Modality East Surrey Medical Practice

Updated 28 November 2016

Smallfield Surgery offers primary medical services to the population of Smallfield in Surrey and the surrounding area. There are approximately 6,600 registered patients..

Smallfield Surgery is situated in a semi-rural location in Horley and offers services to patients in Smallfield, the surrounding villages and the Eastern part of Horley. The ground floor has disabled access with two seated waiting areas. All of the GP consulting rooms and treatment rooms are located on the ground floor. Staff offices and facilities are located on the first floor. There is an accessible toilet for patients on the ground floor and there are baby changing facilities.

Smallfield Surgery is run by four partner GPs (two male and two female). The practice is also supported by two salaried GPs and two registrars, a GP retainer, a specialist nurse practitioner, a practice nurse, two healthcare assistants and a phlebotomist. The practice also has a team of receptionists, administrative staff and a practice manager.

GP registrars are fully qualified and registered doctors who are on a three year GP training course. This involves further medical training in specialities and are attached to a practice under a supervising qualified GP. (The GP Retainer scheme enables GPs to work up to four sessions a week in general practice, in an educationally protected environment. The scheme is intended to ensure that GPs are able to keep up to date and develop their career in general practice with the aim of returning to a more substantive post in general practice at some time in the future).

The practice runs a number of services for its patients including asthma reviews, child immunisation, diabetes reviews, new patient checks and holiday vaccines and advice.

Services are provided from:-

Smallfield Surgery, Wheelers Lane, Smallfield, Horley, Surrey, RH6 9PT

Opening Times

Monday to Friday 8.30am to 1pm and 2pm to 6pm

Extended hours are on Saturday mornings 9am to 12pm.

During the times when the practice is closed, the practice has arrangements for patients to access care from an Out of Hours provider.

The practice population has a higher number of patients aged between 40 and 69 years of age than the national and local clinical commissioning group (CCG) average. The practice population shows a lower number of patients aged from 15 to 39 years of age than the national and local clinical commissioning group (CCG) average. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for England. Less than 10% of patients do not have English as their first language.

The following regulated activities are carried out at the practice: Treatment of disease, disorder or injury; Surgical procedures; Family planning; Diagnostic and screening procedures; Maternity and midwifery services.

Updated 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Smallfield Surgery on 20 October 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.
• There was a holistic approach to assessing, planning and delivering care and treatment to patients. For example, patients could attend a Chronic Disease Monitoring (CDM) appointment to assess all of their long term conditions needs. Therefore patients were not inconvenienced by having to attend several appointment and patients conditions were assessed as a whole rather than individually.
• 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.
• Risks to patients were assessed and well managed.
• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care. For example, 95% of patients described the overall experience of this GP practice as good compared to the national average of 85%.
• Feedback from patients we spoke with or who provided feedback, (50 comments cards and five patients spoken with) were continuously positive about the way staff treated them and other patients. Patients said staff went the extra mile and the care they received exceeded their expectations. Patient’s also told us that it was easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they meet patients’ needs. For example, the practice was involved in the forgetmenot club and the Wellbeing Advisor Project (the Wellbeing Advisor Project provides services such as befriending to reduce the risk of social isolation on patients health and wellbeing).
• The practice was proactive in the identification of carers and had identified 244 patients as carers (4% of the practice list).
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was run efficiently and was well organised. 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 practice was part of a national pilot on preventing type 2 diabetes (National Diabetes Prevention Programme) as well as taking part in the National Diabetes Audit.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 November 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 comparable with the local clinical commissioning group (CCG) and national averages. For example, 81% of patients with diabetes, whose last measured total cholesterol was in a range of a healthy adult (within the last 12 months). Which was the same as the clinical commissioning group (CCG) and national average.
• 95% of patients with chronic obstructive pulmonary disease (COPD) had a review undertaken including an assessment of breathlessness, which was comparable with the national average of 90%
• 80% of patients with asthma had an asthma review performed in the previous 12 months. This was higher than the national average of 75%
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured bi-annual or annual review to check their health and medicines needs were being met. The practice offered patients a Chronic Disease Monitoring appointment which reviewed all of the patients conditions in one appointment and was set for the patients birth month.
• The practice could refer patients to exercise classes for those patients with diabetes and cardiovascular diseases to help manage their condition.
• 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 28 November 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 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 ensured that children needing emergency appointments would be seen on the same day.
• The number of women aged between 25 and 64 who attended cervical screening in 2014/2015 was 83% which was comparable to the clinical commissioning group (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 eight week baby checks and postnatal checks.
• GPs and nurses carried out family planning and contraceptive services which included coil and contraceptive implant fitting.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff.
• Appointments were available at the practice with the GP until 6pm and on Saturday mornings.

Updated 28 November 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.
• Housebound patients could have an annual or biannual Chronic Disease Management review at home.
• Older patients with complex care needs and those at risk of hospital admission had care plans that were appropriately shared with local organisations to facilitate the continuity of care.
• Initiatives were run from the practice such as the Wellbeing Advisor Project which provided services such as befriending to reduce the risk of social isolation on patients health and wellbeing.
• The practice had helped to create the Forgetmenots Club. This was an initiative set up by the practice three years ago and was now run from a local hall as a weekly drop in centre for carers and people living with dementia.
• The practice worked closely with community teams to ensure there was good provision of care and support was in place when needed.
• A Memory Clinic run by the Older Adults Community Mental Health Team was held at the practice once a week.

Updated 28 November 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.
• Appointments were available at the practice with the GP until 6pm and on Saturday mornings.
• Telephone consultations were available during working hours.
• Electronic Prescription Services (EPS) and a repeat dispensing service helped patients to get their prescriptions easily.
• Travel health and vaccination appointments were available.

Updated 28 November 2016

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

• 97% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, with the national average being 84%
• 97% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented, in the last 12 months, with the national average being 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.
• A number of staff had received training to be Dementia Friends and one of the GPs was attending training to become a local Dementia Champion.
• Wellbeing advisors were located in the practice once a week . Patients could be referred to the advisor to help patients access local support available. For example, to help with weight loss, carer support, reducing social isolation and befriending services.

Updated 28 November 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.
• 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.
• Translation services were available for patients who did not use English as a first language.
• The practice could accommodate those patients with limited mobility.
• Carers, and those patients who had carers, were flagged on the practice computer system and were signposted to the local services and the local carers support team.
• The practice support local groups and organisations available and provided information for patients about these. Staff demonstrated they were able to access these in a timely way to support vulnerable patients. For example, through the Carers’ Coordinator, Crossroads (a local organisation who provide home and emergency respite care services) or the forgetmenot club.