Archived: Dr RM Rowland's Practice Also known as The Jenner Practice

Updated 30 July 2015

Dr R M Rowland’s practice (known as the Jenner Practice) is in Forest Hill in the London Borough of Lewisham in South London. The practice has eight GP partners who manage the practice which is based at a single site. The centre is based in a building managed and owned by NHS Property Services Limited (PropCo), and the building contains a number of other health service providers. The practice provides services to approximately 15,000 patients. The practice has a higher than average population size between the ages of 25 and 49. The practice operates in an area where life expectancy is the same as the national average.

The practice is a training practice and had two registrars at the time of the inspection visit. As well as the GP partners, the practice employs two salaried GPs. The GPs in the practice share lead responsibilities for specific areas (for example, safeguarding, clinical governance and nursing). There are approximately equal numbers of male and female GPs. Several nursing staff had recently left the practice but had been replaced. The practice had one practice nurse, one nurse practitioner, one healthcare assistant and one nurse team support staff. The practice has a practice manager, an assistant practice manager, 11 receptionists and a data team of four. A number of other health services are provided at the practice by healthcare professionals from community and hospital teams, including midwifery.

The practice is contracted for personal medical services (PMS) and is registered with the Care Quality Commission (CQC) for the following regulated activities: treatment of disease, disorder or injury, maternity and midwifery services, surgical procedures, and diagnostic and screening procedures at one location.

The practice provides a range of essential, enhanced and additional services including childhood vaccination and immunisation, extended hours access, facilitating timely diagnosis and support for people with dementia, minor surgery, patient participation, remote care monitoring and influenza and pneumococcal immunisations

The practice is open five days a week from 8:00am to 6:30pm on Tuesdays, Wednesdays and Fridays; from 7:30am to 7:00pm on Mondays and 7:30am to 6:30pm on Thursdays. Out of hours services for the practice are provided in partnership with an external agency when the surgery is closed. The practice operates a booked appointment system, but on Mondays and Fridays the practice also offered a walk in surgery for patients registered with the practice.

Parking is available at the site and is shared by staff and service users for all of the facilities in the building.

Updated 30 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr RM Rowland’s Practice on 16June 2015.

We found the practice to be good for providing safe, effective, caring, responsive and well led services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working age people including those recently retired and students, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• There were comprehensive systems in place to ensure that the practice provided safe care. The practice reviewed policies regularly to ensure that they remained fit for purpose. The practice also had an appropriate system in place to review untoward incidents which were used to inform how services might be developed to improve patient care.

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents.

• The practice did not own the building from which it operated. Those areas of care provision (such as some aspects of infection control) which required working with the owner of the building were less effective. The practice had written to the owner of the building in order to address this. The practice had specifically asked for cleaning orders, improved toilet facilities on site and further cleaning to these facilities.

• Outcomes for patients at the practice were in line with or better than national averages, and a developed system of audit was in place at the practice, with evidence that this had led to improvements in patient care.

• Multidisciplinary meetings were carried out and information was shared with a range of different services to ensure continuity of care for patients.

• Patients reported that they were pleased with the level of service provided by the practice, and an active patient participation group was in place at the practice, with whom the practice had worked to improve services to patients.

• The practice had actively reviewed its patient population so that services could be targeted to meet the needs of everyone.

• Information about services and how to complain was available and easy to understand. This included the practice’s website which was thorough, clear and informative. Appointments could be made and prescriptions requested online.

• There was a clear practice strategy, which included delivering improved governance over the next two years.

• Staff felt well-supported by the practice team and felt able to raise any concerns

We saw several areas of outstanding practice including:

• Care plans were in place for many patients in the practice. For example the practice had recently allocated each of its housebound patients over the age of 75 to one of the duty doctors, and when they had been the “on call” doctor at the practice they had proactively contacted and visited each of these patients over a two month period. New care plans had been implemented for those patients that needed them. A further example was that the practice worked closely with a homeless hostel in the area, and had again proactively seen patients to determine whether or not a formalised care plan would be of benefit.

• Two staff at the practice had taken a course in basic sign language such that a better service could be provided to patients with hearing difficulties. This was appropriate given the needs of the practice population.

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

In addition the provider should:

• Ensure with the owner of the practice that they are provided with infection control information including environmental audits, and that the patient toilets in the practice are appropriately cleaned and fit for purpose. Further ensure that any areas not cleaned by the building’s owner (for example computer equipment) are kept clean.

• Ensure that all checks that have been completed and safety measures taken are clearly recorded (this includes checks on emergency equipment, records of drug expiry dates and staff immunisations against hepatitis).
• Ensure that where vaccine refrigeration temperatures are outside of safe ranges that any actions are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 July 2015

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

The nurses in the practice took the lead in the management of long term conditions (including asthma, diabetes and hypertension). There was a GP practice lead for medicine’s management and protocols were in place which were used by the practice nurses. Where patients had multiple conditions, the practice made provision by allowing extended appointments so that all issues could be addressed in one appointment so the patient did not have to re-attend.

All patients who had asthma or chronic obstructive pulmonary disease (COPD) had individualised care plans which allowed them to manage their conditions. This optimised patients’ independence and reduced unfavourable outcomes. The practice also ran a neighbourhood community pulmonary rehabilitation service on site.

The practice lead for diabetes ran a joint clinic with a diabetic specialist nurse from the local diabetes service. This allowed for more intensive care for patients with more complex management issues. The practice initiated insulin therapy in these clinics to reduce the need for onward secondary care referral.

Blood tests were available at the practice which provided greater convenience for patients. Where patients were newly diagnosed with a long term condition, further information to advise patients how to manage their condition was proactively provided by clinical staff.

Updated 30 July 2015

The practice is rated as good for providing services to families and young people.

The practice provided a range of services for young people including contraception clinics, cervical screening (with an uptake level of 83%, compared to 82% nationally) and chlamydia screening (uptake information was unavailable).

In supporting pregnant women the practice had an antenatal clinic run by a midwife from the local hospital and there were regular meetings with midwives to discuss vulnerable women. The practice also offered a one appointment service for postnatal checks, child development checks and first immunisations at eight weeks. Uptake of child immunisations was higher than the average for all immunisations at age 12 months, 24 months and five years. There was a breast feeding café at the practice every Friday morning, which provided advice and support to breastfeeding parents. This was run by the health visitors and all new mothers were invited.

In supporting children the practice had a dedicated play area in the waiting room. The named GP lead for child safeguarding held monthly meetings with clinicians and the link health visitor who was based in the same building. All staff in the practice had a minimum of Level 1 child protection training and all clinicians had Level 3 training which was updated annually. The GP lead attended bimonthly Lewisham-wide child safeguarding meetings. Computer records were tagged if there were child protection concerns. The practice also had a system in place to follow up children who did not attend hospital visits

Appointments with GPs and nurses were available in the practice both pre-bookable and on the day and access for families, children and young people was adequate.

Updated 30 July 2015

The practice was rated as good for the care of older people.

All patients in the practice over the age of 75 had a named GP in order to improve patient care, and this was clearly flagged within the patient record. The practice had made full assessments of patients within this group and those in the most vulnerable group had individualised care plans.

Consultations for this patient group were available face to face, and for those who were not able to attend the surgery in person, telephone consultations and home visits were available through a duty doctor who was available throughout the day. Specific appointment slots were available to older patients, and reception staff were aware of this. A primary care assistant practitioner was also available to visit patients at home.

The practice held regular monthly multi-disciplinary team meetings with healthcare providers in the community. This included meetings with both district nurses and palliative care teams. Within the previous six months, the practice had pro-actively carried out home visits for patients over the age of 75 who were housebound.

Updated 30 July 2015

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

The practice offered appointments from 8:00am to 6:30 pm five days a week with early opening at 7:30 am twice a week and late closing at 7:00pm once a week. Appointments could be booked both on the telephone and online. In addition the practice had created special telephone workflow slots to follow up and action pathology results and hospital letters which could reduce the need for patients to have to come in to the surgery.

In the waiting area in the practice there were two “pods” where people could measure their blood pressure, height and weight. These could be accessed at any time when the practice was open without appointment. Instructions on how to use the pods was provided in several languages.

The practice had an in house dietician who accepted both GP and self-referrals. The practice showed the inspection team awards won by the nurses in the delivery of smoking cessation services in the past three years, but exact figures for the last year were not available.

The practice offered a walk in phlebotomy service every morning including pre bookable appointments before 8am for those that were working. The practice also offered a joint injection clinic late on Friday afternoon.

Updated 30 July 2015

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

The practice area covered a number of homes and hostels for people with enduring poor mental health. The practice reported that they had a good working relationship with community mental health and community psychiatric teams, and meetings were held regularly with them both at and away from the practice.

The practice had several patients with chronic psychosis for whom they ran regular clinics. The practice undertook physical health checks annually for all patients with serious mental illness. This included routine blood tests, electro cardiogram (ECG) and health promotion advice.

The practice reported that they were proactively asking patients about memory problems. Those patients who were identified as being at risk were referred onwards to the community memory clinic. Patients with established dementia had annual reviews which included medication reviews, blood tests, support offered for carers and safeguarding.

Updated 30 July 2015

The practice is rated as good at providing services for people whose circumstances might make them vulnerable.

The practice recognised that people who were homeless and those with learning disabilities had particular requirements and might face problems accessing the care that they needed, and systems were in place to allow them to access care at the practice.

The practice carried out annual health checks for patients with learning difficulties. Within the area that the practice covered there was a homeless hostel for which the practice ran outreach clinics in order to be responsive to the needs of these patients. This addressed some difficulties that they might otherwise have in accessing care. A number of patients in this group had drug and alcohol problems and chronic mental health issues which were reflected in their individualised care plans.

All practice staff had completed training on detection of domestic violence and local resources were available, including multi-agency risk assessment conferences (MARAC).

The practice had a large group of non-English speaking patients including refugees who had access to interpreting services. Some of the staff in the practice spoke languages other than English.

The practice had a thorough set of risk assessments in place. Policies for the safeguarding of both children and vulnerable adults were in place, and members of staff were aware of the procedures for managing any issues arising. Chaperoning services were available at the practice, and this service was prominent in notices in the waiting room, but not in the consulting rooms.