Sunny Meed Surgery

Updated 27 January 2017

Sunny Meed Surgery offers primary medical services to the population of Woking in Surrey and the surrounding area. There are approximately 9,300 registered patients. Sunny Meed Surgery has a main site and a smaller branch surgery at Goldsworth Park Health Centre.

The practice was situated over two floors. The first floor is for administration staff only. Most of the GP rooms are accessed via a small number of steps. However, there are two treatment rooms on ground level. Patients can be offered appointments in these two rooms if required. There is disabled access with a seated waiting area. There is an accessible toilet for patients on the ground floor and there are baby changing facilities.

Sunny Meed Surgery is run by three partner GPs (two male and one female). The practice is also supported by three salaried GPs (one male and two female), one female GP registrar and one female Foundation Year doctor, three practice nurses, a health care assistant and a clinical prescribing pharmacist. The clinical team is supported by a full-time practice manager and assistant practice manager and a team of administrative, secretarial and reception staff. (Clinical pharmacists work as part of the general practice team to resolve day-to-day medicine issues and consult with and treat patients directly. This includes providing extra help to manage long-term conditions, advice for those on multiple medicines and better access to health checks. The clinical pharmacist at this practice is able to prescribe medicines).

Sunny Meed Surgery is a training practice for GP Registrars and Foundation Year doctors. GP registrars are fully qualified and registered doctors who are on a three year GP training course. This involves further medical training in specialities and are attached to a practice under a supervising qualified GP. The foundation programme usually involves six different rotations or placements in medical or surgical specialties. The rotations enable doctors to practice and gain competence in basic clinical skills under supervision.

The practice runs a number of services for its patients including asthma reviews, child immunisation, diabetes reviews, new patient checks and holiday vaccines and advice. As well as spirometry, minor operations, cryotherapy, ear syringing, injections to treat symptoms of prostate, breast cancer, secondary bone cancer or endometriosis, Cardiovascular disease (CVD) reviews, pre-diabetic reviews, and a specialised blood test for Deep Vein Thrombosis (DVT) and ECGs

Services are provided from two locations:-

The main Surgery

Sunny Meed Surgery, 15-17 Heathside Road, Woking, Surrey, GU22 7EY

Opening Times

Monday to Friday 8am to 6.30pm

Extended hours

6.30pm to 8.30pm Monday and Thursday evenings with the Practice Nurse and the HCA

6.30pm to 8.30pm on a rotating basis either on a Wednesday, Thursday or Friday evening with one of the GP partners.

And the branch Surgery

Goldsworth Park Health Centre, Denton Way, Woking , Surrey , GU21 3LQ

Opening Times

Monday , Tuesday and Thursday 8am – 6.30pm

Wednesday and Friday 8am to 1.30pm

During the times when the practice is closed, the practice has arrangements for patients to access care from an Out of Hours provider.

The practice population has a higher number of patients aged between birth and nine years of age, 40-54 and 85+ years of age than the national and local clinical commissioning group (CCG) average. The practice population shows a lower number of patients aged from 15 to 29 and 60-69 years of age than the national and local CCG average. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for England. Less than 10% of patients do not have English as their first language.

Updated 27 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sunny Meed Surgery on 24 November 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.
• We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
• 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. Same day appointments were available for children (under the age of 16 years) who required same day consultation.
• The practice participated in the hospital admission avoidance scheme and maintained a register of patients who were at high risk of a hospital admission.
• The practice encouraged and valued feedback from patients, the public and staff.
• The practice was open between 8am and 6.30pm Monday to Friday, The practice offered extended hours from 6.30pm to 8.30pm Monday and Thursday evenings with the Practice Nurse and the HCA  and 6.30pm to 8.30pm on a rotating basis either on a Wednesday, Thursday or Friday evening with one of the GP partners.
• 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.
• All staff were trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguard (DOLS). All staff were trained to be ‘dementia friendly’.

• The practice was actively ensuring that patients had accessible information provided to them in the format required. For example, in the form of large print or access to interpreters or translation services

We saw several areas of outstanding practice:

• The practice had a holistic approach to assessing, planning and delivering care and treatment for young patients who use services. The practice had carried out work with young patients to improve their awareness of what general practice could offer and information about their rights regarding access and confidentiality. We saw notices around the practice informing young patients of this and the practice had a young person’s champion. The practice had created a questionnaire specifically for young patients and had created an action plan from the comments received. Results indicated that 100% of those that responded felt they had been able to get an appointment that suited them and felt at ease during their consultation. The practice had thought about ways to engage with younger patients and there were links to ‘YouTube’ videos for younger patients to access.

The areas where the provider should make improvement are:

• Ensure that patient privacy is reviewed in consulting rooms overlooking the drive

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 January 2017

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

• The clinical pharmacist and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Performance for diabetes related indicators was comparable or higher than the local clinical commissioning group (CCG) and national averages. For example, 85% of patients with diabetes had a last measured total cholesterol within range of a healthy adult (within the last 12 months). This was higher than the CCG and national average. Diabetic patients were given information about their condition which included a care plan and a guide produced by the Diabetes UK and information relating to the 15 healthcare essentials for diabetes (this is a guide to the minimum level of healthcare patients with diabetes should expect. For example, foot checks and having your eyes screened for signs of retinopathy). The practice website had links to various support groups as well as a video ‘how to take a blood glucose test’.
• The practice had audited patients with a diagnosis of diabetes aged 16-24 years who were or had transitioned from child to adult services. The audit was to ensure patients were still being seen by a specialist team. Audit results showed that 100% of patients had on-going follow up arrangements in place.
• 94% of patients with chronic obstructive pulmonary disease (COPD) had a review undertaken including an assessment of breathlessness, which was comparable with the national average of 90%

• 82% of patients with asthma had an asthma review performed in the previous 12 months. This was higher than the national average of 75%
• Longer appointments and home visits were available when needed.
• The practice had developed a new booking system to remind patients of future reviews. For example, if repeat blood tests were required the reception team would contact the patient to book an appointment.
• The practice had a number of in-house services that reduced the need for patients to travel to hospital. This included initiating insulin, blood testing that measures how long blood takes to clot, blood monitoring for patients taking medicines given to patients with rheumatoid arthritis and 24 hour blood pressure monitoring.
• Patients were supported to self manage their long-term condition by using agreed plans of care and were encouraged to attend self-help groups.
• The practice had links with the South East Coast Ambulance Service NHS Foundation Trust (SECAmb) and was able to uploaded information to their database for emergency care. This enabled ambulance clinicians to have up to date information about a patient's health, their care plans, their needs and wishes.

Updated 27 January 2017

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

• The practice had a young person’s champion. The practice had created a questionnaire specifically for young patients and had created an action plan from the comments received. Results indicated that 100% of those that responded felt they had been able to get an appointment that suited them and felt at ease during their consultation. The practice had thought about ways to engage with younger patients and there were links to ‘YouTube’ videos for younger patients to access.
• GPs were able to prescribe medicines for attention deficit hyperactivity disorder (ADHD) under a shared care arrangement and were planning to extend this service by offering children in-house six monthly reviews with paediatric support.
• There were processes in place for the regular assessment of children’s development. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice ensured that younger patients (under the age of 16 years) needing emergency appointments would be seen on the same day.
• Pregnant women were able to access an antenatal clinic provided by midwives attached to the practice.
• The number of women aged between 25 and 64 who attended cervical screening in 2015/2016 was 92% which was higher than the clinical commissioning group (CCG) and 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.
• The practice had carried out work with young patients to improve their awareness of what general practice can offer and their rights regarding access, consent and confidentiality.
• The practice had baby changing facilities, and a small play area was available for children. The practice welcomed mothers who wished to breastfeed on site, and offered a private room to facilitate this if requested.

Updated 27 January 2017

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 patients in their population. All patients over the age of 75 had a named GP and patients over the age of 75 were offered an annual health check. The practice worked to reduce the unplanned hospital admissions for patients.
• The practice was able to refer older patients to a locality multiagency community frailty hub to support independent living and reduce emergency hospital admissions and visits made to Accident & Emergency departments. The hub gives older people aged 75 and over access to a range of health, social care and community services – all in one place. The practice had referred 46% of their older patient group to this service to access additional support. The practice was one of the highest referring practices in the clinical commissioning group area. The practice was able to access consultations notes made by hub clinicians through patients consenting to share record information.
• The practice was working to the Gold Standards Framework for those patients with end of life care needs. (The Gold Standards Framework is a framework to enable an expected standard of care for all people nearing the end of their lives. The aim of the Gold Standards Framework is to develop a locally-based system to improve and optimise the organisation and quality of care for patients and their carers in the last year of life).
• GPs and the clinical pharmacist provided medicine reviews for patients who were on multiple medicines to improve safety.
• The clinical pharmacist visited housebound vulnerable older patients for routine reviews including flu vaccines, chronic obstructive pulmonary disease (COPD) /asthma reviews and medicine reviews.
• Patients who were newly retired were routinely offered a health check.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered immunisations for shingles and pneumonia to older patients.
• There were nominated Elderly Care Leads who were active in ensuring that all older patients registered had access to any support and guidance required.
• The practice had links with the South East Coast Ambulance Service NHS Foundation Trust (SECAmb) and was able to uploaded information to their database for emergency care. This enabled ambulance clinicians to have up to date information about a patient's health, their care plans, their needs and wishes.

Updated 27 January 2017

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.
• The practice had identified that a large proportion of their patients were commuters, and designed access to accommodate this. This was facilitated by a system of triage, extended hours sessions, and telephone consultations. For example, the practice offered extended hours from 6.30pm to 8.30pm Monday and Thursday evenings with the Practice Nurse and the HCA  and 6.30pm to 8.30pm on a rotating basis either on a Wednesday, Thursday or Friday evening with one of the GP partners to enable improved access for working patients.
• Telephone consultations were available during working hours.
• The practice sent text reminders for appointments and when receiving test results.
• Electronic Prescription Services (EPS) and a repeat dispensing service helped patients to get their prescriptions easily.
• Travel health and vaccination appointments were available.
• Health checks were offered to all 40-74 year olds and appointments for these checks were available in the evening for working patients.
• The practice recorded patients retirement date to ensure those patients were offered a health check. The practice website had references for health promotions and advice for patients who were retired.
• Smoking cessation clinics were held in the evening to improve access for the working population.

Updated 27 January 2017

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

• 98% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, with the national average being 84%
• 100% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented, in the last 12 months, with the national average being 88%
• 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. The practice actively screened patients with long-term condition for dementia. Staff had undertaken dementia friends training.

Updated 27 January 2017

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 patients 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 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.
• Patients with a learning disability or other significant disability were known to the practice. This meant staff could quickly identify when dealing with a patient, if they required additional assistance.
• The practice could accommodate those patients with limited mobility or who used wheelchairs.
• Carers and those patients, who had carers, were flagged on the practice computer system and were signposted to the local carers support team.
• The practice used Carer Prescriptions. The Carers Prescription is a referral tool to offer carers the support they need and to help the carer have a better balance between their caring role and their life away from caring

• The practice had a ‘carers champion’ and held monthly clinics as well as phone consultations where support and advice could be offered to patients. The carers champion also had regular contact and meetings with the GP Carer Awareness Advisor for North West Surrey.