7 December 2016
Claremont Medical Centre provides primary medical services in Surbiton to approximately 11,000 patients and is one of 23 practices in Kingston Clinical Commissioning Group (CCG). The practice provides training placements for GP registrars and GPs returning to clinical practice.
The practice population is in the second least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 10%, which is lower than the CCG average of 12%; and for older people the practice value is 13%, which is the same as the CCG average. The practice has a smaller proportion of patients aged 10 to 24 years and aged 45 years and older, and a larger proportion of patients aged 25 to 44 years. Of patients registered with the practice, the largest group by ethnicity are white (80%), followed by asian (12%), mixed (4%), black (2%) and other non-white ethnic groups (2%).
The practice operates from a 2-storey purpose-built premises. A small amount of car parking is available at the practice, and there is space to park in the surrounding streets. The reception desk, waiting area, four GP consultation rooms and a treatment room are situated on the ground floor. The practice manager’s office, three GP consultation rooms, a treatment room and three counselling rooms are situated on the first floor. A lift is available for patients who are unable to access the first floor using the stairs.
The practice team at the surgery is made up of one part time female GP and three part time male GPs who are partners. In addition, three part time female salaried GPs are employed by the practice and one GP registrar. In total 35 GP sessions are available per week, plus six registrar sessions. The practice also employs two part time female nurses and two part time healthcare assistants. The clinical team are supported by a practice manager, deputy practice manager, six reception staff, and a secretary.
The practice operates under a General Medical Services (GMS) 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 open between 8:20am and 6:30pm every weekday apart from Wednesday when they close at 5:50pm. Appointments start at 8.30am every weekday morning and run until 12:00pm on Mondays and Tuesdays, to 12:40pm on Wednesdays and to 1:30pm on Thursdays and Fridays. Afternoon clinics run from 3pm to 6:30pm on Mondays, from 3:20pm to 6:30pm on Tuesdays, from 1pm to 5:30pm on Wednesdays, and from 2pm to 6:30pm on Fridays. Extended hours surgeries are offered between 6:30pm and 7:50pm on Mondays, from 6:30pm to 7:20pm on Thursdays and from 8:30am to 11:30am on Saturdays.
When the practice is closed patients are directed to contact the local out of hours service.
The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.
7 December 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Claremont Medical Centre on 18 October 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. When a significant event occurred it would be discussed and notes of the discussion and agreed actions were kept; however, although there was a significant event recording form available for staff to complete, this was not used consistently.
- Risks to patients were assessed and well managed.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance; safety alerts and guidance updates were distributed to relevant staff; however, no log was kept of the action taken as a result.
- Data showed patient outcomes were better than the national average; however, the practice had excepted a higher than average proportion of patients from Quality Outcomes Framework indicators, but were unaware of this. We checked a sample of records of patients who had been excepted from diabetes indicators and found that in all cases the reason for the patient being excepted was clinically appropriate.
- Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
- Overall, 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; however, some patients said that they found it difficult to get through to the practice by phone. The practice was in the process of promoting their online booking system, and felt that as the online system became more popular, telephone access for those patients who chose not to book appointments online would improve.
- 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.
We saw one area of outstanding practice:
The practice employed a part-time counselling co-ordinator whose role was to liaise with local training providers to arrange for their counselling students to provide a service to the practice’s patients. Students provided this service on a voluntary basis as part of their training, and were supervised by their university tutors or the counselling co-ordinator. In total 110 hours of counselling per week was provided to the practice’s patients via this scheme, and on average patients who were referred received a course of 12 sessions.
The areas where the provider should make improvement are:
- They should ensure that their record-keeping processes are effective, including those for reporting and recording significant events, logging stocks of prescription sheets, recording verbal complaints, and logging action taken following the receipt of safety alerts and updates.
- They should review their rate of exception reporting from Quality Outcomes Framework indicators to assess whether there are areas where patient care can be improved.
- They should review their appointment booking system to identify whether any changes could be made to improve telephone access to the practice.
- They should ensure that their recruitment policy is sufficiently detailed with regards to pre-employment checks.
- They should ensure that they are managing the risk of Legionella.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
7 December 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.
- Overall, performance for diabetes related indicators was better than the Clinical Commissioning Group (CCG) and national average. The practice achieved 100% of the total QOF points available, compared with an average of 92% locally and 89% nationally; however, their exception reporting rate was higher than average for all but two of the 10 diabetes indicators. We viewed a selection of patient notes for diabetic patients who had been excepted from diabetes indicators and found that in all cases the reason for them being excepted was clinically appropriate.
- 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.
7 December 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.
- Cervical screening had been carried-out for 82% of women registered at the practice aged 25-64, which was comparable to the Clinical Commissioning Group (CCG) average of 83% and national average of 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.
7 December 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.
- A monthly hearing aid clinic was provided at the practice, which was delivered by a volunteer from the audiology department at the local Hospital; the clinic included hearing aid checks and battery fitting.
- There was a designated GP responsible for end of life care; with systems in place for them to be contacted outside of working hours.
7 December 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 had recently begun offering Saturday morning appointments for patients who were unable to attend the practice during the week. They also ensured that additional services such as in-house counselling and the smoking cessation support group were provided at times when working people could attend.
- 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.
- The practice provided a full range of sexual health services, including contraceptive implants and coils. They were in the process of working towards accreditation from the Kingston Integrated Sexual Health Network, which recognised high quality sexual health services. The practice provided anonymised sexually transmitted infection testing kits in the reception area.
7 December 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- The practice had 40 patients diagnosed with dementia and 88% of these patients had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 83% and national average of 84%.
- The practice had 91 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 100% of these patients, compared to a CCG average of 92% and national average of 88%.
- The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
- The practice registered all patients living in a local care home for patients with severe mental health needs and held quarterly meetings with staff from this facility to review the needs of these patients.
- The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. They had produced a mental health “crisis” sheet for patients to advise them how to seek help should their mental health deteriorate.
- The practice provided an in-house counselling service for patients, which was delivered by volunteer counsellors.
- The practice carried out advance care planning for patients with dementia.
- There was a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
7 December 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, and those with a learning disability. A YMCA homeless shelter was located a short distance from the practice, and we were told many of the people staying there registered with the practice. Information about housing support services and charities was available for these patients.
- The practice offered longer appointments for patients with a learning disability; this was flagged on the practice’s computer system so that a longer appointment was automatically booked for these patients.
- The practice 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.
- Two of the GPs at the practice had completed diplomas in drug misuse and the practice was able to prescribe medicines such as methadone for patients who were withdrawing from illegal drug use.
- 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.