Archived: Henley Cross Medical Practice

Updated 30 April 2015

Henley Cross Medical Practice is a GP practice in the London Borough of Greenwich. The practice’s main site is located in purpose built premises within the regenerated Kidbrooke village housing development. The practice also has a branch location at 444-446 Rochester Way, Eltham. London. SE9 6LJ.

The practice is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures, family planning services, maternity and midwifery services, surgical procedures, treatment of disease, disorder or injury. The practice is able to provide these services to all groups in the population.

The CQC intelligent monitoring placed the practice in band three. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

The practice staff team comprised four GPs, a practice nurse, a healthcare assistant, practice nurse, reception supervisor, secretary and a team of 5 reception staff. The practice staff were a long serving team, with the lead GP having been in the practice for 38 years. The healthcare assistant had been in post in the practice for 11 years.

At the time of our inspection the practice had 3860 registered patients. The practice has experienced a reduction in its patient population in recent years whilst the regeneration of the area was taking place, and many people located out of the area. The practice population was growing again, and the management team told us they had noticed a particular increase in the numbers of professional working people registering in the practice.

The practice has a General Medical Services (GMS) contract for the provision of its GP services to the local population.

The practice had opted out of providing out-of-hours services to their patients.

Updated 30 April 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Henley Cross Medical Practice on 09 December 2014. We visited the practice site at 115 Tudway Road, Kidbrooke Village. London. SE3 9YX.

The practice has a branch surgery at 444-446 Rochester Way, Eltham. London. SE9 6LJ. We did not inspect the branch surgery location.

Overall the practice is rated as requires improvement. Specifically, we found the practice to require improvement for providing safe, effective and well led services. We found the practice good at providing caring and responsive services. It was good at providing services for all the population groups we report on, with the exception of people with long term conditions where it requires improvement.

Our key findings were as follows:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice was run by a long serving staff team, who felt well supported and were committed to their roles.

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

Importantly the provider must:

• ensure that written job descriptions are put in place for the staff team. This had been raised and requested by members of staff during their appraisal meetings

• ensure they have a clear policy regarding which staff members would be subject to Disclosure and Barring Service (DBS) checks, and that their recruitment policy is followed in the recruitment of new staff

• improve their arrangements to manage medical emergencies by ensuring recommended equipment and medicines used in the treatment of patients in medical emergencies is available or they undertake a risk assessment if a decision is made to not have these medicines and equipment on site.

• ensure that clear summaries of findings, lessons learnt, actions taken and second cycles of clinical audits are completed.

In addition the provider should:

• consider making arrangements to provide greater privacy in the reception area, as face to face and telephone enquiries were responded to by the same staff, all located at the front desk.
• ensure medicines fridge temperatures are checked in line with published guidelines.

• ensure appropriate guidelines are in place for escalating concerning results found during new patient health checks.

• ensure the gaps in the training of staff in safeguarding adults from abuse are addressed.

• ensure suitable records are kept of multidisciplinary working and meetings so that patients are protected against the risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them

• act on feedback from staff and from the review of patient survey results

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 April 2015

The practice is rated as requires improvement for the care of people with long-term conditions.

Patients with long term conditions were treated in routine consultations with doctors and nurses.

Longer appointments and home visits were available when needed.

All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice used the information collected for the QOF and performance against national screening programmes to monitor outcomes for patients. (QOF is a voluntary incentive scheme for GP practices in the UK. The scheme financially rewards practices for managing some of the most common long-term conditions and for the implementation of preventative measures). The latest published QOF data for this practice at the time of our inspection, for the year 2013 / 14, showed that overall it performed below the local area and national averages achieving an overall score of 74.9% which was 14.6 percentage points below CCG average, 18.6 percentage points below England average. For particular conditions including Dementia, Diabetes, Hypertension, and primary prevention of cardiovascular disease, the practice performance in the care of patients in these groups needed to be improved.

Updated 30 April 2015

The practice maintained a list of seriously ill children, and worked with their local pharmacy to coordinate their care and manage their medicines.

The practice had put arrangements in place to obtain information and update the records of pregnant women and their antenatal care. A weekly antenatal clinical was held in the practice on Thursday morning, and was run by the community midwives.

Specific health promotion programmes were in place for women, in line with national guidelines. For example, 77% of women aged between 25 and 64 whose notes had record that a cervical screening test has been performed for them in the preceding 5 years; this result was the same as the CCG average and 0.1% above the England average.

Staff in the practice were trained to recognise and respond to signs of abuse in children. The administrative team had completed courses in child protection to level two, and the clinical team to level three. There was a practice statement in place that highlighted to their protocols for dealing with suspected cases of child abuse. This included details of key contacts that the matter would be escalated to within and outside of the organisation, and the responsibilities of the designated lead for child protection in the practice.

The practice is rated as requires improvement for the care of families, children and young people. We found the practice to require improvement for providing safe and effective services, and for being well-led, and that these findings affect people in this population group.

Updated 30 April 2015

The practice maintained a register of housebound patients, many of whom were elderly. This register was referred to in the planning of the annual flu vaccination campaign, and all patients over the age of 75 were offered seasonal flu vaccinations. The practice had provided seasonal flu vaccination to 64% of its patients over the age of 75, at the time of our inspection, and with ongoing communication via letters and leaflets, and the reception staff providing telephone invitations, they were confident of achieving the target rate of 75% of this group receiving the vaccine in the year ending 31 March 2015.

The patient records of housebound patients were coded so that when they were accessed by the staff, it was flagged that they were housebound so that the most appropriate course of care was offered to them.

Patients requiring home visits were advised to telephone the practice in the morning. The administrative team presented the house call requests to the GP at the end of morning surgery and the GP telephoned them to decide on the best course of action.

Appointments were normally ten minutes long, but longer appointments were available for patients if they had that need.

The practice provided the direct enhanced service (DES) for unplanned admissions. The service was intended to proactively case manage at-risk patients, and required at least 2% of the practice population over 18 years of age to be included in this group. At the time of our inspection, there were 60 patients receiving additional care and support as part of the unplanned admissions DES. Patients in this group received annual reviews and we saw records indicating that they had care plans prepared with their involvement. The clinical staff told us that patients in this group were often offered reviews opportunistically as part of other appointments, to ensure their broader care and treatment needs were addressed.

The practice held clinical meetings, attended by the doctors, nurse and healthcare assistant. The meetings were also attended by other practitioners involved in the care of their patients, such as district nurses and members of the local palliative care team. At these meetings the care, progress and patient outcomes were discussed for specific and complex cases.

The practice is rated as requires improvement for the care of older people. We found the practice to require improvement for providing safe and effective services, and for being well-led, and that these findings affect people in this population group.

Updated 30 April 2015

As of August 2014, 500 patients were of working age in the practice population.

The practice was able to refer patients between the ages of 40 and 74 for NHS health checks at local outreach services. The practice also managed the administration of this checks for their registered patients.

The practice administration team offered a text reminder service for appointments. Patients were also able to cancel their appointments remotely through an automated cancellation service.

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). We found the practice to require improvement for providing safe and effective services, and for being well-led, and that these findings affect people in this population group.

Updated 30 April 2015

The practice maintained good working relationship with the local (Greenwich) mental health service, which offered a range of services in acute and community settings for adults and children.

The mental health service offered ‘Time to Talk’, which is part of a national programme to Improve Access to Psychological Therapies (IAPT). The programme is for people with mild problems of anxiety or depression who are motivated to work to change the problem. Patients were able to access the Time to Talk programme through GP or self-referral.

The practice nurse was a trained mental health nurse. The practice was performing well against certain indicators related to the care of patients experiencing poor mental health. For example, 92.7% of patients with physical and/or mental health conditions had a record in their notes of their smoking status in the preceding 12 months; the national average was 95.3%. 94.6% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months; the national average was 86.1%. 73% of patients with schizophrenia, bipolar affective disorder and other psychoses had a record of alcohol consumption in the preceding 12 months; the national average was 88.6%.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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 including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). We found the practice to require improvement for providing safe and effective services, and for being well-led, and that these findings affect people in this population group.

Updated 30 April 2015

The practice maintained a register of patients living in vulnerable circumstances including people who needed treatment as a result of substance misuse substance, and those with a learning disability. It offered longer appointments for people with a learning disability.

Patients who needed additional treatment and support as a result of substance misuse were referred to specialist services. The practice staff told us they had seen a real reduction in the numbers of patients needing the substance misuse treatment services since the regeneration of the local area. One of the changes they had made as a result was to stop being a methadone prescribing practice, as the result of the reduction in demand for this service.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

It had told 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. However we saw there were gaps in the training of staff in safeguarding adults from abuse.

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. We found the practice to require improvement for providing safe and effective services, and for being well-led, and that these findings affect people in this population group.