The Knoll Also known as Cheam Family Practice

Updated 30 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 16 February 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach of regulation 12(1) (2) Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this desk-based focussed inspection on 10 October 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Cheam Family Practice on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

Our key findings across all the areas we inspected were as follows:

• Risks to patients were assessed and well-managed, including those related to recruitment checks, monitoring of vaccines stored on the refrigerators, monitoring of cleaning of the premises and fire safety.

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

• Improve the practice systems for managing, monitoring and improving outcomes for diabetic patients.
• Improve recording of minutes for multidisciplinary team meetings to ensure patients are monitored effectively.
• Consider improving accessibility in the patient toilet at the Gander Green Lane site for patients with restricted mobility.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 April 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.
• All these patients had a named GP, however not all patients had been offered a structured annual review to check their health and medicines needs were being met.
• Performance for diabetes related indicators was below Clinical Commissioning Group (CCG) and national averages. For example, the number of patients who had received an annual review for diabetes was 62% which was significantly below the CCG average of 86% and national average of 88%.
• The percentage of diabetic patients who had received the flu vaccination in 2014/15 was 86%, which was below Clinical Commissioning Group (CCG) and national averages.
• However, the number of patients with Chronic Obstructive Pulmonary Disease (COPD) who had received annual reviews was 94% which was above CCG average of 91% and national average of 90%.
• The practice were signed up to the national avoiding unplanned admissions enhanced service, to identify those patients most at risk of admission to hospital. The practice was also signed up to a local initiative to identify those at risk with two or more long-term conditions. The practice provided care plans for these patients.
• 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.
• The practice provided an in-house phlebotomy clinic with a health care assistant, three mornings per week across both sites for practice patients.
• Longer appointments and home visits were available when needed.

Updated 14 April 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 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided combined baby checks and postnatal care and a midwife-led antenatal clinic was run weekly at the practice.
• Chlamydia screening and a full range of contraceptive services were provided by GPs and nurses.
• The practice’s uptake for the cervical screening programme was 80%, which was in line with the Clinical Commissioning Group (CCG) average of 83% and the national average of 82%.

Updated 14 April 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 provided twice-weekly lunch clinics for older people at The Knoll practice site.
• The practice provided services to six nursing homes. One of these homes had re-located residents to new location out of the area, however the practice continued to provide medical services to their known patients for continuity of care.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mostly above averages.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was lower than the national average at 69% for 2014/15.

Updated 14 April 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 offered extended hours every Monday evening at both practice sites, to meet the needs of their working-age population who were not able to attend during normal opening hours.
• The practice provided an in-house phlebotomy clinic with a health care assistant, three mornings per week across both sites for practice patients.
• 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 including smoking cessation in-house and travel vaccinations.

Updated 14 April 2016

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

• 72% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which was below the Clinical Commissioning Group (CCG) average of 81% and national average of 84%. However, the practice had a high achievement in the CCG area for improving their dementia diagnosis rate, at 70.5% for 2014/15.
• Performance for mental health related indicators was below the CCG and national averages for the number of patients who had received an annual review at 46%; compared with CCG average of 87% and national average of 88%. However data on the inspection day indicated this had improved to 79%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice 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 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 provided general medical services to two Her Majesty’s Prison (HMP) service sites. A large proportion of this work was with patients experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 April 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 and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice was signed up to the enhanced service to offer physical health checks to those patients with learning disabilities and 43 out of 65 patients had received an annual review from the advanced nurse practitioner, which was 66%.
• The practice had identified 101 patients as carers which was 1% of the practice list. They had offered flu immunisations to 81% of carers.
• 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.
• The practice provided general medical services to two Her Majesty’s Prison (HMP) service sites. A GP visited four mornings per week at one site and five mornings per week at the other prison site.
• The practice provided a shared care clinic for substance misuse at the Gander Green Lane site on behalf of the Clinical Commissioning Group (CCG). Practice patients and patients from other practices across the CCG were able to access this service, which included access to methadone prescriptions.
• 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.