Archived: Fieldway Medical Centre

Updated 24 February 2017

Fieldway Medical Centre provides primary medical services in New Addington to approximately 3600 patients and is one of 59 practices in Croydon Clinical Commissioning Group (CCG). The practice population is in the second most deprived decile in England. The practice is one of the three in the New Addington Group Practices which includes Headley Drive Surgery and Parkway Health Centre. All the three surgeries are managed by AT Medics.

The practice population has a higher than CCG and national average representation of income deprived children and older people. The practice population of children is higher than the CCG and national averages and the practice population of working age people is lower than the CCG and national averages; the practice population of older people is lower than the local average and national average. Of patients registered with the practice for whom the ethnicity data was recorded 19% are black African, 17% are white British and 4% are black British.

The practice operates in converted premises. All patient facilities are wheelchair accessible. The practice has access to one doctor consultation room, one nurse consultation room, one pharmacist consultation room and one healthcare assistant consultation room on the ground floor.

The clinical team at the surgery is made up of one part-time male GP who is the director, one part-time female salaried GP, two part-time male regular locum GPs, two part-time female practice nurses and two part-time female healthcare assistants. The non-clinical practice team consists of practice manager, quality assurance co-ordinator, site co-ordinator and four administrative and reception staff members. The practice provides a total of 13 GP sessions per week.

The practice was previously managed by an individual GP and AT medics took over the practice in November 2013.

The practice operates under an Alternative Provider Medical Services (APMS) 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 till 6:30pm Monday to Friday. Appointments are available from 9:00am to 12:00pm and 3:00pm to 6:00pm every day. Extended hours surgeries are offered at Parkway Health Centre on Monday to Friday from 6:30pm to 8:00pm and on Saturdays from 9:00am to 1:00pm and 3:00pm to 7:00pm and on Sundays from 3:00pm and 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 Croydon CCG.

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

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fieldway Medical centre 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 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 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.

We saw two areas of outstanding practice:

• The practice had on screen alerts set up for prescribing broad spectrum antibiotics; this made the prescriber aware that they can only prescribe medicines in the formulary and they must record their justification for prescribing these medicines which was linked to the patients’ notes. For example the practice had an automated template for acute tonsillitis which made clinicians complete a centor score (predicts the likelihood of bacterial infection) to justify use of antibiotics. Following the implementation of this system monthly antibiotic prescribing audits showed a decrease in prescribing rates from 772 to 573 in a four month period. The practice looked at the antibiotic prescribing of individual GPs as part of this monthly audit.
• The practice offered frontline telephone clinic between 9:00am and 1:00pm everyday where patients could speak to a GP who provided telephone advice or offered face to face appointments where appropriate. On average GPs were able to deal with 35 patients each day compared to 17 face to face appointments in a traditional setting. Following the implementation of this clinic the practice’s DNA rate (number of patients who did not attend their appointment) had reduced by 5%.

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

• Review practice procedures to ensure that there is a system in place for monitoring the use of blank prescriptions.
• Review systems in place to ensure that patients with a learning disability are regularly reviewed.
• Review the feedback from national GP patient survey to identify and act on areas that can be improved.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 February 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 national Quality and Outcomes Framework (QOF) data showed that 84% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 72% and the national average of 78%. The number of patients who had received an annual review for diabetes was 96% which was above the CCG average of 86% and in line with the national average of 88%.
• The national QOF data showed that 85% of patients with asthma in the register had an annual review, compared to the CCG average of 75% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• The local respiratory team visited the practice on a fortnightly basis to screen pre Chronic Obstructive Pulmonary Disease (COPD) patients.
• The practice had a central recalling system to monitor patients with chronic diseases; this improved their monitoring of these patients.
• 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 a phlebotomy service, electrocardiography and spirometry to improve monitoring of patients with long term conditions.
• The practice used a risk stratification tool that analysed medicine interactions and blood result anomalies on a weekly basis; this was monitored and actioned by the in-house pharmacist.

Updated 24 February 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 80%, 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.

Updated 24 February 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 patients over 75 years of age had a named GP and were given priority access.
• The practice worked with the local community development pilot project and referred isolated patients, vulnerable patients, carers and single parent families to a health connector to join local groups.

Updated 24 February 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.
• Patients can send a message to their GP through the practice’s website for advice and guidance.
• The practice provided self-referral forms and information on the website for antenatal care, weight management, children’s health, drug and alcohol services, eye conditions, lifestyle and healthy food projects and mental health. 

Updated 24 February 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 75% which was below the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.
• 96% of 23 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 85% and national average of 88%.
• 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 had access to a counsellor who provided bi-weekly clinics which made it easier for local patients to attend.
• The practice worked with a social enterprise to tackle health and social issues affecting Muslim communities, especially around mental health. They co-produced a short film ‘Talking from the heart’ exploring mental health diagnosis and therapy by combining medical and faith advice.   

Updated 24 February 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; only 9% (5 patients) out of 54 patients with learning disability had received a health check in the last year. The practice GPs provided care for a learning disability/autistic adults home supporting the needs of eight 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.
• The provider ran a monthly substance misuse clinic at Headley Drive Surgery which is one of the three practices in New Addington Group.
• 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.