St Marks PMS

Updated 4 November 2016

The practice operates in South-East London’s Royal Borough of Greenwich from its main site St Marks Medical Centre on 24 Wrottesley Road Plumstead, and a branch site Nightingale Surgery at 19 Milward Walk Woolwich Common. It is one of 42 GP practices in the Greenwich Clinical Commissioning Group (CCG) area. There are approximately 7,939 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning services, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice has a personal medical services contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include:

• Dementia diagnosis and support

• Flu and pneumococcal immunisations

• Learning disabilities, minor surgery

• Patient participation, rotavirus and shingles immunisation

• Unplanned admissions.

Compared to the national average, practice has an above average population of patients aged from birth to 49 years, and a below average population of patients aged 55 to 84. Income deprivation levels affecting children and adults registered at the practice are above the national average.

The clinical team includes two male GP partners, a male salaried GP, a male and a female locum GP. The GPs provide a combined total of 32 fixed sessions per week. There are three female salaried practice nurses, one of whom recently trained to become a nurse manager. The clinical team is supported by a practice manager, an assistant practice manager, an information technology manager, and 10 receptionists.

The main site is open from 8.00am to 6.30pm Monday to Friday, and is closed on bank holidays and weekends. Appointments with GPs and nurses are available from 8.10am to 1.30pm and from 2.00pm to 6.30pm. Extended hours are available from 6.30pm to 8.30pm on Mondays.

The premises at the main site operates over two floors of a purpose built building. On the ground floor there are six consulting rooms and a treatment room. There is a waiting area and a reception area. On the first floor there is a room use by district nurses and various staff and administrative rooms. There is wheelchair access throughout the ground floor, a lift, disabled parking, two toilets (one of which is wheelchair accessible) and baby changing facilities available.

The branch site is open from 9.30am to 2.30pm Monday to Friday, and is closed on bank holidays and weekends. Appointments with GPs and nurses are available between 9.30am and 2.00pm.

The premises at the branch site operates on one floor of a purpose building. On the ground floor there are three consulting rooms, a disabled patient toilet, a reception area and a waiting area. There is wheelchair access throughout and baby changing facilities.

The practice advises patients needing urgent care out of normal hours to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on the urgency of their medical concern.

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Marks PMS at its main site St Marks Medical Centre on 24 Wrottesley Road Plumstead, and its branch site Nightingale Surgery on 19 Milward Walk Woolwich Common on 4 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.
• Risks to patients were assessed and well managed.
• 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.
• Data showed that some outcomes for patients with and diabetes and chronic obstructive pulmonary disease were below national averages, in relation to the Quality and Outcomes Framework. The practice’s analysis of their performance showed that there had been an improvement in the management of patients with COPD; this data had not been published or independently verified at the time of our inspection.
• 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, but the practice did not always inform patients that had complained of how to escalate their concerns if they were dissatisfied by the practice’s response. 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.
• 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.

The areas where the provider should make improvement are:

• Improve outcomes for patients with diabetes and chronic obstructive pulmonary disorder, in relation to the Quality and Outcomes Framework.

• Review how patients with caring responsibilities are identified to ensure information, advice and support is made available to them.

• Ensure the complaints procedure includes information about how patients can escalate their complaint.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 4 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.

• Nationally reported data for 2014/2015 showed that outcomes for patients with diabetes were mostly in line with national averages, but below average for administering flu vaccines to patients with diabetes.

• Longer appointments and home visits were available when needed.

• All patients with a long-term condition had a named GP and the majority had received a structured annual review to check their health and medicines needs were being met.

• In 2014/2015, 86% of patients with asthma had an asthma review. This was in line with the national average of 75%.

• In 2014/2015, 78% of patients with chronic obstructive pulmonary disease had a review of their condition. This was below the national average of 90%. The practice’s analysis showed that performance had improved to 79% in 2015/2016; this data had not been published or independently verified at the time of our inspection.

• The practice offered spirometry testing (a test to assess how well the lungs work) and ambulatory blood pressure monitoring in-house.

• 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 4 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 Accident and Emergency attendances.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had a dedicated baby clinic every Monday and we saw positive examples of joint working with midwives, health visitors.

• In 2014/2015, 81% of women aged between 25 to 64 years had a cervical screening test. This was in line with the national average of 82%.

• The practice offered family planning services and opportunistic screening for sexually transmitted infections.

Updated 4 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 created monthly reports of housebound patients and followed up on their care needs.

• The practice provided care on a twice weekly basis for 466 patients aged over 75 that resided in local care homes, three of which had specialised dementia units.

• Nationally reported data for 2014/2015 showed that outcomes for conditions commonly found in older people were in line with local clinical commissioning group (CCG) and national averages. For example, 87% of patients with hypertension had well-controlled blood pressure (CCG average 81%, national average 84%).

• The practice held palliative care meetings attended by multidisciplinary healthcare professionals and representatives from the local care homes every three months to discuss the care of patients that were terminally ill.

• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.

• The practice also attended quarterly meetings with an elderly care psychiatrist, where individual patient cases were discussed.

Updated 4 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.

• 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 offered daily telephone consultations, and extended hours appointments were available from 6.30pm to 8.30pm on Mondays for working patients who were unable to attend the practice during normal opening hours.

Updated 4 November 2016

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

• In 2014/2015, 81% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan in their record. This was in line with the national average of 88%.

• In 2014/2015, 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting, which was above the national average of 84%.

• 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 4 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability, and 53% of 40 patients who had a learning disability had received a health check in the previous three months.

• 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.

• A GP at the practice held a level 2 qualification in drug and alcohol management.