Swiss Cottage Surgery

Updated 16 September 2016

Swiss Cottage Surgery is located in the London Borough of Camden. The practice has a patient list of approximately 21011. Thirty six percent of patients are aged under 18 (compared to the national practice average of 15%) and 9% are 65 or older (compared to the national practice average of 17%). Thirty five percent of patients have a long-standing health condition.

The services provided by the practice include child health care, ante and post-natal care, immunisations, sexual health and contraception advice and management of long term conditions.

The staff team comprises five GP partners (three male and two female, working a combined total of 27 sessions per week), three female salaried GP’s (working a combined total of 12 sessions per week), three GP registrars (one male, two female working a combined total of 20 sessions per week), a male Physician’s Associate (PA) who worked eight sessions per week, three full time female practice nurses and a female healthcare assistant (working a combined total of 38 sessions per week). The practice also consisted of a practice manager, assistant practice manager, secretarial and administrative staff. The practice offers a total of 97 clinical sessions per week. Swiss Cottage Surgery holds a General Medical Service (GMS) contract with NHS England.

The practice is open between 8.00am and 6:30pm Monday to Friday. Appointments are from 8.00am to 12.00pm every morning and 3.00pm to 6.00pm daily. Extended hours appointments were offered on a Saturday between 9:30am and 1.00pm. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments are also available for people that need them.

Outside of these times, cover is provided by an out of hour’s provider.

The practice is registered to provide the following regulated activities which we inspected: treatment of disease, disorder or injury; surgical procedures; diagnostic and screening procedures and maternity and midwifery services.

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swiss Cottage Surgery on 16 June 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However staff had not undertaken formal adult safeguarding or Mental Capacity Act training. Awareness was shown of each of these subjects.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Some of the written practice policies did not reflect practice and were in need of some revision.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review policies to ensure they reflect what is happening in practice and ensure there are no discrepancies. For example ensuring the right level of safeguarding training is displayed in the procedure.

• Ensure all staff receive formal Mental Capacity Act and adult safeguarding training.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 16 September 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.

• The percentage of patients whose last blood pressure reading was 140/80 mmHg or less was 77% compared to the national average of 78%. The percentage of patients with a recorded foot examination and risk classification was 93% compared to the national average of 88%.

• Longer appointments were available with the Physician Associate (PA).

• There was an increase in the number of people on the long term conditions registers through early diagnosis provided by the PA.

• 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 and PA worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 16 September 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.

• 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.

• The practice provided a full post and antenatal service including a weekly baby clinic to provide support and immunisations.

• The practice provided a consultant paediatrician led clinic.

• The practice’s uptake for the cervical screening programme was 73%, which was comparable to the CCG average of 72% and the national average of 81%.

• 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 16 September 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 worked with complex care nurses in the management of patients on the practice frailty register.

• A weekly ward round was conducted at a local assisted living and care home.

• Multi-disciplinary meetings were conducted on a monthly basis with the management of the care home, geriatrician, occupational therapist, community nursing team and social workers.

Updated 16 September 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 bookable Saturday morning appointments with both GP and nurse.

• The practice was proactive in offering online services including booking appointments, ordering prescriptions and reviewing medical records.

• The practice offered an email address to patients for them to contact the practice regarding medicines, investigations and for routine advice.

• A full range of health promotion and screening that reflects the needs for this age group.

Updated 16 September 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented in the record was 93% compared to the national average of 88%.

• The percentage of patients diagnosed with dementia who had received a face to face review was 73% compared to the national average of 84%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 16 September 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.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice proactively visited local homeless shelters in order to find their registered patients and provide a service to them. They also welcomed new homeless people as patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice offered a GP led substance misuse clinic and six monthly drug monitoring programme.

• All palliative care patients had a named GP and routine home visits were carried out to all patients on the register.

• 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.