Warlingham Green Medical Practice

Updated 23 January 2018

Warlingham Green Medical Practice is located in a residential area close to the boundary with the London Borough of Croydon. There are11,500 patients on the practice list and the majority of patients are of white British background. The population distribution as recorded by Public Health England indicates a slightly higher than average working population as well as the percentage of patients with a long term health condition. Warlingham Green incorporates a branch surgery at

Chaldon Road with a shared patient list. Warlingham Green is part of the SWC (Selsdon, Warlingham and Caterham) Group, a group of local practices sharing management resource and support.

The practice is a training practice. The training is managed by a GP Training Lead and there are currently three full-time GP registrars at the practice. The practice also takes medical students from medical schools in the area.

There are a total of seven GP partners (three male, four female) and six salaried GPs. Medical staff at the practice can be utilised to support services at either practice, particularly during peak annual leave periods. They are however, generally based at a single location. Patients can opt to attend either location. There are three Practice Nurses (PN) and seven Health Care Assistants (HCA) based at Warlingham Green and Chaldon Road. Support staff consists of a director of operations who covers all practices within the group and leads for areas such as information technology and finance. There are two site specific managers, one at Warlingham, one at Chaldon and a Patient Services Manager. There is also a team of reception, administration and secretarial staff.

The practice is open from 7.30am to 6.30pm Thursdays and Fridays, from 7.30am to 7.00pm on Mondays, from 8am to 6.30pm on Tuesdays and from 8.30am to 8pm on Wednesdays. Extended hours appointments are available on Mondays and Wednesday evenings and Monday, Thursday and Friday mornings. Appointments are available from 8am to12.30pm, 3pm to 6pm and 6.30 to 7pm on Mondays and 6.30 to 8pm on Wednesdays. Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hour’s service on telephone number 111.

The practice has a General Medical Service (GMS) contract and also offers enhanced services for example: Childhood Vaccination and Immunisation Scheme and also extended hours. The Chaldon Road Surgery, Chaldon Road, Caterham, CR3 5PG was not visited as part of this inspection.

Updated 23 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection December 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Warlingham Green Medical Practice on 20 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those with enhanced needs were also provided the same day.

• There was an active patient participation group in place who told us that they had seen improvements within the practice.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice worked closely with other practices in order to provide and improve services for their patient populations.

• Staff were positive about working in the practice and were involved in planning and decision making.

• The practice had increased GP, nursing and healthcare assistant hours in order to meet the needs of patients.

• Patient survey results were largely positive and higher than average in a number of areas.

The areas where the provider should make improvements are:

• Ensure that the practice lead for infection control has access to relevant infection control leads’ training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 February 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. Clinics and reviews were co-ordinated to support the management of Diabetes, Rheumatoid Arthritis, Chronic Obstructive Pulmonary Disease (COPD) and Hypertension. Patients suffering from chronic disease were offered enrolment onto the practice Avoidance of Unplanned Admissions scheme.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. There was a system in place to ensure that the patient was reminded of the need for review.

• For those people with the most complex needs, their needs could be discussed during the twice weekly Referral Meetings to identify options for achieving the best outcome.

• Where appropriate the practice engaged and worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 4 February 2016

The practice is rated as good for the care of families, children and young people.

• The practice offered childhood immunisations to all babies and children registered at the practice. The uptake of childhood immunisations was comparable to other practices within the Clinical Commissioning Group (CCG) area. The practice also offered a weekly well-baby clinic with a Health Visitor and Antenatal clinics with a midwife.

• Patients and staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals. We saw evidence to confirm this. When providing care and treatment for children and young people, staff carried out assessments of capacity to consent in line with relevant guidance. The practice had developed a ‘Gillick Competency’ form to record clinical decisions and rationale in relation to the issue of oral contraception to relevant young people.

• The percentage of women aged 25-64 whose notes recorded a cervical screening test within the preceding five years was comparable to the national average.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Baby changing facilities were available.

• All staff had been trained to recognise the signs of abuse in children and the relevant action to take.

Updated 4 February 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care plans to meet the needs of the older people in its population. This was corroborated by patients that we spoke to.

• The practice was responsive to the needs of older people, and offered home visits on request and urgent appointments for those with enhanced needs. Longer appointments were available for older people, and this was acknowledged positively in feedback from patients.

• Complex health needs were discussed at clinical meetings to promote good continuity of care.

• Best interest decisions were made as appropriate in line with relevant legislation.

• The percentage of people aged 65 or over who received a seasonal flu vaccination was comparable with the Clinical Commissioning Group ( CCG) and national averages. Vaccination against Pneumonia was also offered to patients.

• The practice offered regular medication reviews for all patients over the age of 75. There was a hearing loop system in the waiting room and all signage contained clear, large lettering.

Updated 4 February 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 and it was possible to speak to a doctor on the telephone.

• Two late evening clinics for routine pre-bookable appointments were available and designed to support the working population. Early morning clinics were also available at the branch practice.

• Hepatitis B immunisation was offered to those patients whose employment placed them at risk.

Updated 4 February 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 higher than the CCG and national average.

• The dementia diagnosis rate was similar to the national average. 84.61% of people diagnosed with dementia were in receipt of a care review by way of a face to face meeting in the last 12 months.

• Staff had received locally delivered training in relation to Dementia with presentations from a nationalalzheimer’s charity. The practice had also made changes to lighting, notice boards, signs and the consulting rooms to develop a more Dementia friendly environment.

• All patients diagnosed with dementia were identifiable via a flagging system on the practice computer system.

• 96.15% of patients with schizophrenia, bipolar affective disorder and other psychoses were in receipt of acomprehensive, agreed care plan documented in the preceding twelve months.

• 98.18% of patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses had had their alcohol consumption recorded in the preceeding 12 months.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• 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 people with mental health needs and dementia.

Updated 4 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice offered enhanced services for those patients with a learning disability. The practice maintained a learning disabilities health check register which facilitated annual health checks and the creation of a health action plan.This provided a regular opportunity for the promotion of a healthy lifestyle, medication reviews and for the practice to identify new issues and concerns.

• The practice was also proactive in identifying and supporting carers with active participation in a scheme run by a local charity entitled the ‘Carers Break’ scheme.

• Staff had received training in and knew how to recognise signs of abuse in vulnerable adults. They were aware of their responsibilities and what action to take.

• All staff were aware of where safeguarding policies and procedures were located and who the practice lead was.