Elizabeth House Medical Practice

Updated 18 August 2017

Elizabeth House Medical Practice is based in Warlingham and covers the adjacent villages of Farleigh, Chelsham, Woldingham, Hamsey Green and parts of Whyteleafe, Caterham and Sanderstead. The practice is located in a converted residential property which has been extended. The practice holds a contract to provide personal medical services and has approximately 5,900 patients on the practice list.

The practice has a slightly higher than average number of patients over 50 years old, particularly patients over 85 years old. They also have a slightly lower than average number of patients from 10 to 39 years old. The number of patients on the practice list with long standing health conditions is in line with local and national averages. The practice is located in an area that is considered to be in the second least deprived area nationally, and is in line with local averages for children and older people affected by deprivation. The practice has recently taken on a contract to provide care to the residents of two small homes for patients with learning disabilities.

The practice has two GP partners and two salaried GPs (two male and two female). They are supported by two practice nurses, a practice manager who is also a nurse practitioner, two phlebotomist/health care assistants and a team of administrative staff. The practice is a training practice (training practices offer placements to GP trainees and foundation year two doctors).

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are offered 6.30pm to 8pm Monday evenings when there is a partner, a practice nurse and a health care assistant available. When the practice is closed patients are advised to call NHS 111 where they are given advice or directed to the most appropriate service for their medical needs.

The service is provided from the following location:

515 Limpsfield Road, Warlingham, Surrey, CR6 9LF

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elizabeth House Medical Practice on 10 November 2016. The overall rating for the practice was good although the practice was rated as requires improvement for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Elizabeth House Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The practice had reviewed their adult safeguarding policy following the last inspection. The policy contained local contact details and outlined the different types of abuse that staff should be aware of.
• Sharing of learning from significant events and incidents was a regular agenda item at team meetings for non-clinical staff.
• The practice had reviewed their sharps protocol to reflect best practice guidance for the use of sharps bins.
• The arrangements for ensuring security of blank prescription forms had been reviewed and a new protocol implemented.
• The practice had commenced a log of health and safety related risk assessments which were updated regularly to ensure actions were completed.
• The emergency medicines list had been updated to include expiry dates to ensure medicines were fit for use in the event of an emergency occurring. However, the interval between checks of the emergency medicines was after some of the medicines were due to expire.

Areas where the practice should make improvements:

• Ensure the interval for checks of the emergency medicines is reviewed and reflects best practice guidelines.

We have changed the rating to reflect the findings for the provision of safe services. The practice is now rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 January 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.
• Practice performance for diabetes indicators was comparable to local and national averages. For example; 83% of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less, compared to Clinical Commissioning Group (CCG) average of 79% and the national average of 78%.
• 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 10 January 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.
• 85% of eligible female patient’s notes recorded that a cervical screening test had been performed in the preceding five years which is comparable with the England 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 10 January 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.

Updated 10 January 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 electronic prescribing which allowed patients to request a prescription be sent to a pharmacist of their choice, which could be close to their place of work.

Updated 10 January 2017

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

• 84% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is the same as the national average.
• 96% of patients with severe and enduring mental health problems had a comprehensive care plan documented in their records within the last 12 months which was comparable to the CCG average of 89% and the national average of 89%.
• 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 10 January 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.
• Patients who the practice were aware found it stressful to visit the surgery were offered appointments outside of normal surgery hours when the practice was quiet or a home visit.