Little London Surgery

Updated 31 October 2016

Little London Surgery is located in Walsall, West Midlands situated in a purpose built building, providing NHS services to the local community. Based on data available from Public Health England, the levels of deprivation in the area served by Little London Surgery is below the national average, ranked at two out of 10, with 10 being the least deprived. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial. The practice serves a higher than average patient population aged 75 years and over and patients aged zero to four years old. The practice also has a higher than the national average number of patients with caring responsibilities.

The patient list is approximately 8,400 of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

Parking is available for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises of five GP partners, three male and two female, four practice nurses, one being an independent prescriber, two Health Care Assistant (HCA), one locum practice pharmacist, one practice manager, one reception manager, two administrators, two secretaries and seven receptionists. The practice is a training practice for GP registrars (fully

qualified doctors who wish to become general practitioners). At the time of the inspection the practice had one GP registrars and one Foundation Year two (FY2) Doctor (a doctor studying the second year of the Foundation Programme).

The practice is open between 8am and 6.30pm on Mondays, Wednesdays, Thursdays and Fridays; 7.15am to 6pm on Tuesdays and 8.30 to 8pm on Wednesdays. On Tuesdays there is an extended hours service when the practice is open from 8am to 8pm. The practice closes on a Thursday at 1pm on the third week of each month and does not re-open during the afternoon. When the surgery is closed during normal opening hours the services is provided by ‘WALDOC’ which is an out-of-hours service provider.

GP consulting hours are from 8am to 10.50am and 4pm to 6pm Mondays to Fridays. Extended consulting hours are offered on Tuesdays from 6.30pm to 8pm.

The practice has opted out of providing cover to patients in their out of hours period. During this time services are provided by Primecare.

Updated 31 October 2016

Letter from the Chief Inspector of General Practice

We carried out a focussed inspection at Little London Surgery on 8 September 2016.

The practice had previously been inspected in November 2015 and was rated as requires improvement for providing safe services and good for responsive. At this time we identitied a breach of regulation around safe care and treatment. This was because the provider did not keep records to reflect the appropriate management of the cold chain (the safe storage and handling of vaccinations). Additionally, records were not in place to support that risk was effectively managed in the absence of disclosure and barring service (DBS) checks for staff and for specific risks associated with health, safety and infection control. During the previous inspection the practice had not reviewed the 2015 national GP patient servey in order to consider whether improvements were needed to improve patients’ experience of the service.

Following the inspection the practice sent us an action plan detailing the actions they were going to take to improve.

We carried out a focused inspection to check whether the provider had made improvements in line with our recommendations and to ensure regulations are now met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Little London Surgery on our website at www.cqc.org.uk.

We found that during our inspection on 8 September 2016, the practice had improved systems and we found the following key findings:

• The practice had established systems and processes to keep patients safe.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. There were effective systems in place to alert the practice when training updates were required.

• Risks associated with health, safety and infection control were effectively assessed and well managed. There were adequate arrangements in place to respond to emergencies and major incidents.

• The practice had systems in place to effectively monitor and audit their processes, including patient correspondence and risk management systems

• The practice had proactively sought patient feedback via patient surveys, and findings had been acted on. The national GP patient survey published 7 July 2016 showed slight improvements in some areas of patient access however were still below local and national averages.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice demographics included a high prevalence of diabetes. There was a GP lead for diabetes who worked alongside the CCG lead to improve the management and treatment of diabetes.
• Longer appointments and home visits were available when needed.
• Patients with long term conditions had a named GP and a structured annual review to check that 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 10 March 2016

• 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 mostly in line with the CCG average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors and school nurses.
• Data showed that the practice’s uptake for the cervical screening test was 71% which was much lower than the national average of 81.8%. However, we saw evidence that the practice had taken action to increase uptake.

Updated 10 March 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population and provided a range of enhanced services, for example, in dementia and end of life care.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.
• The practice provided a directed enhanced service to two nursing homes. Managers of both homes provided positive feedback on how well the practice worked with them to manage patient’s health needs.

Updated 10 March 2016

• 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 reflected the needs for this age group.
• The practice provided smoking cessation advice, cervical screening and NHS health checks for patients aged 40 to 74 years.
• There were extended opening hours on Tuesdays which would benefit working patients.

Updated 10 March 2016

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 75% which was lower than the national average of 83.8%. However, the practice had taken action to make improvements.

• The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It 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.
• It 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 people with mental health needs and dementia.

Updated 10 March 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and poor mental health.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multidisciplinary teams in the case management of vulnerable people.
• It had told 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.
• The practice provided a directed enhanced for substance misuse and there was a GP lead.