Park Green Surgery

Updated 7 February 2017

The practice delivers commissioned services under the Personal Medical Services (PMS) contract. Nine GPs, a practice nurse, two nurse prescribers and a healthcare assistant provide clinical care. There is a mix of male and female GPs and each individual leads in areas of special clinical interest, such as menopause, dermatology and men’s health. A practice manager leads a team of secretaries and receptionists and there is dedicated IT support.

The practice is a training practice and a registrar as well as trainee doctors are supported to provide supervised clinics. The practice delivers scheduled clinical education sessions to other clinical staff in the Clinical Commissioning Group area. The practice offers a minor surgery service.

The practice is situated in a purpose-built building that is shared with other healthcare providers, including other GP practices and a pharmacy. There is an attached car park with lift access to every floor of the building.

Appointments are from 8am to 6.30pm Monday to Friday. Outside of these hours, patients have access to an urgent medical care centre, which is open 24 hours, seven days a week. The practice offers online booking and text message reminders.

The practice serves a list of 11,119 patients in an area of very low deprivation.

Fifty six per cent of patients are of working age, compared to the England average of 67%. The practice has a higher number of patients with a long-standing health conditiont (59%) compared with a national average (54%).

Updated 7 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Green Surgery on 20 May 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.
• 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 duty of candour is a regulation that requires providers to be open and transparent in their communication with patients about errors, mistakes and incidents.
• Processes to monitor and audit how staff acted on safeguarding alerts were robust and embedded into practice, with dedicated and consistent multidisciplinary input.

The areas where the provider should make improvements are:

• Make the complaints process more visible and accessible in patient areas.
• Ensure the patient participation group is made available to all patients.

We saw areas of outstanding practice:

• The practice used patient feedback to make the service more accessible, such as training new doctors in the use of the hearing loop system and training staff in deafness awareness.
• Staff worked proactively within innovative local partnerships to provide an extensive range of additional services to people with specific needs, including patients recovering from drug abuse and young people who needed sexual health services. This meant vulnerable patients with complex needs had rapid access to care and treatment and helped to reduce pressure on other services.
• The practice sought accreditation of national bodies to benchmark and improve practice, such as the Customer Service Excellence award and Investors in People status. Staff used their learning from the accreditation process to improve patient service and care at all points of contact, such as reception and in clinical areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 February 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.
• Some clinical staff had specialist qualifications that enabled them to provide clinics for conditions such as asthma and diabetes.
• Longer appointments and home visits were available when needed.
• 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.
• A GP prescription and medicines lead was in post who worked closely with the medicines management team to monitor prescribing.
• A monthly multidisciplinary team meeting took place with the palliative care team that complemented an active programme of case management.

Updated 7 February 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.
• A child safeguarding lead GP was in post and had established significant safety systems to ensure children were protected from harm.
• Sick children would always be seen in an emergnency appointment.
• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. This included the use of appropriate consent protocols when discussing sexual health with teenagers.
• 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.
• A range of contraceptive services were available, including coil fitting and removal.

Updated 7 February 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.
• A dedicated GP provided care and ward rounds in a residential home.
• GPs conducted anticaptory ward rounds for patients with behavioural and psychological symptoms of dementia to improve care interventions.
• The practice was working actively towards achieving the Gold Standards Framework for end of life care.

Updated 7 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• NHS health checks were offered for all new patients and those aged 40 – 75 years of age.
• 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 could be booked online and text message appointment reminders were available.

Updated 7 February 2017

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

• 90% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• GPs conducted weekly ‘ward rounds’ in care homes to provide support for patients with dementia and mental health needs.
• 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 nurse and a receptionist were in post as carers links, to provide one-to-one guidance to carers.
• Counsellors were available in the practice and were available for rapid or crisis referrals.
• An active recall system was in place for patients with a severe and enduring mental illness.
• The practice operated a shared care clinic for patients with opiate dependence.

Updated 7 February 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 offered longer appointments for patients with a learning disability and used an active recall system to ensure attendance. This included calling patients or their nominated carer to remind them about appointments.
• All patients with a learning disability had a named GP.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice nurse conducted outreach visits to day centres.
• 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.
• All staff had deafness awareness training and two receptionists were fluent in British Sign Language.