Archived: Downland Surgery

Updated 8 August 2017

Downland Surgery provides primary medical services in Coulsdon to approximately 1700 patients and is one of 59 practices in Croydon Clinical Commissioning Group (CCG). The practice population is in the third least deprived decile in England.

The practice had been taken over by a new provider since the last inspection and they were in the process of changing their registration with the CQC.

The practice population has a lower than CCG and national average representation of income deprived children and older people. The practice population of children is lower

than the CCG and in line with the national average and the practice population of working age people is lower than the CCG and national averages; the practice population of older people is higher than the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded 34% are British or Mixed British, 4% are Other White and 3% are African.

The practice operates in converted premises. All patient facilities are wheelchair accessible. The practice has access to two doctors’ consultation rooms and one nurse consultation room on the ground floor.

The clinical team at the surgery is made up of two part-time male GPs who are partners; one part-time female GP (currently on 12 months sabbatical), one female salaried GP and one part-time female practice nurse. The non-clinical practice team consists of a practice manager and three administrative and reception staff members. The practice provides a total of nine GP sessions per week.

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 reception and telephone lines are open from 8:00am to 6:30pm Monday to Friday. Appointments are available from 9:30am to 11:30am every day and from 4:30pm to 6:30pm on a Monday and from 4:00pm to 6:30pm on Tuesdays and Thursdays and from 3:00pm to 5:00pm on Friday. Booked appointments are not available on Wednesday afternoons but a GP is available for emergencies. Extended hours surgeries are offered on Tuesdays and Thursdays from 6:30pm to 7:00pm.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8:00am and directs patients to the out-of-hours provider for Croydon CCG.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

Updated 8 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Downland Surgery on 15 November 2016. The practice was rated overall as good and requires improvement in safe. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Downland Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 10 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation 12 (1) and (2) Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 that we identified in our previous inspection on 15 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had been taken over by a new provider since the last inspection and they were in the process of changing their registration with the CQC.
• Risks to patients were assessed and well managed.
• The practice updated its recruitment and selection policy to ensure references are obtained before recruiting new members of staff.
• The practice introduced a confidentiality and security policy to ensure confidentiality agreements are in place for all members of staff.
• The practice had made improvements to the patient toilet to make it accessible for disabled patients.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure that a comprehensive legionella risk assessment is undertaken and that recommendations following the risk assessment are actioned.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 11 January 2017

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 practice offered 30 minute appointments with a nurse or doctor for patients with long –term conditions if required.
• The national Quality and Outcomes Framework (QOF) data showed that 69% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 70% and the national average of 78%. The number of patients who had received an annual review for diabetes was 88%.
• The national QOF data showed that 86% of patients with asthma in the register had an annual review, compared to the CCG average of 74% and the national average of 76%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice provided minor surgical procedures, phlebotomy, spirometry and electrocardiography to improve monitoring of patients with long term conditions and managed complex leg ulcer dressings which reduced the need for referrals to hospital.

Updated 11 January 2017

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 urgent care and 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.
• The practice’s uptake for the cervical screening programme was 94%, which was in line with the Clinical Commissioning Group (CCG) average of 91% and above the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice prioritised appointments for children aged under five years.

Updated 11 January 2017

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 GPs provided care for three local care, nursing and residential homes supporting the needs of 84 residents; the practice GPs made weekly visits to these care homes. As part of the ward rounds care home staff and residents were able to request a consultation. The practice also arranged for seasonal flu vaccinations.
• The practice had alerts set up for elderly patients to highlight when their vaccinations were due.

Updated 11 January 2017

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.

Updated 11 January 2017

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

• The number of patients with dementia who had received annual reviews was 100% which was above the Clinical Commissioning Group (CCG) average of 83% and national average of 84%.
• 88% of 32 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was in line with the CCG average 86% and national average of 89%.
• The Practice GPs provided care for one local severe long-term mental health care home supporting the needs of three residents.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• The practice offered longer appointments for patients with memory difficulty who usually attended with their family.
• The practice offered an alternative waiting area for patients who found it difficult to wait in the regular waiting area as it was quieter.

Updated 11 January 2017

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, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; all of the eight patients with learning disability had received a health check in the last year. The Practice GPs provided care for one local learning disability care home supporting the needs of two residents.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.