Archived: Guildowns Group Practice

Updated 3 August 2016

Guildowns Group Practice is a large training practice providing services from four locations in Guildford which are registered as independent locations with the CQC. A training practice has GP trainees who are qualified doctors completing a specialisation in general practice. At the time of our inspection there were two GP registrars training with the practice. Three of the locations are GP surgeries and the fourth is a university medical practice. There are approximately 24,200 patients on the group practice list and patients can chose to attend any of the four surgeries. Performance is reported by the group practice as a whole so verified data for individual locations is not available. The group practice has a lower than average number of patients from birth to 14 years and 40 to 80 years. The practice has a higher than average number of patients between 15 and 29 years, this is due to providing GP care on a university site.

The practice has nine partners, six salaried GPs and two long term locums (seven male and 11 female). They are supported by a pharmacist, five practice nurses, six healthcare assistants/phlebotomists, a management team, administrative staff and patient services staff. The practice is led by a group director who is responsible for management of all four locations in the group. Most of the clinical staff work across the four locations and other staff can work across all locations if required.

On this occasion only The Oaks Surgery was inspected. The other locations were inspected separately on 23 February 2016, 24 February and 10 March 2016. The Oaks Surgery is a converted residential property across two levels with all patient areas on the ground floor. There are approximately 4,500 patients registered at this location.

The practice is open between 8.30am and 6.00pm Monday, Wednesday, Thursday and Friday, and 8.30am to 12.30pm Tuesdays. When the practice is closed patients can attend one of the other locations. The practice offers an extended hours nurse clinic 7.00am to 8.30am on Wednesday mornings. Patients can attend extended hours surgery that are offered at Stoughton Road or Wodeland Surgery which include some evening, early morning and Saturday mornings. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for patients that needed them, although these may be offered at any of the four locations.

This service is provided at the following locations:

The Oaks Surgery, Applegarth Avenue, Park Barn, Guildford, Surrey, GU2 8LZ.

The other sites in the group practice are:

Wodeland Surgery, 91-93 Wodeland Avenue, Guildford, Surrey, GU2 4YP.

Stoughton Road Surgery, 2 Stoughton Road, Guildford, Surrey, GU1 1LL.

The Student Health Centre, Stag Hill, University of Surrey, Guildford, Surrey, GU2 7XH.

Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hours service NHS 111.

The practice has a Personal Medical Services (PMS) contract. PMS contracts are agreed between the practice and NHS England.

Updated 3 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Guildowns Group Practice on 24 February 2016. This reports refers to the location of The Oaks. Overall the location is rated as requires improvement.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• 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, however the practice could not provide evidence of all appropriate training for example safeguarding training.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough. Patients did not always receive an apology.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example recruitment checks, staff training, infection control and legionella risk assessments.
• Information about services and how to complain was available and easy to understand. However, recording of reviews and investigations were not thorough enough. Patients did not always receive an apology.
• The practice had a number of policies and procedures to govern activity, but there was no system in place to ensure that these were up to date or appropriate for the location where they were in use.

The areas where the provider must make improvements are:

• Ensure that all complaints and safety incidents and their investigation are recorded.
• Ensure that all complaints and safety incidents are investigated thoroughly and ensure that patients affected receive reasonable support and an apology and that learning is shared appropriately to support improvement.
• Ensure recruitment arrangements include all necessary employment checks for all staff, including that a Disclosure and Barring Service check or risk assessment showing a check is not required is in place for all staff.
• Ensure that a system of annual staff appraisals is implemented and that training is completed as appropriate including safeguarding.
• Ensure that policies are up to date and specific to the practice.
• Take action to address identified concerns with infection control and legionella as identified in the infection control and legionella risk assessments.
• Ensure systems are in place to ensure clinical equipment is calibrated and portable electrical equipment is safe.
• Investigate ways to increase engagement with patients, for example re-establish a patient participation group to provide patient input to the practice

In addition the provider should:

• Review telephone access to the surgery.
• Continue to proactively identify carers.
• Review the use of patient specific directions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The practice performance for diabetic indicators was comparable with or above national and clinical commissioning group (CCG) averages. For example the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 75 mmol/mol or less in the preceding 12 months was 92% compared to the national average 87% and CCG average 89%.
• 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.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. However staff we spoke with told us that due to nursing staff shortages not all chronic disease areas had nurse leads, where nurse leads were not available a GP had oversight of the disease area.

Updated 3 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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 high for all 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.
• 80% of eligible female patients had a cervical screening test which was slightly below the CCG and national averages 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 and health visitors.

Updated 3 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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.
• The practice provided a frailty service. The practice kept a register of frail elderly patients and discussed these patients regularly with the community matron to avoid hospital admission where possible.The practice provided remote access lap-tops for GP use whilst visiting nursing homes. This meant that the GPs had access to the patients full medical records while they were in the nursing home.

Updated 3 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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.
• The practice offered electronic prescribing which enabled patients to collect their prescriptions from the pharmacists of their choice which could be close to their place of work.

Updated 3 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.
• The practice performance for mental health indicators was above or comparable with national averages. For example 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate compared to a national average 88%.
• 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 an understanding of how to support patients with mental health needs and dementia.

Updated 3 August 2016

The practice was rated as requires improvement for providing safe and well-led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers 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.