015
The practice is rated as good for the care of older people. The practice had a predominantly older population, and nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It had identified people at greater risk of hospital admissions and put in place additional plans of care for them.
The practice held monthly multidisciplinary team meetings attended by social services, district nursing, the community matron and the health visitor for older people, and the elderly care consultant to help find solutions for health and social issues found among their patients in this population group.
It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs, and their carers. The practice offered seasonal flu vaccinations to patients over the age of 65, and used their healthcare team during these sessions to carry out opportunistic checks, such as of patients’ blood pressure.
The practice provided GP support to a local care home, through regular two weekly visits, and additional visits as they were requested.
The practice patient participation group (PPG) organised first aid classes for the practice’s older patients.
Working age people (including those recently retired and students)
Updated
17 December 2015
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.
People experiencing poor mental health (including people with dementia)
Updated
17 December 2015
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Of the patients on the practice mental health register, 95% had had a comprehensive care plan documented for them in the preceding 12 months. The practice also maintained a register of patients diagnosed with dementia. Of these, 98% had had their care reviewed in the preceding 12 months. All of the practice’s patients newly diagnosed with depression in the preceding 12 months had had a bio-psychosocial assessment by the point of diagnosis. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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 recently started providing the use of a consultation room to their local psychological support team, which allowed improved access to this service for their patients.
People whose circumstances may make them vulnerable
Updated
17 December 2015
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, and those with a learning disability. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.
The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.