Cricket Green Medical Practice

Updated 17 March 2016

Cricket Green Medical Practice provides primary medical services in Merton to approximately 10,100 patients and is one of 25 practices in Merton Clinical Commissioning Group (CCG).

The practice is an outlier for several aspects of its demographic, including the deprivation score of its patient population which is 25, compared to a CCG average of 15. The deprivation score for the practice’s child population is 33 (compared to a CCG average of 20) and for deprivation affecting older people the practice score is 25 (compared to a CCG average of 18).

The practice also has a higher proportion of patients with vulnerabilities which may result in a higher demand for services, for example, 54% have a long-standing health condition (CCG average 48%), 54% have health-related problems in daily life (CCG average 45%), 45% claim disability benefits (CCG average 29%), and 8.5% are unemployed (CCG average 5.8%). The practice has more than double the CCG and national average proportion of patients with a learning disability (0.89% of its total patient population compared to a CCG average of 0.32% and national average of 0.44%) and almost double the proportion of patients with a mental health condition (1.42% of its total patient population compared to CCG average of 0.86% and national average of 0.88%).

The practice population of children aged under four and people aged between 25 and 39 is higher than national averages, and the proportion of people aged over 49 is lower than the national average. Of patients registered with the practice, the largest group by ethnicity are White British (51%), followed by Asian (21%), black (21%), mixed (5%), and other non-white ethnic groups (2%).

The practice operates from purpose-built premises. Patient facilities are split over two floors, with a lift available and disabled toilet facilities on both floors. The practice has access to six doctor consultation rooms and three nurse consultation rooms. The practice team at the surgery is made up of seven full time GPs plus two full time registrars. There are three partners, all of whom are male, plus one male salaried GP and three female salaried GPs. In addition, there are three female practice nurses and one female healthcare assistant. The practice team also consists of a practice manager, and eleven administrative and reception staff members.

The practice operates under a Personal Medical Services (PMS) 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 operates an appointment system which involves an initial telephone consultation with a GP, with the facility for a face-to-face appointment to be booked with a doctor or nurse if necessary. The surgery is open for patients to call to request a GP call-back between 8am and 6.30pm Monday to Friday. GPs conduct telephone consultations between 8am and 11am and then as required during the afternoon, and face-to-face appointments are held throughout the time that the practice is open. Extended hours appointments are available until 7.30pm on Mondays and Tuesdays, until 6.30pm on Wednesdays and until 7pm on Thursdays. It is also open for GP and nurse appointments from 9am to 12noon on Saturday mornings.

When the practice is closed, out of hours care is provided by the locally agreed out of hours provider.

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, family planning, and surgical procedures.

The practice has been previously inspected under the old inspection approach on 20 May 2014, and was found to be compliant in all areas.

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cricket Green Medical Practice on 18 December 2015. Overall the practice is rated as good

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. 

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. The local multi-disciplinary team attended the practice’s monthly educational meetings in order that patients needs could be discussed. They had a strong relationship with their Patient Participation Group (PPG) and sought their views on all aspects of the running of the practice that impacted patients.

• The practice implemented suggestions for improvements and made changes to the way it delivered services in response to feedback from patients and from the patient participation group.
• All staff had been trained as “health champions”, which provided them with insight into difficulties encountered by patients, and enabled them to confidently participate in health promotion initiatives. Positive feedback was received from patients about the improvement to the service they received from reception staff following this training.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and staff had the opportunity to contribute during an away-day.

• The practice had received the gold standard Investors in People award in December 2013, which recognised the success of its leadership approach.

We saw several areas of outstanding practice including:

• In response to feedback about the availability of appointments, the practice had introduced a new system whereby all consultations with adult patients were initially conducted by phone with a GP. During the consultation the GP would either resolve the patient’s issue or arrange for them to be seen in person with an appropriate member of staff. The practice had analysed the impact of the new system and had found that it resulted in a significant increase in appointment availability. Patient feedback about the system was also very positive.

• All staff, including non-clinical staff, had been trained in health promotion, which enabled them to become involved in initiatives such as promoting COPD screening for smokers. This training also increased the awareness amongst non-clinical staff of difficulties encountered by certain patient groups, and we were told by the Patient Participation Group that they, and the patients they had spoken to about the service, had noticed an improvement in the way that staff interacted with patients since having this training.

• The practice had introduced a comprehensive appraisal system for all staff (including GPs), which included a 360º feedback exercise.

However, there was one area of practice where the provider should make improvements:

• The practice should consider having all portable appliances tested by a qualified electrician, and should it decide that this is unnecessary, ensure that it has a comprehensive risk assessment and mitigation plan for this decision.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 17 March 2016

The practice is rated as outstanding 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 practice’s overall performance in relation to long-term conditions was largely comparable to, and in some cases significantly higher than, CCG and national averages. For example, QOF achievement for hypertension indicators was 100% (CCG average was 97% and national average was 98%), for asthma the practice achieved 96% overall (compared with 100% CCG average and 97% national average), and for osteoporosis the practice achieved 100% (compared to CCG average of 83% and national average of 81%).

• The practice’s overall performance in relation to diabetes indicators was higher than both CCG and national averages at 92% of the total QOF points available, compared with an average of 86% locally and 89% nationally. In particular, the number of diabetic patients who had a blood pressure reading of 140/80 mmHg or less in the preceding 12 months was 90% (CCG average was 76% and national average was 78%); the number who had received influenza immunisation was 99% (CCG average 90%, national average 94%); and the number with a record of a foot examination and risk classification in the preceding 12 months was 91% (CCG average 89%, national average 88%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Administrative staff had been trained as “health champions”, and were actively involved in promoting testing for chronic diseases such as Chronic Obstructive Pulminory Disease (COPD).

Updated 17 March 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. A paediatric clinic was run daily.

• Cervical screening uptake at the practice was higher than the national average at 91% compared with 82% nationally.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Appointments for children by-passed the telephone consultation system and were always booked as face to face consultations.

• We saw good examples of joint working with midwives and health visitors.

Updated 17 March 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.

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

• One of the partners had a dedicated day each week to concentrate on services for those over the age of 75, which included performing annual health checks, which were delivered during a home visit for those who were housebound.

Updated 17 March 2016

The practice is rated as outstanding for the care of working age people (including those recently retired and students).

• The practice’s telephone consultation system allowed patients to consult with a doctor without having to take time off from work, and meant that any subsequent face to face consultation that was required would be booked with the most appropriate member of clinical staff, which avoided appointments needing to be re-booked.

• The practice offered a range of appointments outside of normal working hours, including appointments on Saturday mornings with both GPs and nurses.

• The practice offered a range of services that patients would often need to access via a hospital or clinic, for example, they provide HIV testing on the premises and testing for deep vein thrombosis (DVT).

Updated 17 March 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• It 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.

• It 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 people with mental health needs and dementia.

• 77% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared to a CCG and national average of 84%.

• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their notes, compared to a CCG average of 92% and national average of 88%.

Updated 17 March 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 those with a learning disability and those at risk of abusing their prescribed medicines.

• Annual health checks were carried out for people with learning disabilities, and these could take place in the patient’s home if requested.

• It offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told 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.