The Chislehurst Medical Practice

Updated 22 September 2016

Chislehurst Medical Practice provides primary medical services in Chislehurst to approximately 15000 patients and is one of 48 practices in Bromley Clinical Commissioning Group (CCG). The practice population is in the second least deprived decile in England.

The practice population has a lower than CCG and national average representation of income deprived children and older people. The practice population of children is in line with the CCG and higher than national average and the practice population of working age people is lower than the CCG and national averages; the practice population of older people is higher than the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded 60% are white British or mixed British, 8% are other white and 2% are British Indian.

The practice operates in purpose built premises. All patient facilities are wheelchair accessible. The practice has access to eight doctors’ consultation rooms, two nurse/healthcare assistant consultation rooms and one minor surgery treatment room on the ground floor.

The clinical team at the surgery is made up of two full-time male GPs who are partners and five part-time GPs (two male and three female) who are partners, two part-time female salaried GPs, one part-time female nurse practitioner, four part-time female practice nurses and two part-time female healthcare assistants. The non-clinical practice team consists of a practice manager, a deputy practice manager and 26 administrative and reception staff members. The practice provides a total of 56 GP sessions per week.

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 a training practice for trainee doctors, medical and nursing students.

The practice reception and telephone lines are open from 8:00am till 6:30pm Monday and Friday and from 8:00am till 8:00pm on Tuesday and from 7:00am till 8:00pm Wednesday and Thursday. Appointments are available from 9:00am to 11:30am and 3:00pm to 5:30pm every day. Extended hours surgeries are offered on Tuesdays to Thursdays from 6:30pm to 8:00pm.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8am and directs patients to the out-of-hours provider for Bromley CCG. The practice is part of a local GP Alliance which provides further appointments seven days a week through Primary Care hubs which could be booked in advance. (Primary Care hubs provide patients’ with access to a GP seven days per week, where the clinician has, with patients’ consent, full access to their GP records which allows a full general experience.)

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

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chislehurst Medical Practice on 23 August 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 we found some incidents that could have been classed as significant events which may have led to further learning.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

There was one area of outstanding practice:

• The Bromley borough was first in Europe to pilot a diabetes prevention programme for obese patients where these patients were referred to an intensive lifestyle intervention delivered by a private provider. Out of the 14 practices which participated in Bromley the practice had the highest number of referrals (28 patients; 17% of total referrals) with an uptake of 89% (25 patients). Following the programme eight patients (38%) were no longer at risk and nine patients (43%) had reduced their risk. Due to the success of this programme Bromley (along with 12 other South London boroughs) was the first area in the UK to roll out the National Diabetes Prevention Programme.

There were areas of practice where the provider should make improvements:

• Review practice policies and procedures to ensure where appropriate, incidents are considered as significant events and that the recording of significant events is improved.
• Review practice procedures to ensure there is a system in place to monitor implementation of medicines alerts.
• Review practice systems to ensure that lessons are learned from complaints and that they are shared with all relevant staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 22 September 2016

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.
• The national Quality and Outcomes Framework (QOF) data showed that 80% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 90% which was above the CCG average of 86% and in line with the national average of 88%.
• The national QOF data showed that 76% of patients with asthma in the register had an annual review, compared to the CCG average of 74% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had piloted a happiness project to help improve the health, wellbeing and happiness of patients with long-term conditions.

Updated 22 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 urgent care and Accident and Emergency (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.
• The practice’s uptake for the cervical screening programme was 83%, which was in line with the Clinical Commissioning Group (CCG) average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice patients had access to antenatal and postnatal care through midwife led clinics.

Updated 22 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 GPs provided care for four local nursing/residential homes supporting the needs of 113 residents.
• The practice had alerts in their computer system for housebound patients and for patients who were at risk of hospital admission.
• The practice had a Patient Liaison Officer (PLO) who contacted patients who had a recent discharge from hospital to ensure their needs were being met  including any changes to their medicines regime.   

Updated 22 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.
• 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.
• In the past five years 5320 patients (aged 40-74) had been invited for NHS health checks and 85% (4516 patients) had attended.
• The practice was part of local GP Alliance and provided further appointments seven days a week through primary care hubs which could be booked in advance; this was suitable for working age people who could not attend in the normal working hours.

Updated 22 September 2016

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

• The number of patients with dementia who had received annual reviews was 84% which was the same as Clinical Commissioning Group (CCG) average and national average of 84%.
• 95% of 99 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 84% and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• Counsellors provided bi-weekly clinics at the practice which made it easier for local patients to attend.

Updated 22 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, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; 81% (13 patients) of 16 patients with learning disability had received a health check in the last year.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.