Thamesmead Medical Associates - PMS

Updated 25 April 2017

Thamesmead Medical Associates PMS, is an established GP practice situated, in Thamesmead, within the London Borough of Greenwich and lies within the administrative boundaries of NHS Greenwich Clinical Commissioning Group (CCG). The practice provides primary medical services to approximately 17000 patients living within its catchment area of SE28 and some areas of SE18 and SE2 that border SE28. The practice holds a personal medical services (PMS) contract, and has been accredited as a GP training practice (training practices take GP trainees and F2 doctors), on average having 4 trainees at any given time. The practice has its main surgery located in Gallions Reach Health Centre, Thamesmead, SE28 8BE with a branch surgery, approximately one mile away, at Heronsgate Medical Centre, 1A Goosander Way, Thamesmead, SE28 0ER. Both locations have step free and wheelchair access to the entrance of the respective buildings, reception and waiting area. Parking is available on site with a designated parking for people with physical disabilities and a hearing loop is in place at the front reception desk. The main practice building at Gallions reach is a shared building with a dental practice and Pharmacy on site. As part of our inspection we visited both the main and branch surgery.

The practice population is ethnically diverse and the area has significant deprivation with an indices of multiple deprivation (IMD) score of 4 out of 10 (fourth most deprived decile.) People living in more deprived areas tend to have a greater need for health services, although an area itself is not deprived; it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas.

The demographics do not show anything of any particular significance with the population group being reflective of both the CCG and National average across the population groups however it was noted that the practice services higher numbers of children and young people and lower numbers of older adults. The percentage of patients with a long standing health condition appears significantly lower compared to both the CCG and England average.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic & screening procedures, treatment of disease disorder or Injury, surgical procedures, family planning and maternity & midwifery services. Some enhanced services are provided at this practice which includes facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, childhood vaccination and Immunisation scheme, unplanned admission and services for violent patients.

The practice team comprises of one full-time, one part-time female partner and one male full-time partner, three full-time and three part-time salaried GPs. They are supported by one part-time locum GP, two full-time and two part-time trainee GPs, three part time practice nurses, two full-time health care assistants, one full time practice manager, two full-time time reception supervisors, and six administrative and 10 reception staff. There are fifty GP sessions each week.

The main practice (Gallions Reach) and the branch (Heronsgate) are open between 8am and 6.30pm Monday to Friday; however the branch is closed Wednesday afternoons.

Appointments are from 8.10am to 1pm (except Mondays when they are provided until 12 noon) and 2pm to 6pm. Extended hours appointments are offered at the following times, 8.30am to 1pm on a Saturday (Heronsgate.)

Out-of-hours services are provided by the locally agreed service, patients access by calling 111. Further information is provided on the practice telephone line, their website and on the practice notice board.

The practice provides a full range of general medical services including chronic disease management, minor surgery, and NHS health checks. The practice also provides health promotion services including, cervical screening, childhood immunisations, blood taking/phlebotomy, antenatal services, contraception including intrauterine device (IUD - coil) fitting and family planning.

Updated 25 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thamesmead Medical Associates PMS on 15 November 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:

• Improve telephone access to ensure patients can access appointments when required.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 April 2017

The practice is rated as good for the care of people with long-term conditions.

• GPs and 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 similar to the CCG and national average. An example taken from these indicators related to patients on the diabetic register whose last IFCC-HbA1c (a specific blood glucose level test) measured 64 mmol/mol or less was 76%, (CCG 76%, national 78%).

• 78% of patients with asthma had an asthma review that included an assessment of asthma control (CCG 74%, national 75 %).

• 88% of patients with COPD had a review including an assessment of breathlessness using the Medical Research Council dyspnoea scale (CCG 87%, national 90 %).

• 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.

• Longer appointments and home visits were available when needed.

• The practice used audit and the QOF register to recall of Chronic Obstructive Pulmonary Disease (COPD).

• Smoking cessation clinics run by the practice in house pharmacist at Gallions Reach, together with signposting to other locally available support was available to support people with long term conditions.

• The practice proactively identifies those hard to reach groups as demonstrated in their health check pilot at a local supermarket.

Updated 25 April 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 82%, which was comparable to the CCG and 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.

• The practice provided contraception counselling, including intrauterine devices (IUD) or coil clinics.

• The practice had safeguarding policies in place and all patients were coded accordingly. Alerts are in place to alert staff that these patients are a safeguarding concern.

• The practice identified and supported those subjected to domestic abuse.

Updated 25 April 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.

• The practice offered health checks to patients aged over 75.

• The practice triaged all home visit requests and worked in conjunction with other multidisciplinary professionals to facilitate earlier intervention and did joint visits where hospital admission may be an outcome.

• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time. We saw that discharge notes were reviewed daily.

• The practice had a “housebound list” with named GP’s.

Updated 25 April 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 travel advice and vaccinations.

Updated 25 April 2017

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

• 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national average of 84%.
• 80% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan which was comparable to the CCG average of 85% and national average of 88%.

• 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.

• The practice had extensive mental health protocols in place which have been identified as best practice and have now been adopted by other local practices.

Updated 25 April 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 computer system alerted staff to vulnerable people.

• The practice offered longer appointments for patients with a learning disability and those with complex needs.

• 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.

• The practice used the Gold Standard Framework to support individual wishes as part of end of life care.