7 March 2017
Canbury Medical Centre provides primary medical services in Kingston to approximately 9700 patients and is one of 26 practices in Kingston Clinical Commissioning Group (CCG). The practice is registered as a partnership, which also runs a practice based in Surbiton Health Centre. Some staff including GPs, nurses and the practice manager work across sites. The practice is a training practice and provides placements to GP registrars.
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 11%, which is lower than the CCG average of 12%, and for older people the practice value is 16%, which is higher than the CCG average of 13%. The practice has a larger proportion of patients aged 35 to 54 and a lower proportion of patients aged 70+ than the CCG average.
The practice operates from a single storey purpose-built premises. A small amount of car parking is available at the practice, and there is space to park in the surrounding streets. The practice consists of a reception desk area and adjoining waiting area, administrative offices, a library, a staff kitchen, a baby clinic room, and 12 consultation rooms (one of which is a treatment room and one a minor surgery room).
The practice team at the surgery is made up of one part time female GP, one part time male GP and one full time male GP who are partners, one full time and two part time female salaried GPs, and two GP registrars. The practice provides training placements to trainee GPs, and has two GP registrars. In total 30 GP and 12 GP registrar sessions are available per week. The practice also employs two part time female nurse practitioners, three part time nurses, and one part time healthcare assistant. The clinical team are supported by a practice manager, assistant practice manager, a secretary and 13 reception/administrative staff.
The practice operates under a General Medical Services (GMS) 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 reception is open between 8:30am and 6:30pm Monday to Friday and from 8:30am to 12 noon on Saturdays. Appointments are from 8.30am to 6:30pm on Mondays and Fridays, from 7am to 6:30pm on Tuesday, Wednesday and Thursday, and 8:30am to 11:30am on Saturdays.
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.
7 March 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Canbury Medical Centre on 17 January 2017. 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.
- Overall, risks to patients were assessed and well managed; however, one member of non-clinical staff who acted as a chaperone had not received a Disclosure and Barring Service (DBS) check (the practice had risk assessed this decision and internal guidelines stated that the chaperone should not be left alone with a patient).
- The practice had systems in place to ensure that blank prescription sheets and pads were securely stored; however, they did not have a process in place to monitor their use. The practice had a prescribing policy which included the process for disposing of uncollected prescriptions; this did not include clinical oversight of the prescriptions being destroyed.
- 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. The practice had two Advanced Nurse Practitioners who ran acute clinics; we saw evidence that opportunities were available to them to request advice from GPs, however, there was no formal process in place for the supervision of this enhanced role.
- 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; however, the complaint responses we viewed did not include contact information for the Parliamentary and Health Service Ombudsman. Improvements were made to the quality of care as a result of complaints and concerns.
- Some patients said it could be difficult to get through to the practice by phone; however, the practice was in the process of addressing this issue. We viewed the appointments system and found that pre-bookable appointments were available within a few days, and urgent appointments were available the same day, including after-school appointments reserved for children.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- The practice had processes in place to ensure that all permanent staff were up to date with the training they needed to carry-out their roles safely. We saw evidence that the practice checked that locum staff had received the required training prior to starting work at the practice; however, there was no process in place to check that long-term locum staff kept up to date with refresher training.
- 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 areas where the provider should make improvement are:
- They should ensure that all responses to complaints include contact information for the Parliamentary and Health Service Ombudsman.
- They should ensure that all staff who act as chaperones have received a DBS check.
- They should continue to work on implementing a log of prescription sheets and pads received and issued, and review their policy for disposing of uncollected prescriptions to ensure that it includes clinical oversight.
- They should consider reviewing the scope of the Advanced Nurse Practitioner role and the arrangements for their supervision and support to assure themselves that the system is safe.
- They should ensure that processes are in place to check that long-term locum staff are up to date with required refresher training.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
7 March 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.
- Overall, performance for diabetes related indicators was comparable to the CCG and national average. The practice achieved 94% of the total QOF points available, compared with an average of 96% locally and 90% nationally. The practice had conducted an annual asthma review for 73% of patients, which was comparable to the CCG average of 75% and national average of 76%.
- 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.
7 March 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. The practice’s safeguarding lead met fortnightly with a senior health visitor to discuss children who were at risk. 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 77% of women registered at the practice aged 25-64, compared to the CCG and national average of 82%; however, the practice’s exception reporting rate for cervical screening was below local and national averages at 3% compared to a CCG average of 11% and national average of 7%.
- Appointments were available outside of school hours, and the practice reserved a number of late afternoon appointments specifically for children; the premises were suitable for children and babies.
- We saw positive examples of joint working with midwives and health visitors, who were based within the practice.
7 March 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.
- Performance for conditions typically found in older people were comparable with local and national averages; for example, the percentage of patients with hypertension who had well controlled blood pressure was 80% compared to a CCG and national average of 83%.
7 March 2017
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, they had recently started offering Saturday morning appointments.
- 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.
- The practice was working towards accreditation with the Kingston Integrated Sexual Health Network which recognised practices providing accessible and user friendly sexual health services to young people.
7 March 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- The practice had 35 patients diagnosed with dementia and 88% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG and national average of 84%. The practice’s exception reporting rate for this indicator was 3% compared to a CCG average of 6% and national average of 7%.
- The practice had 121 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 98% of these patients, compared to a CCG average of 96% and national average of 89%.
- 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.
7 March 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 and those with a learning disability.
- The practice offered longer appointments for patients with a learning disability.
- 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. They had arranged for a local carers’ charity to provide a fortnightly drop-in service from the practice to provide advice and support to patients with caring responsibilities; this was scheduled to start a few weeks after the inspection.
- 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.