Dr Monella & Partners Also known as Medwyn Surgery

Updated 10 March 2016

Dr Monella & Partners- Medwyn Surgery is located in a residential area on the outskirts of Dorking. There are 10,197 patients on the practice list and the majority of patients are of white British background.

The population distribution as recorded by Public Health England indicates a high working population. Dorking is situated in prime commuter belt.

The practice is a training practice. The training is managed by a GP Training Lead and there are two GP registrars at the practice. The practice also hosts up to 10 attachments of medical students per year from St Georges Medical School as well as Paramedic Practitioners from South East Coast Ambulance Service.

There are a total of five GP partners (three male and two female).

There are four Practice Nurses (PN) and three Health Care Assistants (HCA) based at the surgery. Support staff consists of a Practice Business Manager, Reception Manager, reception and administration teams.

The practice is open from 8am to 6.30pm Monday to Friday with extended hours on a Tuesday and Wednesday to 8pm. Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hour’s service via 111.

The practice has a Personal Medical Service (PMS) contract and also offers enhanced services.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Monella & Partners – Medwyn Surgery on 9 December 2015. Overall the practice is rated as outstanding.

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.
• 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.

We saw several areas of outstanding practice :

The practice was extremely pro-active in supporting the well-being of its patients by engaging with and participating in numerous community support groups. The culture of the practice focused on community engagement and being central to community life. This culture benefited the emotional and physical well-being of the patients. In addition we noted many individual acts of care, compassion and kindness towards patients, by members of the practice team, often in their own time.

The areas where the provider should make improvements are:

• Establish systems and processes to facilitate the efficient on-going monitoring of staff training and registration with professional bodies.

• Ensure that all formal documents are dated or version controlled and records maintained to facilitate efficient review of such documents.

• Ensure that infection control was addressed as part of the practice induction programme for all staff.

• Establish robust systems and processes to ensure that all necessary and relevant recruitment checks are undertaken for all staff prior to employment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

The practice is rated as outstanding for the care of people with long-term conditions.

• Nursing staff were trained and had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• One GP at the practice had a special interest in diabetes

• Performance data showed that the practice generally performed well in relation to diabetes indicators. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 93.13% compared to the CCG average of 88.3%.(01/04/2014 to 31/03/2015) The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015)

• 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 10 March 2016

The practice is rated as outstanding for the care of families, children and young people.

• Antenatal clinics were held twice weekly, as part of the shared care programme.

• Family planning clinics were available with specialist nurses.

• The practice held baby clinics and met with the Health Visiting team on a monthly basis.

• The practice was proactive in identifying and supporting young carers.

• 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, and we saw evidence to confirm this.

• The percentage of women aged 24-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 81.43% compared to the CCG average of 81.83%. 01/04/2014 to 31/03/2015)

• 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.

Updated 10 March 2016

The practice is rated as outstanding for the care of older people.

• All patients falling within this population group had a named GP. There was a GP lead for older people within the practice.

• GPs attended meetings in local care homes and associated social events in their own time.

• Patients with long-term conditions, subject to end of life care or vulnerable due to a variety of circumstances were in receipt of a care plan which was reviewed regularly

• There were raised chairs in the waiting areas for the comfort of older or immobile patients

• The practice engaged with a community organisation focussed on providing physical and mental activities and learning for older people. Members of this group were invited to practice meetings to educate GPs in relation to what they could offer older people and patients were pro-actively encouraged to join.

• The practice engaged with the Community Garden Project, a social horticultural project for those experiencing isolation, bereavement or recovery from psychological or physical ill health. A member of the practice staff volunteered at this project and patients were actively referred.

• The practice engaged with an organisation designed to support patients and families following a Stroke. This group was set up by a patient and his or her family to deliver arts, crafts, excursions and other activities for members. Patients were referred to this group for support following a Stroke.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 10 March 2016

The practice is rated as outstanding for the care of working age people.

• 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.

• Late night surgeries (commuter appointments) were offered twice weekly.

• The practice operated an open-list policy to allow patients working but not living locally to register.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice had also provided Saturday Flu Clinics to meet the needs of this population group.

• A Virtual Patient Reference Group (VPRG) was in place, which complimented the Friends of Medwyn and facilitated patient engagement with this population group.

Updated 10 March 2016

The practice is rated as outstanding for the care of people experiencing poor mental health.

• The percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 94.64% compared to the national average of 89.55%

• 94.55% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the national average of 88.47%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice offered care to residents of a local residential mental health care facility. Residents were automatically provided with double time appointments to meet their needs.

• The practice supported a local mental health project called ‘Art Matters’, by showing the work of its members on the practice premises.

• 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 supported a locally based parent support group for parents of children on the autistic spectrum.

Updated 10 March 2016

The practice is rated as outstanding for the care of vulnerable people.

• The practice engaged with many community organisations in order to meet the patient’s emotional and social needs.

• The practice had a system in place to register patients who were homeless. Staff informed us that it was the only practice locally to offer this service. One of the GPs regularly visited a local site where homeless persons gathered to talk and encourage them to come forward for health checks and care.

• Foodbank – The practice was a hub for the Dorking Food bank. The GPs had been allocated vouchers to give to patients of the practice they identified as being in crisis. The vouchers could be exchanged for three days of emergency food from the bank.

• The practice offered an Interpreter service for those patients who required assistance. The practice also offered a hearing loop to assist the hard of hearing.

• Vulnerable patients were identifiable via prompts on the computer system enabling staff to make appropriate adjustments to meet each individual patient’s needs.

• Longer appointments were automatically offered to those patients with complex needs or vulnerabilities.

• 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.