Archived: Gray's Medical Centre

Updated 13 August 2015

Grays Medical Centre is located in Chessington in the London Borough of Kingston in South-West London. The practice is operated by a corporate provider, Malling Health, who operate a number of GP practices across England. The medical centre shares the premises with a walk in centre which is also operated by Malling Health. The practice provides services to approximately 2,300 patients, and serves a range of patients. The practice has a higher than average population of those aged between 45 and 79. The practice operates in an area where life expectancy is higher than the national average.

The staff in the practice work are employed by both Malling Health services on site. All staff had contracts which included a breakdown of hours worked for each of the services. This was to ensure that there were always sufficient staff on site to meet the needs of both services. Three part time salaried general practitioners work at the practice, with one of them acting as the clinical lead GP. The practice also utilises locum GPs, some of whom work for Malling Health across a number of sites that they operate, with others that are employed through a locum agency. Of the three salaried GPs, one is male and two are female The practice also employs three nurses, a phlebotomist, nine reception and administrative staff, a practice manager and an assistant practice manager.

The practice is contracted by NHS England for general medical services (GMS) and is registered with the Care Quality Commission (CQC) for the following regulated activities: treatment of disease, disorder or injury, maternity and midwifery services, surgical procedures, family planning services, and diagnostic and screening procedures at one location.

The practice provides a range of essential, enhanced and additional services including extended hours access, the learning disabilities health check scheme, sexual health, and facilitating timely diagnosis and support for dementia.

The practice is open five days a week from 8:00am to 6:30pm on Mondays, Wednesdays and Thursdays; from 8:00am to 7:30pm on Tuesdays and 8:00am to 7:00pm on Fridays. Out of hours services for the practice are provided in partnership with an external agency when the surgery is closed. However, as the walk in practice in the same building is operated in parallel by the same staff, it was reported that patients in the practice could see their own GP until 8:00pm any evening.

The practice moved to its current location two years ago from an adjacent building. Although not a purpose built building it has been extensively renovated for clinical use. The practice is well decorated and all areas were noted on the day of the inspection to be clean and bright. The practice has appropriate facilities and access for all patients, including for wheelchair users. All of the clinical rooms in the practice are on the ground floor. There are three consulting rooms, two treatment rooms and a small room used by the phlebotomist. There is also a combined reception and waiting area at the premises. The upper floor contains a number of staff offices, plus other staff areas which are all only accessible by keypad. Parking is limited outside the practice as it is a converted residential building, but one disabled parking place is available, as is on street parking.

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gray’s Medical Centre on 2nd June 2015.

We found the practice to be good for providing safe, effective, caring, responsive and well led services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working age people including those recently retired and students, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key inspection findings were as follows:

• There were comprehensive systems in place to ensure the delivery of safe care including safeguarding processes, health and safety assessments and equipment to deal with emergencies.

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents. The practice adapted a learning approach to significant events such that incidents were investigated and any outcomes were used to improve patient care.

• The practice had actively reviewed its patient population so that services could be targeted to meet the needs of its patient population.

• Patients reported that there had been improvement in both access to appointments and delivery of care in the past six months.

• Multidisciplinary meetings were carried out and information was shared with a range of different services to ensure continuity of care for patients.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance ensuring patient-centred care was provided

• Information about services and how to complain was available and easy to understand.

• There were a number of policies and procedures available to govern activity and these were updated regularly

• Staff felt well-supported by the practice team and felt able to raise any concerns

• Although information was shared within the practice, there were not always good communication links to cascade information from the provider organisation to all staff

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

• Ensure that all patient group directions (PGDs) are updated in line with recognised guidance.

• Ensure that there is a robust system in place to consistently record and monitor vaccine refrigerator temperatures.

• Ensure that a developed system of audit is continued in the practice.

• Ensure that a patient participation group is set up to assist in improving services.

• Ensure that online prescriptions and appointments are available in line with contractual obligations.

• Ensure that staff and patients are able to clearly differentiate between the general practice and walk in centre services that are provided within the same building. This includes ensuring that governance systems are in place to ensure that delivery of the walk in service does not impact on the care provided to the Gray’s practice. It should also include regular review of the sufficiency of staffing at both practices.
• Ensure that it is clear who has the role of strategic lead in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 August 2015

The practice is rated as good for the care provided to people with long term conditions.

The care of patients with long term conditions such as diabetes was provided by both GPs and nurses in the practice. Records for patients with long term conditions were identifiable on the practice database and flags were in place to ensure that review dates were not missed.

GPs and nurses reviewed care in clinical meetings and meetings took place where necessary with other health care providers to ensure a multi-disciplinary approach to the care being provided. Annual reviews were carried out for patients with long term conditions. Care plans were completed and those patients with care plans were able speak to a GP within 24 hours.

Blood tests were available at the practice which was more convenient for patients. Where patients were newly diagnosed, further information to advise patients how to manage their condition was proactively provided by clinical staff. This provision of information was to help avoid unplanned hospital admissions by improved patient self-management.

Updated 13 August 2015

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

Appointments were available in the practice both pre-bookable and on the day and access for families, children and young people was adequate. Appropriate referral systems were in place to ensure ante-natal care both in hospitals and in community care. Baby changing facilities were in place in the patient toilet in the practice.

All staff in the practice had completed safeguarding training to the required level, and there were suitable safeguarding policies in place. Notices detailing safeguarding contacts were in all of the clinical rooms in the practice, and in the reception area. There was a nominated safeguarding lead in the practice as well as nominated deputy in the absence of the lead. There was clear communication with other healthcare professionals including health visitors. Young people who were subject to child protection were read coded in the clinical system and patient alerts flagged on their record when entering the patient record.

Child immunisations were provided at the practice and uptake was in line with national averages. The whooping cough vaccine (Pertussis) was offered to all women who were 28 weeks pregnant or over.

Updated 13 August 2015

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

The practice was responsive to the needs of older patients. Regular multi-disciplinary team meetings took place at the practice with other health providers in the community to ensure that there was integrated care. All patients 75 years of age and over had a named GP and could access urgent daily appointments where required. Telephone appointments were also available for those patients who were not able to attend the practice.

The practice had systems in place to ensure that regular medication reviews were completed for patients. The practice provided a proactive health check service for housebound patients and implemented care plans where required, and this was on-going at the time of the inspection. The practice also ensured that each patient on the avoiding unplanned admission register had a care plan in place.

The practice provided flu vaccinations to patients over 65 either at the practice in conjunction with community healthcare providers.

Updated 13 August 2015

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

Pre-bookable and same day appointments were available with GPs, and the practice offered telephone appointments for those who worked a distance away for the practice. Formal extended hours were available twice a week, although informally (due to the walk in centre) all patients could see a doctor in the practice until 8 o’clock any evening. The practice had recently increased the number of daily telephone appointments to meet the needs of working age patients. At the time of the visit online prescription and appointment access were not available, however were shown that the practice was implementing this within the next month.

The practice offered both in house blood testing and electrocardiogram (ECG) services providing greater convenience to patients at the practice.

Updated 13 August 2015

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

Patients on the mental health register at the practice had annual reviews which included review of their needs and medications. Those patients with care plans had been allocated a specific GP which allowed the patient to speak to that GP within 24 hours. The practice was signed up to the dementia local enhanced service (DES) which aimed to improve timely diagnosis and signposting to support services, although no data was provided as to the efficacy of this service. A review of patient records showed that patients with dementia and mental health issues were receiving regular reviews.

The community mental health team were invited to the monthly multi-disciplinary team meetings, and any at risk patients were discussed at these meetings. Contact details for support workers and carers were recorded in the patients’ notes and these details were checked with the patients during consultations.

Updated 13 August 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice had a thorough set of risk assessments in place. Policies for the safeguarding of both children and vulnerable adults were in place, and staff were aware of the procedures for managing any issues arising. Chaperoning services were available at the practice, and there were prominent notices in both clinical rooms and the waiting area advertising this.

One member of staff had been trained formally in the Mental Capacity Act (MCA), and they had trained the rest of the practice team. All of the clinical staff detailed a full understand of the application of the MCA, and knew what actions were required. Non-clinical staff understood some of the basic principles of the MCA, but several staff were not aware of the practice policy relating to it. Extended appointments were available to patients with learning disabilities.

The practice manager confirmed that registration systems were in place for all potential service users including those in the traveller community and homeless patients who may have difficulty providing a proof of address that is normally required.

The practice clinical staff held regular clinical meetings with district nurses and health visitors to discuss care and treatment for patients who were at risk and deemed vulnerable.