Archived: Dun Cow Surgery

Updated 6 April 2016

Dun Cow Surgery is in the London Borough of Southwark. Although the site is part of a practice with two other sites, at the time of the inspection the three sites were registered separately.The practice has six partners who are all full time who manage all three of the sites. Dun Cow Surgery is based in a former public house which has been adapted to meet clinical needs. The address of the dite is Dun Cow Surgery, Old Kent Road, London, SE1 5LU

The practice is based in an area of relatively high depravation compared to national averages. The practice serves a diverse practice population with a high proportion of patients for whom English is not their first language. Staff in the practice speak French, Yoruba, Arabic, Cantonese, Mandarin, Portuguese, Urdu and Punjabi.

Overall the practice has approximately 21,000 patients, with approximately 6,000 being registered at this site. The practice employs six salaried GPs (4.25 whole time equivalent [WTE]) , and at the time of the visit there was a registrar attached to the practice. Of the permanent GPs eight are male and four female.There was also one nurse practitioner, six nurses and a healthcare assistant to WTE of 6.91. There was a practice manager and alarge team of receptionists and administrators based across all three sites.

The practice is contracted to provide Personal Medical Services (PMS) and is registered with the CQC for the following regulated activities: treatment of disease, disorder or injury, maternity and midwifery services, surgical procedures, family planning, and diagnostic and screening procedures at one location.

The practice is open between 8:00am and 6:30pm Monday to Friday. Appointments are from 8:00am to 1:00pm every morning and 2:30pm to 6:30pm daily. Extended surgery hours are offered from 7:00am to 8:00am Monday to Friday and from 6:30 to 8:00pm on Tuesdays.

The practice had not been inspected prior to this inspection.

Updated 6 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dun Cow Surgery on 14 January 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 and recording significant events.

• 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 areas where the provider should make improvement are:

• The practice should consider reviewing the appointment system that require patients to queue for same day appointments.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 6 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.

• Indicators for the management of long term conditions were better than the national average.

• We noted that the way in which tasks were shared across the nursing team was particularly effective. For example, we saw that one of the nurses had extra time to provide better care to patients with long term conditions due to the way tasks were allocated in the team. This level offocussed specialism improved co-ordination of care for patients.

• 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.

Updated 6 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Eighty one per cent of patients with asthma had been reviewed in the preceding 12 months, a higher rate than local or national averages.

• 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.

• Seventy five per cent of eligible patients had a cervical smear test in the preceding five years, a similar rate to local and national averages.

• 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, health visitors and school nurses.

Updated 6 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 way in which learning in the practice was shared benefitted older patients, as it did other groups.

• The way in which the nursing team specialise in how care was delivered was beneficial to older patients.

• Care plans for older patients were person centred and included specific details of any issues which might impact on patients managing their own health.

Updated 6 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 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.

Updated 6 April 2016

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

• 100% of the practice’s 70 patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average.

• Outcome criteria for the management of mental health was higher than national averages. For example, the percentage of patients with poor mental health who had a fully individualised care plan in the last 12 months was 89% of 220 patients.

• 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.

Updated 6 April 2016

The practice is rated as good for the care of people who 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.

• 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.

• The practice had dedicated safeguarding meetings on a quarterly basis where on going care and new cases were discussed. We saw in minutes from these meetings that cases were flagged for discussion with healthcare providers in the community where relevant. There was a robust follow up process in place to ensure that the practice met all of its requirements.

• Housebound patients were provided with appointments up to two hours in length which involved a full health assessment but also co-ordination with the Safe and Independent Living team, a representative from which attended the practice every week. This allowed the practice to tailor care to these more vulnerable groups.