Background to this inspection
Updated
2 June 2016
The Green Surgery provides primary medical services in Twickenham to approximately 8800 patients over two sites,
and are one of 29 practices in Richmond Clinical Commissioning Group (CCG).
The practice population is in the fourth least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 15%, which is higher than the CCG average of 10%, and for older people the practice value is 14%, which also higher than the CCG average of 11%. The practice has a higher population of people aged between 30 and 49 years than the national average and a lower proportion of patients aged 74 years and over. Of patients registered with the practice, the largest group by ethnicity
are white (81%), followed by asian (10%), mixed (4%), black (3%) and other non-white ethnic groups (2%).
The practice operates from its main site, The Green Surgery, which is a purpose built premises, and from a branch site, Fir Road Surgery, which is a converted residential premises, which had been recently extended.
At the main site all patient facilities are on the ground floor, with three doctor’s consulting rooms and a nurse’s consulting room available. At the branch site patient facilities are split over two floors, with a doctor’s consulting room and two nurse’s consulting rooms on the ground floor, which are used for patients who were unable to use the stairs. On the first floor there are two doctor’s consulting rooms and a room for notes storage.
The practice team at the surgery is made up of two part time female GPs who are partners, one full time female salaried GP and three part time female salaried GPs and a GP registrar. A total of 41 GP sessions are provided per week. The practice also has one part time female nurse and a female healthcare assistant. The practice team also consists of a practice manager, secretary, and twelve members of reception/administrative staff. The practice manager and clinical staff all work across both sites. The administrative staff mainly work at a particular site, but provide cross-site cover when required.
The practice is open between 8:30am and 6pm Monday to Friday. Appointments are from 9am to noon every morning and from 2.50pm to 5pm every afternoon. The practice does not offer extended hours appointments, but patients can access appointments with a GP outside of normal surgery opening times via the Richmond GP Alliance's seven-day opening Hub, which is hosted by several local surgeries and offers appointments from 8am until 8pm every day.
When the practice is closed patients are directed to contact the local out of hours service.
The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; and family planning.
Updated
2 June 2016
Letter from the Chief Inspector of General Practice
We
carried out an announced comprehensive inspection at The Green and Fir Road
Surgeries on 23 February 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 which most staff were aware of.
-
Risks to patients were assessed and well managed with
the exception of those relating to the practice’s ability to respond to a
medical emergency.
-
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.
-
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; however, there was no information about making
a complaint displayed in the waiting area at the Fir Road site.
-
Patients said they found it easy to make an appointment
with a named GP and that 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:
-
Ensure
that all staff are aware of the process for reporting and recording incidents.
-
Ensure
all staff complete training updates
within recommended timescales.
-
Ensure
that language translation services are advertised to patients.
-
Ensure
that information about how to complain is available to patients at both sites.
-
Ensure
that they identify all patients who are carers.
-
Ensure
that there is provision for patients to access a male GP.
-
Review
their risk mitigation plan with regards to their access to a defibrillator to
ensure that it is sufficiently robust.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
People with long term conditions
Updated
2 June 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.
-
The practice’s overall performance in relation to long-term conditions was below CCG and national averages. For example, QOF achievement for the percentage of patients with hypertension who had well controlled blood pressure was 77%, the CCG average was 83% and the national average was 84%. For asthma the practice achieved 93% overall performance compared with a CCG and national average of 97%, and the practice had recorded having carried-out a review in the preceding 12 months of 84% of patients with chronic obstructive pulmonary disorder (COPD), compared to a CCG average of 92% and national average of 90%.
-
The practice’s overall performance in relation to diabetes indicators was below CCG and national averages at 58% of the total QOF points available, compared with an average of 90% locally and 89% nationally. In particular, the number of diabetic patients who had well controlled blood pressure was 58% (CCG average was 79% and national average was 78%); the proportion with well controlled blood sugar levels (IFCC-HbA1c 59mmol/mol or less) was 50%, compared to a CCG average of 71% and national average of 70%; and the proportion with a record of a foot examination and risk classification in the preceding 12 months was 73% (CCG average 90%, national average 88%). The practice had recognised that they were performing poorly in this area and were in the process of addressing this by providing dedicated diabetes clinics. QOF results for the current year to date in this area showed an improvement in patient outcomes and demonstrated that the measures put in place by the practice were having a positive effect.
-
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 was offered by the practice but not always taken-up by patients. 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.
Families, children and young people
Updated
2 June 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 comparable to CCG averages for all standard childhood immunisations.
-
70% of patients diagnosed with asthma had received an asthma review in the past 12 months, compared to a CCG average of 74% and national average of 75%.
-
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.
-
Data showed that 81% of patients at the practice aged 25-64 had a record in their notes that a cervical screending test had been performed in the preceding 5 years, which was comparable to the national average of 82%.
-
The practice provided coil fitting to both their own patients and patients from other local practices.
-
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
2 June 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. The practice made use of the Richmond GP Alliance’s Rapid Response Team, which enabled patients who needed urgent home visits to be seen quickly.
-
All patients aged 75 and over had a named GP.
-
Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable to local and national averages. For example, of patients with hypertension who had a record of blood pressure reading in the past 12 months, 77% had blood pressure that was well managed, compared to a CCG average of 83% and national average of 84%.
Working age people (including those recently retired and students)
Updated
2 June 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.
-
An in-house phlebotomy service was offered which avoided patients having to attend hospital for blood tests.
-
Although the practice did not offer extended hours appointments, patients could access early morning, evening and weekend appointments via the Richmond GP Alliance’s seven-day opening hub.
People experiencing poor mental health (including people with dementia)
Updated
2 June 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
-
96% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG and national average of 84%.
-
The practice had recorded a comprehensive care plan for 95% of patients with schizophrenia, bipolar affective disorder and other psychoses, compared to a CCG average of 92% and national average of 88%.
-
The practice regularly worked with multi-disciplinary teams in the case management of people 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.
People whose circumstances may make them vulnerable
Updated
2 June 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 those with a learning disability. Staff told us that in the past they had registered patients who were homeless or from travelling communities.
-
The practice offered longer appointments for patients with a learning disability.
-
The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
-
The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, they had referred patients who were at risk of rough sleeping to the “Second Night Out” project.
-
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.