Glebe Road Surgery - Botting Also known as Glebe Road Surgery

Updated 13 October 2016

Glebe Road Surgery provides primary medical services in Barnes to approximately 9500 patients and is one of 29 practices in Richmond Clinical Commissioning Group (CCG).

The practice population is in the second least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 7%, which is lower than the CCG average of 9%, and for older people the practice value is 11%, which is the same as the CCG average. The practice has a smaller proportion of patients aged 20 to 34 than the CCG average. Of patients registered with the practice, the largest group by ethnicity are white (88%), followed by asian (5%), mixed (4%), black (1%) and other non-white ethnic groups (2%).

The practice operates from a 2-storey converted residential premises. Car parking is available in the surrounding streets. The reception desk, waiting area, a number of GP consultation rooms, and the nurse and healthcare assistant consultion rooms are situated on the ground floor. Further consultation rooms are available on the first floor, which is accessible by both a flight of stairs and a lift. The practice has access to 10 doctors’ consultation rooms, one minor surgery room, and two nurse consultation rooms.

The practice team at the surgery is made up of one full time and one part time male GPs and one full time and three part time female GPs who are partners, one full time male salaried GP, one female GP registrar and two foundation year 2 doctors (one male, one female), and one female physician assistant; in total 49 GP sessions are available per week. In addition, the practice also has two part time and one full time female nurses and one full time female healthcare assistant. The practice team also consists of a practice manager, assistant practice manager, six receptionists, two administrators and two secretaries.

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 8:30am and 6:30pm Monday to Friday. Extended hours surgeries are offered between 6:30pm and 7pm on Mondays, Tuesdays and Thursdays, and until 7:50pm on Wednesdays; and early morning appointments are available from 7:10am on Tuesday mornings. Patients can also access appointments via the CCG seven-day opening Hub, which offers appointments from 8am until 8pm every day at a nearby practice.

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, disorder or injury; surgical procedures; and family planning.

Updated 13 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Glebe Road Surgery on 2 August 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.
• Overall, risks to patients were assessed and well managed; however, the practice did not have an up to date fire risk assessment.
• The practice was clean and tidy. The practice informally monitored the performance of the cleaner, who was employed via an external company; however, there was no cleaning schedule or record of cleaning carried-out.

• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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.

We saw two areas of outstanding practice:

The practice provided joint consultations with psychiatrists in order to provide an enhanced level of care to patients with mental health needs, whose conditions were difficult to manage, but were not sufficiently severe to meet the criteria for hospital referral; they had provided this service to seven patients since 2012, and on average had provided approximately three appointments of this kind per patient. Where appropriate, these appointments had been provided in the patient’s home. In each case a tailored care plan had been developed for the management of the patient’s condition.

The practice showed a strong commitment to contributing to the future of general practice and was a learning hub for a broad spectrum of roles, both clinical and non-clincial. This involved providing training placements for medical students, foundation year doctors (including “trainees in difficulty”), GP registrars, and for student nurses. They also provided training opportunities to allied health professionals such as physiotherapists and paramedics, and to specialist doctors such as dermatology registrars. The practice had also participated in the pilot scheme for training physician associates. In addition to training clinical staff, the practice also provided work experience placements for school students and apprenticeship placements. The practice produced its own resources to support its trainees, such as personal induction booklets and tailored work books.

The areas where the provider should make improvement are:

• They should ensure that their business continuity plan is reviewed and updated.
• They should update their fire risk assessment and risk mitigation plan.
• They should put in place a cleaning schedule, outlining the cleaning tasks required, and ensure that a record is made of the cleaning completed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 13 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, including anti-coagulation, diabetes care (including insulin initiation), and respiratory conditions; patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators were better than the CCG and national average. Overall the practice achieved 100% of the total QOF points available, compared with an average of 90% locally and 89% nationally.
• 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 13 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.
• 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.
• We saw positive examples of joint working with midwives and health visitors.

Updated 13 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 planned and delivered a successful ‘flu campaign, where they encourage uptake by contacting patients by text, telephone and letter, and specifically wrote to all patients who had newly turned 65 years, who may not have been aware that they were entitled to the vaccine.
• For patients at risk of unplanned admission, summarised medical records were provided to the out of hours provider to ensure continuity of care.

Updated 13 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 sent appointment reminders and health promotion information by text message.

Updated 13 October 2016

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

• The practice had 65 patients diagnosed with dementia and 84% 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 and national average of 84%.
• The practice had 58 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 98% 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. They also provided joint consultations with psychiatrists in order to provide an enhanced level of care to patients with mental health needs whose conditions were difficult to manage but were not sufficiently severe to meet the criteria for hospital referral.
• 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, including providing care to residents of a local care home. Staff had completed training to become “Dementia Friends” in order to gain an enhanced awareness of the issues affecting patients with dementia.

Updated 13 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 homeless people, travellers 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.