Archived: Triangle Surgery

Updated 7 April 2017

Triangle Surgery provides primary medical services in Wandsworth to approximately 4,800 patients and is one of 44 member practices in the NHS Wandsworth Clinical Commissioning Group (CCG). The practice operates under a Personal Medical Services (PMS) 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% fewer older people than other south west London boroughs, reflected in the patient demographics for the practice with 11% of patients aged 65 or over, 69% of patients aged 18-65 years old and 20% aged 18 or younger.

The practice population is in the fourth least deprived decile, with income deprivation affecting children and adults in line with local averages. Ethnicity data for the practice shows that 51% of patients are from minority ethnic backgrounds.

The practice operates from a purpose built property with three floors. There are patient facilities including reception and waiting area on the ground floor with further treatment and consultation rooms on the first floor. There are practice management and staff facilities on the second floor, all of which are accessible by lift or stairs. The building is wheelchair accessible with disabled access facilities.

The practice clinical team is made up of two male GP partners, two female nurses and one female healthcare assistant who is also a trained receptionist. The practice also has a regular female locum GP who provided three sessions per week. The practice doctors together provide 20 sessions per week. The non-clinical team consists of one practice manager and two receptionists.

The practice opens between 8.15am and 1.30pm and 3.00pm and 8.00pm Monday to Friday.

Morning surgery times are between 8.20am and 1.30pm. On a Monday, Tuesday, Thursday and Friday, afternoon surgery times are between 4.20pm until 6.30pm. On Wednesdays, afternoon surgery times are between 5.00pm and 6.30pm. Prebookable appointments during extended hours are available between 6.30pm and 8.00pm Monday to Friday.

Practice telephone lines and reception are operational between the hours of 8.15am and 1.30pm and 3.00pm and 6.30pm. Between 1.30pm and 3.00pm, patients are asked to contact the locally agreed out of hours provider who will assess the needs of the patient and where necessary contact the on duty GP from the practice who will in turn contact the patient.

The provider has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8.15am 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 7 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Triangle Surgery on 26 August 2016. The overall rating for the practice was good, with the rating for providing safe services requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Triangle Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 February 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 26 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good, with the rating for providing safe services now Good.

Our key findings were as follows:

• The provider had purchased and installed an automatic external defibrillator (AED).

• Staff at the practice had been trained in the use of the AED.

• The provider had reviewed how patients with caring responsibilities were identified and recorded on the clinical system. The provider introduced a carer’s policy which defined the role of the carer, how to identify carers, including young carers, and what support should be offered. Support for carers included written information and signposting to relevant local services, priority and flexibility in appointment length and time, and an annual health and social care review and support under the local clinical commissioning group scheme. The provider had now identified 65 patients as carers which was 1.3% of the practice population, compared to 33 patients (0.7%) at our last inspection.

• The provider had introduced a range of information leaflets, DVDs and posters for patients in languages and subjects appropriate to the practice population. The subjects included diabetes, fasting during Ramadan, smoking cessation and health screening, and leaflets were printed in Urdu, Arabic, Spanish, Gujarati, Hindi, Tamil, Punjabi, Somali and Polish.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 26 August 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 similar to the Clinical Commissioning Group (CCG) and national averages.
• For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 87% (CCG 88%, National 88%).
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and 87% had 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 26 August 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 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.
• The practice’s uptake for the cervical screening programme was 73%, which was comparable to the CCG average of 72% and the national average of 74%.
• 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 26 August 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 patients had a named GP responsible for their care.

Updated 26 August 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 26 August 2016

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

• Performance for mental health related indicators was similar to the national average, for example;

• 85% 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 of 84%.
• 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 26 August 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, 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.