Archived: The Junction Health Centre

Updated 30 June 2017

The Junction Health Centre is part of Wandsworth CCG and serves approximately 7200 patients. The practice is registered with the CQC for the following regulated activities: diagnostic and screening procedures, maternity and midwifery services, family planning services, treatment of disease disorder and injury and surgical procedures. In addition to a list of registered patients the location also operates as a walk in centre for patients who are not registered at the practice.

The practice population is predominantly working age with 50% of the population under 30 and only 1.5% over the age of 60. The practice has greater number of working age patients compared to local and national averages and lower numbers of children and older people compared to local and national averages. The practice population has higher levels of deprivation among its child and older person population and higher levels of employment compared with local and national averages. The practice is located in an area ranked fifth most deprived decile on the index of multiple deprivation. The patient list is ethnically diverse with 5.6% of mixed ethnicity, 7.4% Asian, 16.4% black and 2.2% non-white ethnic background.

Six GPs (two male and four female) are employed at the practice working the whole time equivalent of 3.1 GPs. The practice has six Nurse Practitioners working the full time equivalent of 3.5 nurse practitioners. The practice also has a female practice nurse and a healthcare assistant.

The practice is a location operated by Care UK limited who provide operational and governance support.

The practice is open between 8 am and 8 pm seven days per week. The practice offers booked and emergency appointments for registered patients in addition to walk in appointments for those who are not registered at the practice.

The Junction Health Centre operates from Arch 5-8, Clapham Junction Station; Grant Road, London, SW11 2NU which are purposed built premises owned by Network Rail. The practice leases the premises and maintenance is undertaken by a property management company. All consulting rooms are located on the ground floor and the premises are accessible to those with mobility issues.

Practice patients are directed to contact local out of hours provider when the surgery is closed.

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). These are: s moking cessation, NHS health checks, chlamydia screening, HIV screening, long acting contraceptive implants and in uterine contraceptive device implants, ECG, spirometry, phlebotomy, flu, child immunisations, minor surgery, avoiding unplanned admissions, learning disability.

The practice is part of Wandsworth GP Federation.

Updated 30 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Junction Health Centre on 16 March 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety across both the GP and walk in service and a system in place for reporting and recording significant events.
• The practice’s systems and processes for monitoring patients prescribed high risk medicines did not always ensure patient safety.
• There were clearly defined and embedded systems to minimise other risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Most of the results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Although scores related to nursing care were lower than local and national averages, the practice had identified these lower scores and were taking action to improve in these areas. The service had scored highly against its performance targets for access to the walk centre.
• The practice had only identified five patients (0.07%) with caring responsibilities on its GP patient list though we saw evidence that they were actively trying to increase identification.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Improve systems for monitoring patients prescribed high risks medicines.

The areas where the provider should make improvement are:

• Improve the identification of patients with caring responsibilities to be able to provide appropriate support and signposting.

• Improve patient satisfaction with the practice nursing service and waiting times.

• Improve uptake of national screening programmes.

• Improve their approach to managing patients living with diabetes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 30 June 2017

The service is rated as requires improvement for safe and caring leading to the practice being rated as requires improvement overall. The issues identified impact on the care provided to this population group. However we did see examples of good practice

• Clinical staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice participated in the Planning all Care Together (PACT) scheme in Wandsworth which aimed to limit unplanned contact with secondary care services by managing patients effectively in the community through creation of a comprehensive care plan addressing both health and social needs.

• Practice performance for diabetes was comparable in most areas with the exception of the indicator related to good blood sugar control. Performance in this area was 62% compared with the CCG average of 72% and the national average of 78%. The practice said that this was in part as a result of the demographics of the practice as 40% of their diabetic patients were patients with type 1 diabetes which they told us was harder to manage and because a lot of their patients would spend significant periods of time outside of the country.

• 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.

• The practice encouraged self-management and provided patients with health promotion on how to manage better their conditions and participated in a patient self-management scheme through a local wellbeing hub. This offered lifestyle advice and training courses aimed at helping patients effectively manage their long term condition.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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 30 June 2017

The service is rated as requires improvement for safe and caring leading to the practice being rated as requires improvement overall. The issues identified impact on the care provided to this population group. However we did see examples of good practice:

• From the 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 slightly below average in respect of some standard childhood immunisations.
• Staff told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice was open 8am – 8pm seven days a week. Consequently there was availability of appointments outside of school hours. The premises were suitable for children and babies and the practice had created a children’s area in the reception on the basis of patient feedback.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. The practice held monthly meetings with the health visitor team.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice offered chlamydia screening for all patients aged 16 – 24 in Wandsworth.
• The practice undertook weight screening at pre-school immunisations due to high prevalence of obesity in children in the area.

Updated 30 June 2017

The service is rated as requires improvement for safe and caring leading to the practice being rated as requires improvement overall. The issues identified impact on the care provided to this population group. However we did see examples of good practice.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

• The practice would identify at an early stage older patients who may need palliative care as they were approaching the end of life. It would involve older patients in planning and making decisions about their care, including their end of life care. The practice worked with other agencies in the management of palliative care patients.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 30 June 2017

The service is rated as requires improvement for safe and caring leading to the practice being rated as requires improvement overall. The issues identified impact on the care provided to this population group. However we did see examples of good practice:

• The needs of these populations 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, the practice was open from 8 am to 8pm seven days per week and operated both as a walk in centre as well as a GP practice.

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

• The practice had participated in a 24/7 telephone consultation pilot.

• Patients received text reminders for appointments.

Updated 30 June 2017

The service is rated as requires improvement for safe and caring leading to the practice being rated as requires improvement overall. The issues identified impact on the care provided to this population group. However we did see examples of good practice:

• The practice carried out advance care planning for patients living with dementia.

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average. The practice had a higher rate of exception reporting for patients with dementia. However, this was because the practice only had three patients with dementia due to the young demographics of the practice.

• Patients suffering from a mental health crisis were given priority appointments.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for other mental health indicators was higher when compared with local and national averages.

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

• Patients at risk of dementia were identified and offered an assessment and refer to a memory assessment service where appropriate.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

• The practice offered text message appointment reminders which benefitted this population group.

• Staff from the practice undertook a visit to a local facility which supported patients with poor mental health.

Updated 30 June 2017

The service is rated as requires improvement for safe and caring leading to the practice being rated as requires improvement overall. The issues identified impact on the care provided to this population group. However we did see examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability. Two of the reception staff had expressed an interest in setting up a pathway to improve the wellbeing of homeless patients. The practice was currently in the process of setting this up. The practice provided appointments to vulnerable patients when required.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• All unplanned attendances at secondary care were reviewed to ensure that vulnerable people were identified and offered appropriate support.

• 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.