Archived: The Junction Health Centre

Updated 9 January 2018

The Junction Health Centre is part of Wandsworth CCG and serves approximately 8000 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: smoking 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 and learning disability.

The practice is part of Wandsworth GP Federation.

Updated 9 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Junction Health Centre on 16 March 2017. The overall rating for the practice was requires improvement. The full comprehensive report from the 16 March 2017 inspection can be found by selecting the ‘all reports’ link for The Junction Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 29 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 March 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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Overall the practice is now rated as Good.

Our key findings were as follows:

• The practice had taken action to ensure that systems and processes in place for high risk drug monitoring kept patients safe. All patients prescribed high risk medicines whose records we reviewed were being monitored in accordance with current guidance and best practice.

• Feedback in the national patient survey regarding the care received from the practice nursing staff had improved and was now in line with current guidance and best practice.

• The practice had taken action to increase the number of patients identified as carers though this was still less than 1% of the patient list. The practice attributed the lower number of carer to the fact that the majority of their patients were working age.

• No data had been published since our last inspection regarding the percentage of patients screened for breast or bowel cancer. However, the practice had undertaken work to try to improve cancer awareness and attendance at national screening programmes. The practice had a meeting with the cancer lead within the CCG, reviewed their eligible patients and discussed strategies for increasing attendance. The practice healthcare assistant became the cancer screening champion and attended a meeting with Public Health England to get information on how to encourage uptake. The practice coded all eligible patients for both screening programmes, sent out letters to all these patients and then contacted them after 10 days to confirm that they had received the letter and encourage them to attend. The practice planned to implemented telephone consultations with a GP for those patients who had still not attended.

• The practice provided data on childhood immunisations which showed that the percentage of children under two who were fully immunised was 93% and the percentage of eligible children who had their pre-school immunisations was 91%.

• Data from the quality outcomes framework (system intended to improve the quality of general practice and reward good practice) for 2016/17 indicated that the percentage of patients with diabetes who had well controlled blood sugar was 68% this was still below national averages (80%) but in line with the local average (73%). The percentage of patients exception reported was 11% compared to 9% in the CCG and 14% nationally (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). The practice had 89 patients with diabetes and 40 of these had type 1 diabetes which is more challenging to manage. Type 1 patients were mainly managed by secondary care services. However, the practice had made efforts to improve performance in this area. For example meetings were held within the CCG where clinicians would discuss complex cases and obtain advice on how to better manage these patients. The nurse practitioner acted as a diabetes champion and consulted with the most complex patients and had attended specialised diabetes training. The practice also had access to advice from a consultant specialist for diabetes via a computer software programme.

• Feedback from the national patient survey indicated that satisfaction with wait times was still lower when compared to the local and national average (38% compared with 61% locally and 58% nationally). The practice again attributed this to their registered patients using their walk in service where patients can expect to wait up to an hour for an appointment. We were told that 100 of the practice’s registered patients used the walk in service each week. However, in order to improve wait times for registered patients the practice had introduced a catch up slot for each GP per every five appointment slots. The practice also now advertised that only one issue could be dealt with per appointment and encouraged patients to book a double appointment if they had multiple concerns. The practice had been conducting their own patient survey and using text message feedback to produce monthly reports on patient satisfaction. Patient feedback from the previous three months regarding waiting times was mixed.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

• Continue with work aimed at identifying patients with caring responsibilities to be able to provide appropriate support and signposting.

• Improve patient satisfaction with waiting times.

• Continue with action aimed at increasing the uptake of national screening programmes for breast and bowel cancer.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice