Archived: Sunray Surgery

Updated 1 September 2016

Sunray Surgery provides primary medical services in Tolworth to approximately 3850 patients and is one of 26 practices in Kingston Clinical Commissioning Group (CCG).

The practice population is in the second least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 13%, which is higher than the CCG average of 12%, and for older people the practice value is 12%, which is lower than the CCG average of 13%. The practice has a smaller proportion of patients aged 55 and older than the CCG average, and a larger proportion of patients aged 30 to 40 years. The ethnicity distribution for the area where the practice is located shows the largest group by ethnicity are white (66%), followed by asian (25%), mixed (3%), black (3%) and other non-white ethnic groups (2%); however, due to the enhanced service provided to the local Tamil community by the practice, the ethnic break-down for the practice's patient population shows that 35% patients are from the Tamil community.

The practice operates from a 2-storey converted residential premises. A small amount of car parking is available at the practice, and there is plenty of space to park in the surrounding streets. The reception desk, waiting area, and four consultation rooms are situated on the ground floor. The practice manager’s office, a consultation room which is seldom used, server room and staff kitchen are situated on the first floor. The practice has access to three doctors’ consultation rooms and two nurse consultation rooms.

The practice team at the surgery is made up of one part time female GP, one full time male GP and one part time male GP who are partners, in addition, two part time female salaried GPs are employed by the practice. In total 14 GP sessions are available per week. The practice also employs two part time female nurses and one part time phlebotomist. The clinical team are supported by a practice manager, six reception/administrative staff, and a part time IT specialist.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8am and 6:30pm Monday to Friday. Appointments are from 8.20am to 11.30am every morning, and 2:30pm to 6pm every afternoon. Extended hours surgeries are offered between 6:30pm and 8pm on Mondays.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 1 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sunray Surgery on 7 July 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 a system in place for reporting and recording significant events; however, this was in need of review to ensure it was robust.
• Overall, risks to patients and staff were assessed and well managed; however, at the time of the inspection risk assessments and risk mitigation plans were not always recorded.

• 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; however, there was no process in place to ensure that nursing staff received the update training they needed at the correct intervals.
• 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 on request and easy to understand. Complaints were responded to quickly; however, patients did not always receive a written response to their complaint and verbal complaints were not always recorded. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.

We saw one area of outstanding practice:

• The practice had a high proportion of patients who did not have English as their first language. The majority of these patients were Tamil speakers, some of whom were refugees or asylum seekers. The practice kept registers of these patients and had recorded 191 refugees/asylum seekers and 1106 patients with poor English language skills. In order to engage with these patients, signs in the practice were written in both English and Tamil, and the practice had produced several information leaflets in Tamil. Patients were also able to consult with GPs in Tamil (three of the five GPs at the practice spoke the language, as did a member of reception staff and the practice nurse). We were told by the practice that patients who were Tamil-speakers often remained registered with them when they moved away from the area, as these patients preferred to be able to consult with a doctor in their native language; the practice allowed these patients to remain registered and for this reason did not operate a strict patient area boundary; this was confirmed by some of the patients who provided feedback via the CQC comments cards.

The areas where the provider should make improvement are:

• They should review their process for recording and reporting significant events to ensure that all staff are aware of the threshold for recording a significant event and that all staff are involved in the process.
• They should ensure that action is taken to manage risks to patients and staff and that this is recorded. In particular, they should consider whether fire drills should be carried-out whilst patients are on the premises; they should also review their process for checking that prescriptions are collected by patients.
• They should ensure that information about bereavement support is available to all patients.
• They should review arrangements to identify carers so their needs can be identified and met.
• They should review the way that they handle complaints to ensure that patients receive a written response, which includes details of the Health Service Ombudsman. They should also ensure that verbal complaints are recorded.
• They should ensure that they have a consistent approach to recording care plans and that a copy of each care plan is saved to the relevant patient’s records.
• They should ensure that records and plans are in place to enable the smooth running of the practice should a key member of staff be absent.
• They should review their nursing provision to ensure that staff have sufficient protected time to carry-out areas of their role such as infection control and administration, and that nurses are receiving update training at the correct intervals.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 September 2016

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

• One of the GP partners co-ordinated the care of patients with long-term conditions to ensure that they received regular care reviews. These patients were initially seen by the nurse and then by a GP to ensure they had a thorough review of their symptoms and medication.
• Patients at risk of hospital admission were identified as a priority. 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.
• Performance for diabetes related indicators were better than the CCG and national average. Overall the practice achieved 100% of the total QOF points available, compared with an average of 92% locally and 89% nationally.
• Longer appointments and home visits were available when needed.

Updated 1 September 2016

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.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Cervical screening had been carried-out for 86% of women registered at the practice aged 25-64, which was comparable to the CCG average of 83% and 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 and health visitors.

Updated 1 September 2016

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.
• The practice made use of the local rapid response team to ensure that these patients receive a home visit promptly when needed.

Updated 1 September 2016

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

• 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. For example, evening appointments were offered one day per week to accommodate people who found it difficult to attend during the day.
• 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.

Updated 1 September 2016

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

• The practice had nine patients diagnosed with dementia and all of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 83% and national average of 84%.
• The practice had 20 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 95% of these patients, compared to a CCG average of 92% and 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 1 September 2016

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, asylum seekers, and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice had a high proportion of patients who did not have English as a first language. The majority of these patients spoke Tamil. In order to engage with these patients, signs in the practice were written in both English and Tamil, and the practice had produced several information leaflets in Tamil. Patients were also able to consult with GPs in Tamil (three of the five GPs at the practice spoke the language, as did one member of reception staff and the practice nurse).
• 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.