Elm Lodge Surgery

Updated 26 May 2017

Elm Lodge Surgery is part of Southwark Clinical Commissioning Group (CCG) and serves approximately 7700 patients. The practice is registered with the CQC for the following regulated activities; surgical procedures, diagnostic and screening procedures, maternity and midwifery services, treatment of disease, disorder or injury and family planning. The practice informed the inspector that they were no longer providing maternity and midwifery services.

The practice population is largely reflective of national averages in terms of age. The practice is located in an area ranked within the third least deprived decile on the Index of Multiple Deprivation Scale.

The practice is run by two male GP partners and one female partner. The practice has one salaried GP and one GP who provides a weekly dermatology clinic. There are three nurses and one nurse practitioner, a diabetes specialist nurse and an elderly care nurse. The practice has a healthcare assistant. The practice is a teaching practice but there were no students on placement at the time of our inspection. The practice offers 23 GP sessions and six Advanced Nurse Practitioner sessions per week.

We were informed at the time of our original inspection that the practice had experienced challenges following the departure of the former practice manager two years ago which related to practice finances and a high rate of staff turnover.

The practice is open between 8.00 am and 6.30 pm Monday to Friday. The practice offered both booked and emergency appointments.

The Elm Lodge Surgery operates from 2 Burbage Road, Southwark; London, SE24 9HJ which are purpose built premises owned by one of the current partners and two former partners. The service is accessible for patients with mobility problems. The practice was located over two floors with consulting and treatment rooms available on the ground floor.

Practice patients are directed to contact the local out of hours provider when the surgery is closed.

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). These are: childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for people with dementia, improving patient online access, influenza and pneumococcal immunisations, minor surgery, patient participation, rotavirus and shingles immunisation and unplanned admissions.

The practice is a member of GP federation Improving Health Limited.

Updated 26 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elm Lodge Surgery on 10 May & 7 June 2016. The practice was rated good overall and requires improvement for key question: Are services safe? The full comprehensive report from this inspection can be found by selecting the ‘all reports’ link for Elm Lodge Surgery on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 10 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 May & 7 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection undertaken on 10 May & 7 June 2016, we rated the practice as requires improvement for providing safe services as:

• The practice had not taken the necessary action to mitigate risks associated with infection control.

• The practice did not have a supply of chlorphenamine (used to treat allergic reactions) and hydrocortisone for injection (used to treat swelling or inflammation) in their supply of emergency medicines in accordance with current legislation and guidance.

• Not all equipment in the doctor’s emergency bags had been calibrated to ensure that it was functioning and safe to use.

• Not all staff had received essential training including safeguarding, basic life support training and infection control.

In addition to the breaches in regulation we found areas where we suggested the practice should make improvement. For example:

• The practice had identified a lower number of patients with chronic obstructive pulmonary disease compared to rates of identification in other practices locally and nationally.

• The practice’s system of recruitment checks was not sufficiently comprehensive.

• One member of staff was not chaperoning in accordance with current guidance.

The practice is now rated as good for the key question: Are services safe?

Our key findings were as follows:

• The practice had taken actions to ensure that risks associated with infection control had been addressed.

• The practice had a supply of emergency medicines which reflected current guidelines.

• All staff had completed essential training in accordance with current recommendations and guidance.

• All clinical equipment had been calibrated.

  We also saw evidence the practice had:

• Undertaken comprehensive recruitment checks for their most recently recruited member of staff.

• Sent a reminder to staff regarding chaperone procedures within the practice.

• Not taken action to increase the identification of patients with Chronic Obstructive Pulmonary Disease. However, the practice had reviewed their performance and attributed lower prevalence to being located in an area of low pollution and as a result of having a lower proportion of smokers on their patient list.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 21 October 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. For instance one of the nurses specialised in the management of diabetic patients and another in chronic obstructive pulmonary disease.

• The practice performed similar to national averages in the management of its diabetic patients.

• The practice carried out ambulatory blood pressure monitoring and had provided this service for the whole locality.

• Longer appointments and home visits were available when needed.

• 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.

• The practice hosted staff from a charity which provides advice on managing long term conditions who ran two educational sessions at the surgery. The practice told us that the patients who attended these sessions planned to continue to meet regularly.  

Updated 21 October 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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was comparable to 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 and health visitors.

• One of the practice nurses was engaged with a local project to develop children’s services and organised training for the practice reception team to enable them to respond to the specific needs of children of all ages.

Updated 21 October 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 had a dedicated elderly care nurse who conducted holistic health assessments for housebound patients over 65 and those over 80 as part of a local scheme within the CCG.
• The healthcare assistant at the practice had been trained as Primary Care Navigator who would undertake holistic reviews of patients to ensure that their social, as well as health needs, were being addressed.

• The practice hosted an osteopath.
• The practice PPG established an art group based at the practice which was open to all patients; though a large proportion of participants were older people.
• The practice provides GP services for residents at a local sheltered housing service.

Updated 21 October 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.

• The practice participated in establishing an extended access centre in conjunction with other practices in the federation and were able to refer patients to this service between 8am and 8pm 7 days per week.

• The practice provided a web triaging service through their website with a response time of 24 hours.

Updated 21 October 2016

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

• 72% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was comparable to the national average.

• Other mental health indicators were comparable to local and national averages.

• The practice regularly worked with other organisations in the case management of patients experiencing poor mental health, including those with dementia; including a national dementia charity.

• 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.

• The practice hosted a monthly carer support group run by a national dementia charity.

• The practice hosted a counselling service that patients could be referred to.

Updated 21 October 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. The practice would enable homeless patients to register using the practice address.

• 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.