Fairview Medical Centre

Updated 27 June 2017

The Fairview Medical Centre provides primary medical services in Norbury to approximately 7400 patients and is one of 57 practices in Croydon Clinical Commissioning Group (CCG). The practice population is in the fifth more deprived decile in England.

The practice population has a higher than CCG and national average representation of income deprived older people and in line with the CCG and higher than national average representation of income deprived children. The practice population of children is below the CCG and in line with the national average and the practice population of working age people is higher than the CCG and national averages. The practice population of older people is below the CCG and national averages. Of patients registered with the practice for whom ethnicity data was recorded 17% are Other White, 14% are White British and 10% are of Pakistani origin.

The practice operates in purpose built premises. All patient facilities are wheelchair accessible on the ground floor. The practice has access to two GP consultation rooms, one nurse and two healthcare assistant consultation rooms on the ground floor and two GP consultation rooms and one counselling room on the first floor. There is no lift access to the first floor; patients with limited mobility are seen on the ground floor.

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 doctors and GPs.

The clinical team at the surgery is made up of a lead female GP who is a partner and four salaried GPs (one male and three female), one female practice nurse and two healthcare assistants (one male and one female). The non-clinical practice team consists of practice manager, assistant practice manager and nine administrative and reception staff members. The practice provides a total of 40 GP sessions per week.

The practice reception and telephone lines are open from 8:00am to 6:30pm Monday to Friday. Appointments are available from 8:30am to 12:30pm Monday to Friday and from 2:30pm to 5:30pm Monday to Friday except Wednesdays. The practice is closed on Wednesday afternoons; however an on-call GP is available for emergencies and patients are seen if needed. Extended hours surgeries are offered on Mondays from 6:30pm to 8:00pm.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8:00am and directs patients to the out-of-hours provider for Croydon CCG.

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

Updated 27 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fairview Medical Centre on 24 May 2017. 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 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.
• 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 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.

There were areas of practice where the provider should make improvements:

• Review practice systems to ensure there is a clear system in place to monitor the implementation of medicines and safety alerts.
• Review practice procedures to ensure all staff have regular appraisals.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 27 June 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. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
• The national Quality and Outcomes Framework (QOF) data showed that 69% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 70% and the national average of 78%. 98% of patients with diabetes had received a foot examination in the preceding 12 months compared to the CCG average of 87% and national average of 89%.
• The national QOF data showed that 85% of patients with asthma in the register had an annual review, compared to the CCG average of 74% and the national average of 76%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice offered minor surgical procedures including joint injections, phlebotomy, spirometry, electrocardiography and blood pressure monitoring which reduced the need for referrals to hospitals.

Updated 27 June 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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. The practice was one of the lowest for emergency admissions in Croydon.
• 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 had alerts set up for children on the child protection register.
• The practice’s uptake for the cervical screening programme was 83%, which was in line with the Clinical Commissioning Group (CCG) average of 81% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had set up alerts in their clinical system for at risk children.
• The practice GPs provided antenatal and postnatal checks.
• The practice patients had access to family planning clinics and provided advice on smoking cessation and nutritional advice by an in house nutritionalist.

Updated 27 June 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• 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 visited housebound patients at least every six months and often much more regularly.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs. The practice had detailed end of life care plans for patients.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The lead GP of the practice helped to design a national course ‘Difficult Conversations’, which is a communication training for healthcare professionals who find themselves having to deliver bad news. The lead GP is also the lead for End of Life care education for Croydon and had developed Royal College of General Practitioners end of life care module.
• The practice GPs undertook regular weekly ward rounds for a local nursing and residential home supporting the needs of 47 residents.
• The practice ran flu clinics on Saturdays each year.

Updated 27 June 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 extended hours appointments and telephone consultations with GPs which suited working age people.

Updated 27 June 2017

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

• 93% of 71 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 86% and national average of 89%.
• 87% of patients with dementia had received an annual review which was above the Clinical Commissioning Group (CCG) average of 83% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.
• The practice patients had access to two in house counsellors who supported the patients with mental health issues.

Updated 27 June 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, carers, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability. Only 52% (24 patients) out of 46 patients with a learning disability had received a health check in the last year. The practice supported the needs of learning disability patients in a local care home.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed 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.
• In conjunction with the Patient Participation Group the practice had invited external speakers and ran talks on counselling, diet, immunisations and exercise and hosted events for patients who felt isolated.