Archived: Hetherington at The Pavilion

Updated 28 May 2015

The Hetherington at The Pavilion Medical Centre is located in Brixton in the London Borough of Lambeth in south-west London, and provides Alternative Provider Medical Services (APMS) to around 6,187 patients.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; diagnostic and screening procedures, and maternity and midwifery services at one location.

The practice has an Alternative Provider Medical Services (APMS) NHS contract and provides a full range of essential, enhanced and additional services including maternity services, diabetic clinics, child vaccinations and immunisations, family planning, smoking cessation, mental health, contraception services and counselling. The APMS NHS contract is the one kind of contract between general practices and NHS England for delivering primary care services to local communities.

The practice is currently open five days a week from 8.00 am to 6.30 pm. In addition, the practice is open until 8.00 pm on a Wednesday and a Thursday, and from 09.00 till 12.00pm on a Saturday. The practice has opted in for providing out-of-hours services to their patients. Out-of-hours services for Hetherington at The Pavilion medical centre is provided in partnership with South East London Doctors on Call (SELDOC) Out-of-hours service when the surgery is closed.

The practice is one of 49 GP practices located within the Lambeth clinical commissioning group (CCG) and the NHS England local area team, who provide care and services to a diverse population of over 359,394 registered patients within the borough of Lambeth.

The practice is bright, spacious, well lit and ventilated, clean and accessible with automated doors. All rooms and areas within the practice were clean and spacious and secured by lock and key when not in use and facilities such as toilets, disabled toilets and baby changing facilities were also secured but could be accessed on request from staff. The location is smart and clean, with good access and a spacious waiting area and consultation rooms.

The practice comprises of six consulting rooms, a combined reception and waiting area, toilets, disabled toilets, baby change facilities and staff meeting room, and rooms for office space and administration purposes. Parking is limited with few disabled parking bays within the immediate area. The practice is located close to various public transport links.

The practice patient list is varied in ages although adult patients 50 years of age and younger make up the majority of patients registered with the practice. The practice provides approximately 130 patient appointments per day including urgent appointments. The patient list is currently over 6187.

Information held about the practice prior to our inspection suggests that it is rated in the middle range or amongst the worst, within four areas of the effective domain, but with little evidence of risk of harm to patients.

There are 19 qualified staff who work within the practice. The staff mix is comprised of a lead GP with four other GP partners and three full time salaried GP’s. There are two male GP’s and six female GP’s, there is one nurse, one practice manager, one health care assistant, two outreach nurses, and five receptionists, one administrator and one team leader.

There was one safeguarding notification received for the practice in the past 12 months.

One whistle blowing notification received for the practice in the past 12.

The CQC intelligent monitoring placed the practice in band two, with band one representing those services which are the highest priority for inspection and 6 the lowest.

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

The Hetherington at The Pavilion Medical Centre, is located in Brixton in the London Borough of Lambeth in south-west London, and provides a general practice service to around 6,817 patients.

We carried out an announced comprehensive inspection on 19 November 2014. The inspection took place over one day and was undertaken by a lead inspector, along with a GP specialist advisor. We looked at care records, and spoke with patients, members of the patient participation group (PPG), and staff including the management team. The practice is commissioned to provide services under an Alternative Provider Medical Services (APMS) NHS contract, and is registered with the Care Quality Commission to carry on treatment of disease, disorder or injury; maternity and midwifery services; and diagnostic and screening procedures at one location.

Overall the practice is rated as Good.

Our key findings were as follows:

• There were systems in place for reporting, recording and monitoring significant events to help provide improved care. Staff were clear of their roles in regards to monitoring and reporting incidents, safeguarding vulnerable people and children, and following infection prevention and control guidelines.

• Staff shared best practice through internal arrangements and meetings and also by sharing knowledge and expertise with external consultants and other GP practices. There was strong multidisciplinary input in the service delivery to improve patient outcomes.

• Feedback from patients we spoke with during our inspection, in relation to their care and treatment was very positive. However patient feedback seen from the national GP survey 2013/2014 was mostly in the middle range or average with no risk. Patients were treated with kindness and respect and felt involved in their care decisions. All of the 19 comment cards completed by patients in the two weeks prior to our inspection visit had very positive comments about the care and service provided by the surgery.

• The practice was responsive to the needs of vulnerable patients and there was a strong focus on caring and on the provision of patient-centred care. The practice also offered nurse led clinics for health checks, diabetes and asthma checks. Information on health promotion and prevention, on the services provided by the practice and on the support existing in the community was available for patients. The practice had an established patient participation group (PPG) and a virtual patient participation group which can be accessed on line. The practice website was detailed and informative. Patients could make on-line appointments and prescription requests.

• The practice has a clear vision and strategic direction which was to improve the health, well-being and lives of those that they care for at the practice, and was well-led. Staff were suitably supported and patient care and safety was a high priority.

All the population groups including older people; people with long term conditions; mothers, babies, children and young people; the working age populations and those recently retired; people in vulnerable circumstances and people experiencing poor mental health received care that was safe, effective, caring, responsive and well-led.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 28 May 2015

The care of patients with conditions such as cardiovascular diseases, diabetes mellitus, asthma, hypertension and Chronic Obstructive Pulmonary Disease (COPD) was based on national guidance and clinical staff had the knowledge and skills to respond to these patients’ needs. The care and medicines of patients in this group were reviewed regularly and staff worked with other health and care professionals to ensure a multi-disciplinary approach for patients with complex needs.

For example, the practice completed regular monitoring and risk assessments of patients within this group taking hypertension medications. Patients identified with hypertension, had regular reviews and medication audits to update care plans and were provided with education and information during consultations to avoid unplanned hospital admissions. Patients were also sign posted to other specialist services. Patients with Long Term Conditions (LTCs) were monitored for discharge summaries, outcomes of care and were subject to medications reviews in discussion and agreement with patients.

Patients with long term medication needs were registered and monitored every 6 months to ensure blood tests and prescriptions were being managed routinely and in line with guidance, patient’s needs and care plans. The lead GP was the clinical lead for all patients in this group.

The lead GP and partners were engaged with stakeholders working jointly to provide terminal care for patients where required. The practice was providing locally enhanced services such as mental health services and counselling services jointly with other stakeholders.

Updated 28 May 2015

There were suitable safeguarding policies and procedures in place, and staff we spoke with were aware of how to report any concerns they had. Staff had received training on child protection which included Level 3 for GPs and nurses. There was evidence of joint working with other professionals including midwives and health visitors to provide good antenatal and postnatal care. Patients in this group who required an urgent appointment were seen on the same day in addition to booked appointment slots. Child immunisations were provided in line with national guidelines with any non-attendance being followed up by the GPs or nurse. Immunisations were offered and only given with consent of parents which was recorded on the patient’s record. Vaccines were administered by practice GP’s and nurses in line with legal requirements. Contraceptive advice and antenatal clinics were held every week in the presence of a midwife and a practice GP. Data available to us showed that the practice was achieving about 82% coverage for the DTaP / Polio / Hib Immunisation (Diphtheria, Tetanus, a cellular pertussis (whooping cough), poliomyelitis and Hemophilus influenzae type b), Meningitis C and MMR vaccination for children.

Updated 28 May 2015

The practice was responsive to the needs of older people including those with dementia. Older people were cared for with dignity and respect and there was evidence of working with other health and social care providers to provide safe care. Support was available in terms of home visits and rapid access appointments for terminally ill and housebound patients.

The lead GP completed planned weekly and monthly meetings with other health care providers such as health visitors, palliative care nurses and district nurses to discuss registered patients requiring care and treatment and any other patients that were of concern. All patients 75 years of age and over were specifically being cared for by a named GP. Older people were afforded the option of home visits, double appointments and telephone contact to a GP of their choice.

Patients in this group were provided with early identification and access to influenza vaccine appointments including follow ups for patients that did not attend the practice, and had access to electronic prescribing which could be requested once registered with the practice. Bereavement services were available through the practice GPs, with referral to NHS services as required.

Updated 28 May 2015

These patients’ needs had been identified and there were a variety of appointment options available to them such as on-line booking and extended hours. The practice offered health checks, travel vaccinations and health promotion advice including on smoking cessation. The practice also offered telephone consultations throughout the day during opening times Monday to Friday and until 12 pm on every Saturday. The practice nurse was responsible for contraceptive advice and health checks for all patients.

Updated 28 May 2015

The practice was signed up to the dementia local enhanced service (LES) to provide care and support for people with dementia. The services were planned and co-ordinated to ensure that people’s needs were suitably assessed and met. Staff had a clear understanding of the Mental Capacity Act 2005 (MCA) and how to report any concerns and who to report them to within the practice. Reviews of care records of patients with dementia and mental health issues showed they were receiving regular reviews of their health, adequate multi-disciplinary input and support from the community mental health teams, on site counselling and Cognitive Behavioural Therapy (CBT). The provider also ensured that patients within this group received regular medication and care plan reviews.

Updated 28 May 2015

People attending the practice were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse. The practice had policies in place relating to the safeguarding of vulnerable adults and whistleblowing and staff we spoke with were aware of their responsibilities for identifying and reporting concerns.

The practice provided a chaperone and advocacy service at request and could provide trained staff to support patients. Staff within the practice had good understanding of the Mental Capacity Act 2005 (MCA), and how it applies, and were able to talk us through the actions they would undertake if they had concerns for patients, relatives or their carers. They worked with other health and social care professionals to ensure a multi-disciplinary input in the case management of vulnerable people. The practice was signed up to the learning disability Direct Enhanced Service (DES) to provide an annual health check for people with a learning disability to improve their health outcomes.

The practice clinical staff held regular meetings with district nurses and health visitors to discuss care and treatment for people within this patient group. Meetings with other agencies related to patient well-being, for example drug and alcohol rehabilitation teams were regularly attended to analyse patient needs and arrange appropriate care planning and treatment.

The GP partners were able to provide examples which included significant event reviews and actions to maintain care and treatment for vulnerable patients. The practice worked in collaboration with local health care partners and practices, such as refugee clinics for this group of patients. This patient group was able to access care or treatment within the practice and any patient concerns or requests were referred to the GP partners for approval.