Archived: Dr BPC Peiris' Practice Also known as Alderwood Surgery

Updated 26 July 2016

The practice operates from one site in Eltham, London. It is one of 42 GP practices in the Greenwich Clinical Commissioning Group (CCG) area. There are approximately 2,900 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, treatment of disease, disorder or injury, and surgical procedures.

The practice has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include dementia, influenza and pneumococcal immunisations, learning disabilities, minor surgery, online access, patient participation, risk profiling and case management, rotavirus and shingles immunisation, and unplanned admissions.

The practice has an above average population of patients aged 20-29 years, 45-49 years, and 65-84 years. Income deprivation levels affecting children and adults registered at the practice are above the national average.

The clinical team includes three female partners, one of whom is on maternity leave, and a male locum GP. There is a female salaried practice nurse and a female locum practice nurse. The GPs provide a total of 17 sessions per week. The clinical team is supported by a practice manager, an assistant practice manager and five reception/administrative staff.

The practice is open from 8.00am to 6.30pm Monday to Friday, and is closed on bank holidays and weekends. Appointments with GPs are available from 9.00am to 11.00am, and 4.30pm to 6.00pm Monday to Friday, and extended hours are available from 6.30pm to 8.00pm on Tuesdays. Appointments with the nurse are available between 9.00am and 5.00pm Monday to Friday.

There are two consulting rooms and a treatment room on the ground floor, and one consulting room on the first floor. There is on-street restricted car parking and disabled parking available. The practice has wheelchair access but there are no baby changing facilities, and there is no lift to the first floor.

The practice has opted out of providing out-of-hours (OOH) services and directs patients needing urgent care out of normal hours to contact a local contracted OOH provider which is based at the Queen Elizabeth Hospital.

Updated 26 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr BPC Peiris’ Practice on 12 April 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations were thorough and patients always received an apology.
• Risks to patients were assessed but not always well managed. This was in relation to risks which had not been addressed from a fire risk assessment, failure to conduct a risk assessment for the control of substances hazardous to health, and recruitment procedures which were not robust.
• A non-clinical member of staff informed us they updated medical records for patients who had received vaccinations in instances where nurses had failed to, and without specific instructions from the nurse. The practice had not put any systems in place to prevent this from happening again.
• A GP did not document instances where patients had declined a chaperone.
• Data showed patient outcomes were comparable to or below national averages.
• We saw evidence that audits were driving improvements to patient outcomes.
• All of patients we spoke with said they were treated with compassion, dignity and respect; they felt cared for, supported and listened to.

• Information about services was available but there was no information on avenues of support available to carers.

• Patients reported that although urgent appointments were usually available the same day, they had faced difficulties getting pre-bookable appointments.

• The practice had a number of policies and procedures to govern activity, but there was no policy for safeguarding adults.
• There was a clear leadership structure and staff felt supported by management but not all of them felt their views were valued.
• The practice proactively sought feedback from patients, which it acted on.
• Governance arrangements were not effective enough to support the practice’s vision to provide high quality care.

The areas where the provider must make improvements are:

• Ensure clinical staff maintain a contemporaneous record of the care and treatment provided to every service user, and implement processes to investigate any instance where this does not occur.

• Ensure all risks from the fire risk assessment are addressed, and there is a process for reviewing the risk assessment at appropriate intervals; ensure fire alarm systems are tested regularly and these tests are documented.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

In addition the provider should:

• Ensure there is a defibrillator available, or a risk assessment which adequately mitigates the need to have one.

• Improve processes in place for monitoring vaccines fridge temperatures.

• Ensure all clinical staff make a record of instances where patients decline to have a chaperone present during consultations or procedures.

• Ensure there is a policy and named lead for safeguarding adults.
• Review performance for diabetes related indicators, and for exception reporting, and make improvements.
• Ensure a sharps injury protocol is displayed in consulting and treatment rooms.
• Ensure the business continuity plan is sufficiently comprehensive.

• Ensure appraisals are completed annually and appraisal forms are completed appropriately.

• Consider including safeguarding, infection control, and fire safety to the induction process for new staff.

• Improve access to appointments for patients, and ensure translation services are advertised in a format patients can understand.
• Improve the system for identifying carers, and ensure there is sufficient written information available to support carers on the patient list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 July 2016

The practice is rated as requires improvement overall. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• 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 below average in all areas in 2014/2015, but had improved in most areas in 2015/2016. For example, in 2014/2015, 62% of patients with diabetes had well-controlled blood sugar levels (national average 78%). This had increased to 74% in 2015/2016. However, performance remained below average in relation to patients with diabetes who had received a foot examination and risk classification, those who had well controlled blood pressure control and those who had received the annual flu vaccine.

• Longer appointments and home visits were available when needed.

• All of these patients had a named GP and most had received a structured annual review to check their health and medicines needs were being met.

• 65% of patients with asthma had an asthma review in the previous 12 months. This was below the national average of 75%.

• 88% of patients with chronic obstructive pulmonary disease had a review of their care in the previous 12 months. This was in line with the national average of 90%.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals on an ad-hoc informal basis to deliver a multi-disciplinary package of care.

Updated 26 July 2016

The practice is rated as requires improvement overall. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• 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.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• 81% of women aged 25-64 years had a cervical screening test in the previous five years. This was in line with the 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.

Updated 26 July 2016

The practice is rated as requires improvement overall. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• 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 a daily in-house phlebotomy service which could be used by anyone, including older patients who struggled to reach the local hospital.

Updated 26 July 2016

The practice is rated as requires improvement overall. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• 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.

• Health promotion advice was offered and there was accessible health promotion material available throughout the practice.

Updated 26 July 2016

The practice is rated as requires improvement overall. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• 89% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their record. This was comparable to the 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.

Updated 26 July 2016

The practice is rated as requires improvement overall. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, 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.