Mulgrave Road Surgery

Updated 5 December 2016

Mulgrave Road Surgery provides primary medical services in Sutton to approximately 8600 patients and is one of 26 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the second less deprived decile in England.

The practice population has lower than CCG and national average representation of income deprived children and older people. The practice population of children and working age people is in line with the local and national averages; the practice population of older people is above the local and in line with national average. Of patients registered with the practice for whom the ethnicity data was recorded, 23% are British or mixed British, 13% are other White and 10% are White British.

The practice operates in converted premises. Patient facilities are wheelchair accessible on the ground floor. The practice has access to four doctors’ consultation rooms, one nurse and one healthcare assistant consultation room on the ground floor and two doctors’ consultation rooms on the first floor. Patients who are not able to access the first floor are seen on the ground floor.

The clinical team at the surgery is made up of two full-time male GPs and one part-time female GP who are partners and two female part-time salaried GPs, two part-time female practice nurses and two part-time female healthcare assistants. The non-clinical practice team consists of one practice manager and 12 administrative and reception staff members. The practice provides a total of 40 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 is a training practice for GPs and medical students.

The practice reception and telephone lines are open from 8:00am till 6:30pm Monday to Friday. Appointments are available from 8:00am to 7:00pm every day. Extended hours surgeries are offered on Monday to Friday 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 8am and directs patients to the out-of-hours provider for Sutton CCG.

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder or injury and family planning. The practice is providing minor surgical procedures and maternity and midwifery services and are planning to register these services with the CQC. 

Updated 5 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mulgrave Road Surgery on 3 November 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

There were areas of practice where the provider should make improvements:

• Review practice procedures to ensure that all staff have annual basic life support training.
• Review practice procedues to ensure all the recommendations from the legionella risk assessment are implemented and monitored.
• Improve recording of minutes for multidisciplinary team meetings to ensure patients are monitored effectively.
• Review how patients with caring responsibilities are identified to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 5 December 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. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
• 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 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 75% which was below the CCG average of 81%.
• The national QOF data showed that 72% of patients with asthma in the register had an annual review, compared to the CCG average of 73% 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 GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice provided anticoagulation clinics, smoking cessation clinics, phlebotomy, post-operative wound care, electrocardiography, 24 hours blood pressure monitoring and spirometry; the practice told us this had improved monitoring of patients with long term conditions.

Updated 5 December 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 urgent care and Accident and Emergency (A&E) attendances. The practice was lower than the local Clinical Commissioning Group (CCG) average for unplanned A&E attendances over the last year.
• 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 77%, which was in line with the Clinical Commissioning Group (CCG) average of 82% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice sent a ‘Welcome Baby’ letter explaining the post-natal check-up, baby check and immunisation procedure.
• The practice ran a midwife clinic and baby clinic for check-up and first immunisation.

Updated 5 December 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 GPs provided care for two local nursing/residential homes supporting the needs of 57 residents.
• The practice provided a phlebotomy service at the practice which suited older patients who may have difficulty in getting to the hospital.
• One of the practice GPs was a clinical lead for End of Life care for the local Clinical Commissioning Group and Sutton Homes of Care Vanguard programme which aimed to improve the health and quality of life for all residents in care homes in Sutton.

Updated 5 December 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. About 50% of patients in the surgery had registered for online access.
• The practice offered extended hours appointments with GPs which were suitable for working people.
• The practice also offered an online enquiry service and consultations through video conferencing.
• The practice offered health checks to all newly registered patients and they have performed 772 new patient health checks in the last year. This allowed the practice to identify undiagnosed issues such as diabetes and an opportunity for health promotion.

Updated 5 December 2016

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 89% which was in line with the Clinical Commissioning Group (CCG) average of 86% and national average of 84%.
• 87% of 64 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 91% and national average of 89%.
• 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. These patients were prioritised and were seen by a GP as soon as possible.
• 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 5 December 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, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; 87% (13 patients) of 15 patients with learning disability had received a health check in the last year.
• 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.