Archived: Robin Hood Surgery

Updated 3 October 2016

The practice operates from one site in Bromley, London. It is one of 45 GP practices in the Bromley Clinical Commissioning Group (CCG) area. There are approximately 5,030 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include childhood vaccination and immunisation, dementia, extended hours access, improving online access for patients, minor surgery, rotavirus and shingles immunisation, and unplanned admissions.

The practice has an above average population of female patients aged five to 19 years, 45 to 49 years, and 60 to 64 years. It has an above average population of male patients aged 35 to 64 years. Income deprivation levels affecting children and adults registered at the practice are above local and national averages. The practice has a largely transient patient population which is 10% to 14% above the national average.

The clinical team includes a female GP partner, a male GP partner, a long-term male locum GP and a female salaried practice nurse. The GPs provide a combined total of 15 fixed sessions per week. The clinical team is supported by a practice manager, a self-employed business consultant, a secretary, and six administrative/reception staff.

The practice is open from 8.00am to 6.30pm Monday to Friday, and is closed on bank holidays and weekends. Appointments with the GPs are available from 8.30am to 11.50am and 4.30pm to 6.00pm Monday to Friday. Appointments with the nurse are available from 8.30am to 12.30pm and 1.30pm to 6.30pm on Mondays, Wednesdays and Fridays. Extended hours are available from 6.30pm to 8.00pm on Thursdays. The practice can refer patients who are unable to get an appointment at the practice to GP access hubs in Beckenham until 8.00pm on weekdays and from 9.00am to 5.00pm on weekends (an access hub is a GP practice which provides appointments at a different location, and is coordinated in conjunction with the referring GP practice).

The practice operates over two floors of a converted house. There is a waiting area, a reception area, a consulting room, a treatment room and a toilet with baby changing facilities on the ground floor. There are two consulting rooms on the first floor. There is on-street restricted car parking and one parking space available at the practice for patients. The practice’s entrance and toilet are wheelchair-accessible, and there is no lift to the first floor.

The practice directs patients needing urgent care out of normal hours to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on patients’ medical urgency.

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Robin Hood Surgery on 5 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 an effective system in place for reporting, recording and investigating significant events. Lessons were shared to make sure action was taken to improve safety in the practice.
• The provider was aware of and complied with the requirements of the duty of candour.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• There was evidence to show that most staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Although staff had a good understanding of their responsibilities there was no evidence of training that was appropriate to staff roles, such as safeguarding, infection control, information governance and fire safety training for some staff members.
• 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. 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 practice held regular clinical meetings. Meetings with non-clinical staff were informal and were not documented.

The areas where the provider should make improvement are:

• Ensure all staff know how to use the defibrillator.

• Ensure appropriate recruitment checks are conducted for all new staff prior to employment and there is a robust system for documenting processes such as meetings and training received.

• Ensure translation services and the facility to discuss sensitive information in private is advertised in a format patients can understand, and review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Strengthen efforts to establish a patient participation group and improve patient satisfaction, particularly with regard to waiting times, and review opportunities to make the practice more accessible to wheelchair users.

• Continuously monitor and improve outcomes for patients with poor mental health, in relation to the Quality and Outcomes Framework.  

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 October 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.

• Nationally reported data showed that performance for diabetes related outcomes in 2014/2015 was average. For example, 78% of patients with diabetes had well-controlled blood sugar in (national average 78%).

• Longer appointments and home visits were available when needed.

• The patients with a long-term condition had a named GP and the majority had received a structured annual review to check their health and medicines needs were being met.

• In 2014/2015, 74% of patients with asthma had a review of their condition. This was in line with the national average of 75%.

• In 2014/2015, 91% of patients with chronic obstructive pulmonary disease had a review of their condition. This was in line with the national average of 90%.

• 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.

Updated 3 October 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 attendances to Accident & Emergency.

• Immunisation rates were comparable to the local Clinical Commissioning Group average for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way.

• Nationally reported data showed that performance for cervical screening in 2014/2015 was average. For example, 79% of females aged 25 to 64 years had a cervical screening test (national average 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 3 October 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.

• Older patients aged over 75 had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that performance for conditions commonly found in older people in 2014/2015 was average. For example, 84% of patients with hypertension had well-controlled blood pressure (national average 84%).

Updated 3 October 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 opening on a Thursday evening until 8.00 pm for working patients who were unable to attend during normal opening hours.

• The practice was proactive in offering online services such as appointment booking and repeat prescription ordering, as well as a range of health promotion and screening that reflects the needs for this age group.

Updated 3 October 2016

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

• Nationally reported data showed that performance for dementia related outcomes in 2014/2015 was average. For example, 70% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the previous 12 months (national average 84%). The practice provided evidence that performance had improved in 2016, although this had not been made public or independently verified at the time of our inspection.

• Nationally reported data showed that performance for mental health related outcomes in 2014/2015 was below average. For example, 60% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their records (national average 88%). The practice provided evidence that performance had improved in 2016, although this had not been made public or independently verified at the time of our inspection.

• 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 3 October 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability, and they 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. Most staff had received safeguarding training, but there was no evidence of this training for other staff members.

• A GP had received training on domestic violence awareness.

• Patients who were known or suspected gang members were read coded on the computer system in order that they could be provided with the appropriate support in avoiding violence related activities.

• Female patients who had undergone female genital mutilation, or were at risk of undergoing the procedure, were also read coded in order that they could be provided with the appropriate support.