Dr C Wilcock & Partners Also known as Friends Road Medical Practice

Updated 12 May 2016

The practice operates from one location also known as Friends Road Medical Practice. They have below the local and national average number of children under 18 years of age and around the local and national average number of people aged over 65. However, they have a higher proportion of patients aged over 75 and 85 years compared to local averages. Just under half the patient population is from a black and ethnic minority background. Fifty three per cent of patients have long standing health conditions, which is in line with local and national averages. Twenty per cent of patients have caring responsibilities which was just above local and national averages of 16% and 18% and 63% of patients are in paid work or full time education, in line with the CCG average of 65% and the national average of 60%. It is in the fifth most deprived area of England. The practice is registered as a partnership of two GPs and the practice manager, and registered with the Care Quality Commission (CQC) to provide the regulated activities of: diagnostic and screening procedures, treatment disease, disorder or injury, maternity and midwifery services, family planning and surgical procedures.

The practice provides primary medical services through a Primary Medical Services (PMS) contract. A PMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice provides a range of services including long term condition management, minor surgery, health promotion, cervical smears, child and adult immunisations, family planning, maternity care and smoking cessation to just under 8,000 patients in Croydon.

The practice is a member of Croydon Clinical Commissioning Group (CCG) and is one of 58 member practices. It comprises of two male GP partners and two female salaried GPs (equivalent to 3.4 full time GPs), two part time practice nurses (equivalent to 1.5 full time equivalents). There is a full time practice manager and operations manager and ten administrative and reception staff.

The practice is open between 8.00am and 6.30pm Monday to Friday. Appointments are from 9.00 to 11.30am every morning and 4.30pm to 7.00pm daily. Extended hours surgeries are between 7.30am and 8.00 am Tuesday and Wednesday mornings and 6.30 and 7.00pm Monday to Friday.

The practice has opted out of providing out-of-hours services to their own patients and these services are provided by the locally agreed out-of-hours provider for the CCG.

Updated 12 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr C Wilcock and Partners on 20 November 2015. 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.
• Data showed patient outcomes were at or above the local averages.
• 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.
• 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.

We saw some areas of outstanding practice:

• The practice recorded and responded to issues patients experienced with other health services. They recorded when other health professionals did not attend booked home visits for their patients. They also reviewed all discharge letters and when these were not completed in full or included incorrect details, they requested the required details from the service and referred their concerns to the CCG to be addressed. These were reviewed as significant events within the practice to ensure patients received appropriate care and treatment.

• The practice had a long history of providing services to vulnerable patients in the population and demonstrated changes they had made to services to meet the needs of different vulnerable people. For example they provided longer appointments for patients who were refugees and those who required interpreters when they did not have English as their first language. They had systems to sign post refugees to local support services for information and advice. The practice had provided services to local units providing shelter to women and children fleeing domestic violence. The practice was currently providing GP services to a unit providing accommodation to offenders who had just been released from prison.

• The practice achieved Investors in People in Champion in 1998 and Champion Status which in 2005 and went on to mentor and support 10 other practices in the Investors in People journey to achieve this for themselves.

The areas where the provider should make improvement are:

• Update emergency medicines to ensure they were able to deal with a range of medical emergencies.

• Advertise the complaints procedure for patients and display information advising patients that nurses would act as chaperones if required.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 12 May 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.

• Nationally reported data showed outcomes for patients with diabetes were in line or above both local and national averages. For example 87% had a flu vaccination, 74% had their cholesterol measured in the last year and 92% had their feet examined in the last year.

• Longer appointments and home visits were provided when needed.

• All these patients had a named GP who carried out a structured annual review to check that their health and medicines needs continued to be met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 May 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 accident and emergency attendances.

• The practice used ‘celebrate and protect’ style birthday cards to remind parents to bring their children for their childhood immunisations. Immunisation rates were in line or just below the local averages 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.

• Data showed 81% of women attended for a cervical smear test which was in line with local and national averages.

• Appointments were available outside of school hours and the premises were suitable for children and babies with sufficient room for pushchairs and a separate waiting area with a range of toys for younger children.

• The practice liaised with midwives and health visitors to identify children in need and those at risk and there was a system on the patient record to identify these patients. Midwives attended the practice weekly to provide an antenatal clinic.

• The practice provided services to children who were looked after by the local authority and this was identified on the individual patient record.

• The practice offered a full range of family planning and sexual health advice.

Updated 12 May 2016

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

• Older people made up 24% of the practice registered population. The practice provided a named GP for all patients over 75.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided a service to a nursing home and one of the GPs visited twice each week and in-between when required. They provided end of life care, annual flu vaccinations, carried out regular medicine reviews and reviewed all unplanned admissions to hospital. They also provided services to a number of patients living in shelter housing.

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

• The practice worked with other health and social care professionals including falls teams to help reduce the risk of unplanned admissions to hospital.

• The practice identified they had a high percentage of patients needing nursing and palliative care services. They worked with the palliative care team to ensure these patient’s needs were known and met compassionately and their relatives and carers received extra support when required.

Updated 12 May 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. For example they provided booked appointments from 7.30-8.00am two mornings a week and from 6.30pm-7.00pm every weekday evening. In addition, the GPs provided telephone appointments.

• 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.

• The practice website included information about common health conditions and information about local health services.

Updated 12 May 2016

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

• Eighty per cent of the 38 people with dementia had had their care reviewed in a face to face meeting in the last 12 months.

• The practice kept a register of people experiencing poor mental health. Data showed 90% of the 80 patients experiencing poor mental health had a care plan that was reviewed which was above the national average of 86%. Ninety two per cent of these patients had a record of their alcohol consumption above the national average of 89%. They provided longer appointments at times that suited this patient group.

• 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 in the local area.

• 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 had completed training in dementia care so they could meet the specific needs of this patient group.

Updated 12 May 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, those with a learning disability and people who used domestic violence services. The practice held a weekly clinic for patients experiencing domestic violence. They had recently started to provide services to a residential unit for ex-offenders.

• It provided a service to a care home for people with learning disabilities and all these patients received an annual health check. The practice offered longer appointments for people with a learning disability.

• The practice regularly worked with multidisciplinary teams to provide joined up care and treatment to 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 and were clear about their responsibilities to report concerns and how to contact relevant agencies in and out of office hours.