Archived: Dr A Alissa

Updated 16 September 2016

The Alton Practice provides primary medical services in Wandsworth to approximately 3,800 patients and is one of 44 member practices in the NHS Wandsworth Clinical Commissioning Group (CCG). The practice operates under a General Medical Services (GMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

Wandsworth has 50% more 20 to 40 year olds, but 33 per cent fewer older people than other south west London boroughs, reflected in the patient demographics for the practice with 10% of patients aged 65 or over, 68% of patients aged 18-65 years old and 22% aged 18 or younger.

The practice population is in the fourth more deprived decile, with income deprivation affecting children and adults higher than local and national averages.

The practice operates from a purpose-built two storey detached building with access for disabled patients, ground floor includes waiting room, reception, four consulting rooms and two toilets with a side exit as well as the main entrance and a small garden. The first floor includes staff common / seminar room, two administrative rooms, one information technology room, a kitchen, a staff toilet and a store room. There is off street parking space for three cars. The surgery is located at the junction of Danebury Avenue with Roehampton Lane and is in close proximity to the Alton Council Estate. It is a short walking distance to Queen Mary's Hospital and is in close proximity to three pharmacies.

The practice clinical team is made up of two male GP partners, one female regular Locum GP and one female nurse. The practice doctors provide 20 sessions per week. The non-clinical team consists of one practice manager, one administrator and four reception staff.

The practice opens between 8.45am and 1.00pm and 3.00pm and 6.30pm Monday to Friday.

Morning surgery times are between 8.45am and 1.00pm and afternoon surgery times are between 3.00pm and 6.30pm. The practice also opens on a Tuesday at 2.30pm and a Wednesday at 2.00pm for prebooked clinics. Prebookable appointments during extended hours are available between 6.30pm and 8.30pm on a Monday.

Practice telephone lines and reception are operational between the hours of 8.45am and 6.30pm.

The provider has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8.45am when the practice directs patients to seek assistance from the locally agreed out of hours provider.

The practice is registered with the Care Quality Commission to provide the regulated activities of treatment of disease, disorder or injury, maternity and midwifery services, family planning, surgical procedures and diagnostic and screening procedures.

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Alton Practice on 5 May 2016. Overall the practice is rated as good.

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.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Implement, monitor and review actions identified to improve care for patients with diabetes.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Consider and implement ways to improve childhood immunisation performance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 16 September 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.
• Performance for diabetes related indicators was lower than Clinical Commissioning Group (CCG) and national averages.
• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c (a specific blood sugar level test) is 64 mmol/mol or less in the preceding 12 months was 60% compared to the CCG average of 75% and the national average of 78%.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 64% (CCG 74%, national 78%).
• The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March was 98% (CCG 92%, national 94%).
• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 64% (CCG 78%, national 81%).
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 96% (CCG 88%, national 88%).
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and were offered 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 16 September 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 low for 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.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 81% and the national average of 82%.
• 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 16 September 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.
• Older people had a named GP who coordinated their care.

Updated 16 September 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.

Updated 16 September 2016

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

• 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• 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 16 September 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 and those with a learning disability.
• 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.