The Evergreen Surgery

Updated 8 September 2016

The Evergreen Surgery provides NHS primary medical services to around 8800 patients in Wanstead in North East London through a 'personal medical services' contract. The service is run from one surgery which is located in premises which have been adapted for use as a surgery.

The clinical team comprises two GP partners (male and female) and four sessional GPs (male and female), and two practice nurses. The practice also employs a practice manager and a team of receptionists and administrators. The practice is a training practice and at the time of the inspection had two specialist GP trainees in post. The practice participates in the GP 'returners' scheme and also provides teaching placements for undergraduate medical students.

The surgery telephone lines open at 8.30am every weekday. The practice building opens Monday to Thursday 9.00am to 6.30pm and from 8.30am to 6.30pm on Friday. Appointments are available throughout each weekday, the specific times varying depending on the individual GP. The practice offers online appointment booking and an electronic prescription service. The GPs will make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised how to make evening or weekend appointments at one of three other practices offering an extended primary care service in Redbridge. For more urgent problems, patients are advised to telephone '111' to be directed to the most appropriate out of hours service. The practice provides information about its opening times and how to access urgent and out of hours services in the practice leaflet, the website and on a recorded telephone message.

The practice list size is growing. The practice currently has a high proportion of adults aged 25-50 years and patients aged over 85 on its list compared to the English average. The area is ethnically diverse. Around 43% of the resident population of Wanstead described themselves as white and 42% as Asian at the last census. The population is relatively affluent with low unemployment rates and slightly higher life expectancy than the English average.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures, and treatment of disease, disorder and injury.

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Evergreen Surgery on 26 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. The provider was aware of and complied with the requirements of the duty of candour.
• Risks to patients were assessed and well managed.
• 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 and had expanded the range of services available to patients.
• Patients said they were treated well at the practice and we received positive feedback about the practice. The practice scored well on the national GP patient survey for quality of consultations.
• Information about services and how to complain was available at the practice 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 get through to the practice by telephone and their experience of making an appointment was good.
• Patients could consult a male or female GP and a translation service was available. Urgent appointments were 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, an open culture and staff said they were well supported. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice was a training and teaching practice. Feedback from trainees and students about the quality of clinical education at the practice was very positive.

The areas where the provider should make improvement are:

• The practice should consider having a defibrillator on the premises in case of medical emergency.
• The practice should review its mechanisms for identifying patients with significant caring responsibilities and ensuring they have access to appropriate support.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 8 September 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice had allocated lead roles for common long-term conditions to individual GPs. Patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• Patients on the long term conditions registers had a named GP and 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.
• Patients participating in the inspection told us they received very good advice on how to self manage longer-term conditions.

Updated 8 September 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 high for all standard childhood immunisations with the practice achieving 90% targets for all cohorts.
• The practice prioritised young children for appointments the same day.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 8 September 2016

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

• The practice offered personalised care to meet the needs of older patients and carers. Patients told us that the practice was caring and treated older patients with respect.
• All patients over 75 had a named GP and had been informed about this. The practice had secured 'Everyone Counts' funding to provide 20 minute consultations for patients over 75 with more complex conditions.
• The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs.
• The practice offered the flu and shingles immunisations to older patients.
• The GPs made weekly visits to practice patients living in nursing or residential homes who were unable to attend the surgery.
• The practice held regular multi-disciplinary team meetings with the local palliative care nurse and district nursing team to ensure patients with complex needs or those coming to the end of life received coordinated care. Care plans we reviewed were up to date and comprehensive.

Updated 8 September 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 did not offer extended hours opening but informed patients of the availability of extended hours opening at other practices for patients in Redbridge. Patient feedback on access to the service was positive.
• The practice offered online services
• The practice offered a full range of health promotion and screening that reflected the needs for this age group.
• In 2014/15, the practice coverage for the cervical screening programme was 73%, which was in line with the CCG average of 74% but lower than the national average of 82%. A female sample taker was available.

Updated 8 September 2016

The practice is requires improvement for the care of people experiencing poor mental health (including people with dementia).

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 93% (compared to the national average of 84%).
• The practice screened patients at risk of dementia and referred patients with symptoms to a specialist memory clinic.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a documented care plan in the preceding 12 months was 89% (compared to the national average of 88%).
• The practice monitored patients on higher risk medicines such as lithium and methotrexate for example carrying out regular blood tests.
• The practice informed 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 and staff were aware of how to access mental health crisis services.

Updated 8 September 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 with learning disabilities and children known to be at risk were flagged on the electronic records system.
• The practice offered longer appointments for patients with a learning disability and invited patients and their carers if appropriate to attend for an annual review.
• Mental capacity assessments had been carried out in relation to specific decisions involving patients with learning disabilities and the outcome noted in the patient’s medical records.
• 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.
• The practice staff supported patients who needed extra assistance with tasks such as arranging transport to hospital appointments or following up appointments and referrals.