Archived: Wyncroft Surgery

Updated 15 June 2017

Wyncroft surgery is located on Priory Road, Chelmsford Essex in a two story converted bungalow. All patient rooms are located on the ground floor. The practice was able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy.

The practice serves a patient list of 2400 and is in an area of very high deprivation. Of the patient list, 48% are living with a long-term condition compared to the CCG and nation average of 53%. 72% are in paid employment or full time education compared to the CCG and national average of 63%.

The premises have step free access with an accessible toilet and baby changing facilities.

The practice staff includes one principal GP (male) working full time, one regular locum GP that is female working part time. Other staff include a dispenser and a practice nurse. The practice manager is supported by five administration, reception and secretarial staff working a variety of full and part time hours.

The practice is open: Monday and Thursday 8am to 7pm, Tuesday, Wednesday and Friday 8am to 6.30pm and Saturday 9.30am to 10.30am.

On Wednesday there are no afternoon clinical sessions. The practice opens on Saturday morning for collection of prescriptions and the booking of appointments.

Appointments times are Monday 9am to 12pm and 4.30pm to 6.40pm; Tuesday and Friday 9am to 12pm and 4pm to 5.50pm; Wednesday 9am to 12pm; and Friday 9am to 12pm and 4.40pm to 6.40pm.

The practice opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by Primecare services and patients who contact the surgery outside of opening hours are provided with information on how to contact the service. This information is also available on the NHS choices website.

The practice provides the following directed enhanced services:

• Childhood immunisations and vaccinations.
• Dementia screening.
• Flu vaccinations.
• Unplanned hospital admissions avoidance.
• Learning disabilities health checks.

Updated 15 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wyncroft Surgery on 26 April 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Dispensing errors recorded were investigated to identify learning from them. Action taken to mitigate risk was monitored and audited. There was a standard operating procedure in place and this was reviewed annually to ensure it was fit for purpose.
• The practice also monitored trends in significant events and evaluated any action taken.
• The practice was aware of and provided services according to the needs of their patient population. Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Patient’s feedback was consistently positive and the practice preformed significantly better than local and national averages in the National GP Patient Survey.
• The practice did not have an effective system in place to identify patients who were also carers.
• The practice performance for the treatment of patients with conditions such as hypertension (high blood pressure), heart conditions and respiratory illness was above or within the range of the national average
• There was a holistic approach to the planning transfer or transition of patients to other services.
• Patients’ confidentiality was respected at all times. Legal requirements about data protection were met.
• Information about services and how to complain was available and patients told us that they knew how to complain if they needed to.
• The practice offered a range of appointments to suit patient’s needs and to ensure 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.
• The practice had a caring system in place when there was a bereavement. This included contact with the family and a checklist to ensure that all healthcare professionals were informed of the bereavement to reduce the risk of unnecessary stress caused by the receipt of unnecessary correspondence.
• The leadership structure meant staff felt supported and valued, which helped them to give their best. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Improve the identification of patients who are carers and provide them with appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Patients told us they felt that their long-term condition care provided was of a high standard. This was supported by the high QOF performance. For example, the percentage of patients with asthma who had a review within the previous 12 months was 80% compared to the CCG average and national average of 75%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 15 June 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 proactively offered lifestyle advice to this population group as they had identified an increase in obesity and diabetic diagnosis.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of a midwife for antenatal, post-natal every two weeks.

Updated 15 June 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 patients in its population. It was responsive to the needs of older patients.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• The practice offered opportunistic senior health checks or vaccinations when they were seen by a clinician.
• This population group were actively screened for common diseases including osteoporosis, depression and dementia.
• The practice’s approach was to undertake frailty assessments, dementia screening and an integrated approach to include where needed, end of life planning and a multi-agency approach.
• The practice had identified those older patients at risk of hospital admission and had developed care planning which identified key health problems and their ongoing management.
• Where older patients had complex needs, the practice shared summary care records with local care services. The practice described examples where they had worked together with the district nursing team, out of hours services and care home staff to manage patient care.

Updated 15 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
• The practice offered extended hours on Monday and Thursday.
• 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.
• Feedback from patients was consistently positive. They told us they could get an appointment quickly and at a time that was convenient to them. For example, the July 2016 national GP patient survey indicated that 96% of patients were able to get an appointment to see or speak to someone the last time they tried compared to a CCG average of 86% and a national average of 85%.
• Telephone consultations were available each day for those patients who had difficulty attending the practice due, for example, to work commitments.
• The practice nurse provided travel immunisations and travel advice.
• Health promotion advice was available and patients were signposted to external organisations for support.

Updated 15 June 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• For patients with dementia, written consent for relatives to share in medical information and treatment planning was encouraged and well documented.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 100% of patients with severe mental health problems had a comprehensive agreed care plan documented in their records compared with the local average of 85% and national average of 89% with a 0% exception reporting. Alerts on their records meant that they were routinely offered longer appointments.
• The practice used the depression and anxiety screening tool kit to identify the risk of self-harm in this population group. If risk identified referral is undertaken in a timely way and followed up.
• The practice actively screened for signs of early dementia.
• Performance for mental health indicators was 100% which was above the CCG average of 92% and above the national average of 88%. The practice exception rate was 6% which was lower than the CCG average of 17% and lower than the national average of 11%.
• Patients experiencing poor mental health were advised how to access various support groups and voluntary organisations. There was a system to follow up patients who had attended accident and emergency department due to experiencing poor mental health. 

Updated 15 June 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 those with a learning disability. The practice offered longer appointments for these patients and offered opportunistic health screening.
• The practice had identified 13 patients as carers (0.5% of the patient population).
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• Staff had been trained to recognise signs of abuse in vulnerable adults and children and the action they should take if they had concerns.
• 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.
• The practice provided care and support for end of life patients. Patients were kept under constant review by the practice in conjunction with the wider multi-disciplinary team.