Twickenham Park Surgery - Johal

Updated 25 April 2017

Twickenham Park Surgery provides primary medical services in St Margaret’s to approximately 7,500 patients and is one of 29 practices in Richmond Clinical Commissioning Group (CCG). They are a teaching practice for medical students and GP registrars.

The practice population is in the least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 4%, which is lower than the CCG average of 9%, and for older people the practice value is 9%, which is lower than the CCG average of 11%. The practice has a smaller proportion of patients aged 15 to 29 than the CCG average and a higher than average proportion of patients aged between 30 and 49. Of patients registered with the practice, the largest group by ethnicity are white (89%), followed by asian (6%), mixed (3%), and other non-white ethnic groups (2%).

The practice operates from two-storey purpose-built premises. There is no patient car parking at the practice; parking is available in the surrounding areas but this is time-limited. The reception desk, waiting area, and most of the consultation rooms are situated on the ground floor. The first floor contains further consultation rooms, a library and a meeting room. There is a lift between the ground and first floors. The practice has access to ten consultation rooms and one treatment room.

The practice team at the surgery is made up of two part time male GPs, one full time female GP and one part time female GP who are partners, in addition, one male long-term locum GP is employed by the practice, and two GP registrars. In total 14 GP sessions are available per week. The practice also employs one part time female nurse, one part time assistant practitioner in primary care (an enhanced healthcare assistant role), and one trainee healthcare assistant. The clinical team are supported by a practice manager, assistant practice manager, five receptionists and one 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 8:15am and 6:00pm Monday to Friday. Appointments are from 8:30am to 1:00pm every morning, and 2:00pm to 6pm every afternoon. Extended hours surgeries are offered between 6:00pm and 7:30pm on Mondays.

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; and family planning.

Updated 25 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Twickenham Park Surgery on 20 September 2016. The practice was rated as good overall. A breach of legal requirements was found relating to the Safe domain. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that the necessary documentation was in place for the administering of medicines. We also identified areas where improvements should be made, which included advertising the availability of chaperones and language translation, ensuring that staff have received appropriate training in line with the practice’s chaperone policy, ensuring that their recruitment policy is up to date, reviewing the arrangements for storing emergency medicines, reviewing their arrangements for distributing medicines updates to staff, ensuring that complete records are kept relating to complaints, and reviewing the way that significant events are investigated and the learning form them is shared and embedded.

We undertook this focussed desk-based inspection on 9 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Twickenham Park Surgery on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe services. Following the follow-up inspection, they are rated as good overall.

Our key findings were as follows:

• The practice had the correct documentation in place to allow staff to administer medicines, and we saw evidence that the practice had ensured that all staff were aware of the process and their responsibilities in relation to this.
• The practice advertised the availability of language translation services in the waiting area.
• The practice ensured that all staff who acted as chaperones were trained for the role, and they advertised this service to patients in the waiting area.
• The practice’s recruitment policy had been updated to accurately reflect the practice’s approach to carrying-out Disclosure and Barring Service (DBS) checks on staff.
• The practice held stocks of emergency medicines and these were stored in an area of the practice which was secure but easily accessible to staff in an emergency.
• The practice had an effective system in place for distributing medicines updates to relevant staff and kept a record of the action that they had taken in response to these alerts.
• We saw evidence that the practice kept detailed records of significant events, and that action was taken to share and embed learning resulting from incidents.
• The practice kept complete records relating to complaints received, including records of action taken to share learning resulting from complaints with staff. However, we noted that the practice did not always include contact details for the Parliamentary and Health Service Ombudsman in their complaint responses.

One area where the provider should make improvement is:

• They should ensure that they provide contact details for the Parliamentary and Health Service Ombudsman in their complaint responses so that patients can continue to pursue their complaint if they are unhappy with the practice’s response.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 23 November 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.
• Performance for diabetes related indicators was above the CCG and national average. The practice achieved 100% of the total QOF points available, compared with an average of 90% locally and 89% nationally.
• The practice provided blood testing for patients with high blood pressure to allow them to be prescribed the medicine they needed without having to attend hospital.
• 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 23 November 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.
• Cervical screening had been carried-out for 85% of women registered at the practice aged 25-64, which was comparable to the CCG average of 84% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had a dedicated baby clinic, and arranged appointments so that post-natal check-ups for mothers were carried-out at the same time as their baby’s immunisations were given.
• We saw positive examples of joint working with midwives and health visitors.

Updated 23 November 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 used the electronic prescribing system to arrange for patients to collect their repeat prescriptions directly from their local pharmacy.
• A hearing loop was available in the practice for patients who used hearing aids.
• The practice actively invited elderly patients to attend for annual flu and shingles vaccinations.
• The practice worked with the local Community Independent Living Service to support older people to live independently.

Updated 23 November 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. Extended hours appointments were available on one evening per week.
• The practice was proactive in offering online services. Patients could also contact the practice by email and make appointments using a telephone booking system.
• A full range of health promotion and screening that reflected the needs for this age group was available, including family planning and travel immunisations.

Updated 23 November 2016

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

• The practice had 59 patients diagnosed with dementia and 85% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 86% and national average of 84%.
• The practice had 34 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 94% of these patients, compared to a CCG average of 94% 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 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 23 November 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 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.