Dr Fraser & Partners Also known as Upper Gordon Road Surgery

Updated 6 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Lothe & Partners on 16 June 2016. The practice had been rated as good for safe, caring, responsive and well led. However, required improvement in safe. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensure that all staff undertake the practices’ schedule of mandatory training, including basic life support (BLS), safeguarding children and vulnerable adults, fire safety and information governance.

We undertook this announced focused inspection on 10 November 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and is rated as good under the safe domain.

This report only covers our findings in relation to those requirements.

• The practice had created a new training matrix and staff had been notified of outstanding training requirements. We saw evidence that all staff were up to date with the practices mandatory training. Which included, basic life support and using a defibrillator training, information governance, safeguarding vulnerable adults and children, dementia awareness, equality and diversity, infection control and fire safety.

This report should be read in conjunction with the last report from 16 June 2016. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 July 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.
• 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.
• The practice offered regular blood testing clinics for patients on the medicine warfarin, due to some risks associated with this medicine.
• Performance for diabetes related indicators was higher than the clinical commissioning group (CCG) and national average. For example, 90% of patients on the diabetes register, had a record of a foot examination taking place within the last 12 months. This was comparable with the national average of 88%.
• 90% of patients with chronic obstructive pulmonary disease (COPD) had a review undertaken including an assessment of breathlessness, which was the same as the national average 90%
• Two practice nurses and a GP had a special interest in diabetes and had attended an extensive six day course. For patients with more complex diabetic needs the practice could refer to the local community diabetes nurse specialist.
• The practice was able to offer in house exercise information and joint injections. GPs referred patients to an in house NHS physiotherapy team and to Surrey Heath Orthopedic Treatment and Therapy Service (SHORTTs)
• GP were able to offer exercise referrals to the local leisure centre.

Updated 26 July 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.
• 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, health visitors and school nurses.
• The number of women aged between 25 and 64 who attended cervical screening in 2014/2015 was 76% compared to the clinical commissioning group (CCG) and national average of 82%
• The practice had a variety of self help leaflets and information. This included information targeted to parents of young children and a young person’s guide – a leaflet providing information about how to access services at the practice and the local area.

Updated 26 July 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 looked after patients at several care and residential homes. Designated GPs conducted weekly and monthly ward rounds.
• Older patients with complex care needs and those at risk of hospital admission all had personalised care plans that were appropriately shared with local organisations to facilitate the continuity of care.
• The practice was working to the Gold Standards Framework for those patients with end of life care needs.
• The practice nurse telephoned patients on discharge from hospital to offer support, and to enquire whether a visit or other assistance was required.
• The practice worked with the integrated care team to improve communication between different services, for patients who were vulnerable or had complex needs.
• Patients on multiple medicines were reviewed by the clinical commissioning group (CCG) pharmacy team to try to prevent poly-pharmacy complications. (Polypharmacy is the use of four or more medications by a patient).

Updated 26 July 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 was open from 8am to 8pm and provided nurse, GP and phlebotomy services throughout that time.
• The practice offered advice by telephone each day for those patients who had difficulty in attending the practice and there were daily evening emergency appointments available.
• Electronic Prescribing was available which enabled patients to order their medicine on line and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.
• The practice offered NHS health-checks and advice for diet and weight reduction.
• A healthcare assistant was trained to offer smoking cessation advice.

Updated 26 July 2016

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

• 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%
• 99% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the last 12 months, which was higher than the 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.
• 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 26 July 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 engaged with homeless people who were based locally. These patients could register at the practice or at the ‘All Night Café’. The practice signposted these patients to the relevant services available. The All Night café is a safe place for the homeless and people in need. The café opens at 10pm until 8am and serves free home cooked meals as well as complimentary drinks and refreshments throughout the night.
• 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.
• The practice organised separate flu clinics for patients with learning disabilities in order to provide longer appointments and a calmer environment for those that may prefer this.
• Translation services were available for patients who did not use English as a first language Staff also told us they used a sign language service for those patients who had a hearing impairment.
• The practice could accommodate those patients with limited mobility or who used wheelchairs.
• Carers, and those patients who had carers, were flagged on the practice computer system and were signposted to the local services and the local carers support team.