The Old Court House Surgery

Updated 14 April 2016

The Old Court House Surgery provides primary medical services in Sutton to approximately 12800 patients and is one of 27 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the third least deprived decile in England. The practice also has a branch site in Robin Hood Lane Health Centre. Patients are able to attend either site to receive medical services from this provider.

The practice population has an average representation of income deprived children and older people. The practice population of children, older people and those of working age is line with local and national averages. Of patients registered with the practice, 62% are White or White British, 8% are Asian or Asian British and 4% are Black or Black British.

The main practice operates from a converted building; although all consultation rooms are on the ground floor, not all areas are easily accessible. The practice has stairs within the waiting area and indoor ramp access. The practice has access to nine consultation rooms, one nurses’ treatment room and one room used for minor surgery. The branch practice is located within a purpose-built GP premises at a local health centre and the practice has access to three doctors’ consultation rooms and a nurses’ treatment room. The branch practice shares the waiting and reception areas with the other GP surgery. The consultation and treatment rooms are sub-let from the other GP practice at the health centre.

The practice team at the surgery is led by five partners. There are two male and one female full time GPs who are partners and one female part time GP who is a partner. The GP team is also made up of three female salaried GPs who are part time. The total number of GP sessions per week is 51 across both practice sites. The nursing team consists of female full time nurse practitioner who is a nurse prescriber and is the fifth partner in the practice, a further female part time nurse practitioner, two female full time practice nurses who are also nurse prescribers, two female part time practice nurses and a locum female part time practice nurse and three female part time health care assistants. The non-clinical team includes a practice manager, eight administrative staff and 11 reception staff members. The practice were undergoing a change in management structure at the time of the inspection.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). The practice is a training practice for trainee GPs and provides teaching to medical students; however the GP trainer was on maternity leave at the time of the inspection.

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday. Appointments are available between 8am and 12pm every morning and 2pm and 6.30pm every afternoon. Extended hours surgeries are offered from 7.30am to 8am and 6.30pm to 7pm across both practice sites, Monday to Thursday. The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8am and directs patients to the out-of-hours provider for Sutton CCG.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services, family planning services, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

Updated 14 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Old Court House Surgery and the branch practice on 8 March 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.
• Most risks to patients were assessed and well managed with the exception of some health and safety risks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients were very satisfied with the level of service received. They said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had adequate 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.

In addition the provider should:

• Implement a robust system for monitoring and actioning patient safety alerts.
• Ensure that appropriate recruitment checks are undertaken and recorded prior to employment for all staff.
• Improve management and monitoring of health and safety systems in the practice, specifically those associated with control of substances hazardous for health and ensure that there is a system in place to provide assurances that health and safety risks are adequately assessed and managed at the branch practice premises.
• Ensure that all staff employed by the practice have access to required mandatory training including annual basic life support training.
• Ensure that all staff have access to annual appraisals.
• Implement a robust system to ensure that the practice’s urgent onward referrals have been received by other services.

• Ensure that patients wth a learning disability are reviewed and monitored effectively.

• Improve the information available in patient waiting areas for translation services and bereavement support.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 April 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.
• All these patients had a named GP and patients had been offered a structured annual review to check their health and medicines needs were being met.
• The practice were signed up to the national avoiding unplanned admissions enhanced service, to identify those patients most at risk of admission to hospital. The practice was also signed up to a local initiative to identify those at risk with two or more long-term conditions. The practice provided care plans for these patients.
• Nurses were able to offer spirometry testing for those with respiratory conditions.
• The practice provided advanced level diabetic care, including insulin initiation.
• Performance for diabetes-related indicators were mixed. For example, the number of patients who had received an annual review for diabetes was 70% which was below the Clinical Commissioning Group (CCG) average of 86% and national average of 88%. However, the practice had performed in line with averages to monitor specific blood tests for those with diabetes.
• The percentage of diabetic patients who had received the flu vaccination in 2014/15 was 89%, which was below CCG and national averages.
• The number of patients with Chronic Obstructive Pulmonary Disease (COPD) who had received annual reviews was 82% which was below the CCG average of 91% and national average of 90%.
• 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.
• The practice had worked with the Patient Participation Group (PPG) to offer health education sessions. One session on diabetes had been held.

• The practice provided an in-house phlebotomy clinic with a phlebotomist, two mornings per week for practice patients and a phlebotomy service was also provided one morning per week that could be accessed by patients from across the CCG area, who were registered with a GP.

• Cardiography was available two days per week for CCG patients that had been referred to this service.

• Longer appointments and home visits were available when needed.

Updated 14 April 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 (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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided baby checks, midwife-led antenatal care and postnatal care.
• The practice’s uptake for the cervical screening programme was 81%, which was in line with the Clinical Commissioning Group (CCG) average of 83% and the national average of 82%.
• Chlamydia screening and a full range of contraceptive services were provided by GPs and nurses. The practice was the first CCG practice to be signed up to the condom card scheme. Patients aged 16-24 from across CCG practices were able to access this scheme. Those aged 13-16 could also access the service, if they were patients registered with the practice.

Updated 14 April 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 had engaged with local community services to offer an opening morning for those over 75 to improve holistic health and well-being of patients. Those who did not attend were invited to the practice for a health check so they could be monitored.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mostly above averages.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was lower than the national average at 64% for 2014/15.

Updated 14 April 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.
• Extended hours surgeries were offered from 7.30am to 8am and 6.30pm to 7pm across both practice sites, Monday to Thursday.

• The practice provided an in-house phlebotomy clinic two mornings per week for practice patients. This commenced at 7.30am on one day and 8am on the other day, which suited working-age patients.

• The practice provided a community-based cardiography service with qualified cardiographers two days per week, where patients were able to access electrocardiogram (ECG) testing without needing to attend a hospital. Practice patients and patients referred from other practices across the Clinical Commissioning Group (CCG) were able to access this service.
• One of the GPs provided a minor surgery clinic for joint injections and skin conditions at the main practice site.
• 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 including smoking cessation in-house and travel vaccinations.

Updated 14 April 2016

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

• 85% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which was above the Clinical Commissioning Group (CCG) average of 81% and national average of 84%.
• Performance for mental health related indicators was above the CCG and national averages for the number of patients who had received an annual review at 94%; compared with CCG average of 87% and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 April 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, carers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice was signed up to the enhanced service to offer physical health checks to those patients with learning disabilities and six out of 36 patients had received an annual review, in 2014/15 which was 17%. Between April 2015 and March 2016 the practice had provided 11 patients with a learning disabilities health check which was 31%. Health check invitations and care plans we saw were very comprehensive and there was evidence the practice had liaised with the lead nurse for learning disabilities in the local area.
• The practice had identified 352 patients as carers which was 2.8% of the practice list. They had provided flu immunisations to 53% of carers.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people including a monthly meeting with health visitors.
• 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.