Wide Way Surgery

Updated 5 November 2018

The registered provider of the service is Wide Way Surgery. The address of the registered provider is 15 Wide Way, Mitcham, Surrey, CR4 1BP. The practice is registered as a partnership of four partners with the Care Quality Commission to provide the regulated activities of diagnostic and screening services, family planning services, maternity and midwifery services and treatment of disease, disorder or injury. One further partner is due to apply to be added to the provider’s registration.

Regulated activities are provided at one location operated by the provider. The practice website is https://www.widewaymedicalcentre.nhs.uk/your-surgery/.

Wide Way Surgery provides services to 9400 patients in Mitcham, Surrey and is one of 23-member practices of Merton Clinical Commissioning Group (CCG). The practice provides services to one local care home.

The practice has a higher than national average population of children and young people and a lower than local and national average number of those over 65. Deprivation scores are higher than local and national averages and deprivation affecting children is considerably higher. The practice is in the 5th most deprived decile in England. Of patients registered with the practice, approximately 41% are White or White British, 34% are Black or Black British, 17% are Asian or Asian British, and 8% are other or mixed ethnic backgrounds.

Wide Way Surgery operates from a purpose built medical centre, comprising 13 consulting rooms, one treatment room, administrative rooms and a patient waiting area. The surgery is accessible to those with mobility problems. The medical centre also houses other community health services including a local GP access hub for Merton CCG. On the first floor there are dental, midwifery, health visitor, sexual health and family planning services available from other providers.

The practice held a service level agreement with the local extended access hub who shared the premises and were able to access practice equipment and medicines.

There are four part-time GPs who are partners and two part-time salaried GPs. Patients are able to see male or female GPs. The nursing team consists of a full-time advanced nurse practitioner, three part-time practice nurses and a part-time health care assistant. The practice employs a phlebotomist, one part-time clinical pharmacist and a second pharmacist has been recently recruited. In total the medical team provides the equivalent of 45 sessions per week via a skill mix of GPs, pharmacists and the nurse practitioner.

The clinical team is supported by a managing partner, four administrative staff and eight reception staff. A social prescriber works at the practice one day per week.

Out of hours, patients are directed to the local out of hours provider for Merton CCG via 111.

Updated 5 November 2018

This practice is rated as Outstanding overall. (Previous rating 8 October 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Wide Way Surgery on 7 August 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was carried out in line with our next phase inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice understood the needs of its population and tailored services in response to those needs. There was evidence of a number of projects and services the practice had been involved with to ensure patients’ needs were met.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation and engagement with external organisations to improve the quality of services delivered for practice patients and the local population.

We saw areas of outstanding practice:

• The practice had developed a number of bespoke protocols and ‘intelligent’ templates on the electronic record system which included automated prompt messages for care plans, referral forms and direct links to guidance and local services, so that GPs were able to ensure patients received standardised, up to date and timely care and treatment at the point of need. There was evidence that these tailored systems had been shared with and formally adopted by the Clinical Commissioning Group (CCG) and sent to all CCG practices.
• The practice had initiated and developed the proposal for an improved approach to diabetes care and worked with in the local community healthcare NHS trust to deliver this. The proposal was piloted in the practice before being piloted in the three other Primary Care Home (PCH) practices. As part of the project, a diabetes ‘academy’ meeting was set up for staff education and sharing ideas; the lead GP arranged accredited diabetes training for 13 staff across the PCH practices and the practice developed systems to ensure close monitoring for complex diabetic patients. The project involved directly bookable diabetes clinics with a community specialist diabetic nurse via remote email, telephone and joint consultations. Unverified data showed that outcomes for diabetic patients had improved over the last year as a result. The project was in the process of being developed across CCG practices.
• The practice identified the need for additional primary care input into a local care home to improve outcomes for older people. As part of this project, the practice strengthened their systems which ensured older people with frailty received effective care and treatment. The six-month pilot project of weekly ward rounds, joint working and improved access commenced in December 2017. Data from the CCG compared with the previous year showed that after the pilot, the care home had dropped from the first to the fifth highest ambulance conveyor and the number of ambulance conveyances had reduced from 46 in 2017 to 12 in 2018 after the pilot, which was a 74% reduction in ambulance service use by the care home. As a result of this pilot, the scheme had begun to be rolled out CCG wide.
• A social prescribing project which was particularly utilised by vulnerable patients, had produced a reduction in both the number of GP appointments and accident and emergency (A&E) visits by these patients. One of the partners developed the social prescribing model for the CCG. The practice then volunteered to be involved in a local CCG pilot model of Social Prescribing aimed to connect medical care with local voluntary and community resources. Social prescribing appointments were delivered by a Social Prescribing Coordinator (SPC) two days per week. Across the first three months of the project, 138 patients visited two practices for social prescribing appointments (approximately 104 patients from Wide Way Surgery). The pilot saw a significant increase in health and wellbeing for patients as well as significant decreases in both number of GP appointments (by 543) and A&E attendances (by 29 visits) in patients referred to the service. Patients reported better self-management as a result of the scheme. From April 2018 the social prescribing programme was rolled out across nine GP practices in the CCG.
• The practice provided innovative services to support staff and foster a positive culture including staff awards, a daily coffee ‘debrief’ session, three times weekly chair yoga sessions and a well-being services package for staff. The practice was the first practice in South West London to provide additional well-being services for staff.
• The practice had undergone a £1 million premises expansion and redevelopment, which was completed in 2018, partially funded by the practice.
• The practice had initiated and led the creation of the first collaborative working Primary Care Home site in South West London. The lead GP partner was the chair of the local GP collaborative primary care home and the managing partner was the director of the organisation. The practice had been approached by neighbouring London CCGs for advice and sharing their experience of developing primary care at scale. The practice invested time and knowledge to lead the primary care home collaborative, which resulted in improvements in services to benefit the practice population.
• The practice successfully wrote a bid on behalf of the CCG to be part of the NHS England Clinical Pharmacist Programme. The bid led to funding for four clinical pharmacists, one for each PCH practice. The practice continued to drive the Clinical Pharmacist Programme locally, providing clinical and managerial leadership.

The areas where the provider should make improvements are:

• Further develop quality improvement systems to include monitoring and analysing trends from verbal patient feedback.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 5 November 2018

Updated 5 November 2018

Updated 5 November 2018

Updated 5 November 2018

Updated 5 November 2018

Updated 5 November 2018