Heathbridge Practice

Updated 9 August 2016

Heathbridge Practice provides primary medical services in Wandsworth to approximately 16,000 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 per cent fewer older people than other south west London boroughs, reflected in the patient demographics for the practice with 9% of patients aged 65 or over, 76% of patients aged 18-65 years old and 15% aged 18 or younger.

The practice population is in the third least deprived decile with income deprivation affecting children and adults lower than national averages. Ethnicity data shows that 82% of patients are white, 8% Asian, 4% black, 4% have mixed ethnicity and 2% are from other non-white ethnic backgrounds.

The practice operates from two floors of a shared-use purpose built property with patient facilities including reception and waiting areas on both the ground and first floor mezzanine as well as practice management facilities on the first floor, all of which are accessible by lift or stairs. The building is wheelchair accessible with disabled accessible facilities.

The practice clinical team is made up of six GP partners equivalent to 6.9 whole time GPs, one nurse partner, three salaried GPs, three nurses and two healthcare assistants. Four of the doctors are male and six doctors are female. All other clinical staff are female. The practice is a training practice and has one GP registrar. The non-clinical team consists of one practice manager, one data manager, one secretary, one reception manager and 11 receptionists.

The practice opens between 8.00am and 6.30pm Monday to Friday. Telephone lines are operational between the hours of 8.00am and 6.30pm. Extended hours are available Monday from 6.30pm to 8.30pm and Tuesday from 6.30pm to 8.50pm. Appointments during extended hours are prebookable only.

The provider has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8.00am, at weekends and bank holidays 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 surgical procedures, maternity and midwifery services, family planning, treatment of disease, disorder or injury, diagnostic and screening procedures.

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heathbridge Practice on 17 March 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:

• The practice should review their arrangements for identifying and supporting carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 9 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.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and 90% 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.
• The practice performed in line with or above local Clinical Commissioning Group (CCG) and national averages for diabetes care. For example;
• The percentage of patients with diabetes, on the register, in whom the last HbA1c (a specific blood sugar level test) is 64 mmol/mol or less in the preceding 12 months was 82% (CCG 75%, National 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 86% (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 82% (CCG 75%, National 78%)

• The percentage of patients on the diabetes register, with a record of a foot examination

and risk classification within the preceding 12 months was 84% (CCG 78%, National 80%).

Updated 9 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 77% compared to the local Clinical Commissioning Group (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 9 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.
• Longer appointments are available for older people, with the provision of up to 30 minute appointments to discuss care planning and self-management of conditions.

Updated 9 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 9 August 2016

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

• The practice performed better than or in line with local Clinical Commissioning Group (CCG) and national averages for patients experiencing poor mental health including those diagnosed with dementia, for example:
• All the 48 patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months which was better than the CCG average of 87% and the national average of 84% with 0% exception reported.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95% (CCG 91%, National 88%)
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 90% (CCG 89%, national 90%).
• 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 9 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 had a lead GP for engaging with seldom-heard groups of vulnerable people. This GP regularly visited support groups and other organisations, sharing learning with colleagues and using the information to provide additional support and assistance to 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.