Vineyard Hill Surgery

Updated 15 March 2017

Vineyard Hill Surgery provides primary medical services in Wimbledon to approximately 3800 patients and is one of 44 practices in Merton Clinical Commissioning Group (CCG). The practice was taken over by The Groves Medical Centre (who also run three other practices in neighbouring areas) in 2015 following the retirement of the previous partnership.

The practice population is in the least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 7%, which is lower than the CCG average of 17%, and for older people the practice value is 12%, which is lower than the CCG average of 16%. The practice has a higher proportion of patients aged 25 to 54 than the CCG average, and a smaller proportion of patients aged 54 and older. Of patients registered with the practice, the largest group by ethnicity are white (79%), followed by Asian (12%), mixed (4%), black (3%) and other non-white ethnic groups (2%).

The practice operates from a three storey converted residential premises. Free car parking is available on in the surrounding streets during practice opening hours. The reception desk, waiting area, and two consultation rooms are situated on the ground floor. Four consultation rooms are on the first floor, and administrative offices and staff facilities are on the second floor. The practice does not have a lift, but patients who are unable to use the stairs are accommodated in the ground floor consultation rooms.

The practice team at the surgery is made up of one male and one female GP who are partners and both provide one clinical session per week. The practice also has two full time female salaried GPs (one of whom is the lead GP for the practice) and one full time male salaried GP; in total 17 GP sessions are available per week. In addition, the practice also has one part time female nurse and one part time female healthcare assistant. The practice team also consists of a practice manager (who works across all of the provider’s sites), a site manager, and six reception/administrative staff.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8am and 6:30pm Monday to Friday and on two Saturday mornings per month. Appointments are from 8.30am to 12.10am every morning, and 1:20pm to 6:30pm every afternoon. Extended hours surgeries are offered on two Saturdays per month; one Saturday between 9am and 1pm and the other between 8am and 12pm.

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; surgical procedures; and family planning.

Updated 15 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Vineyard Hill Surgery on 31 January 2017. 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. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• We saw evidence that the practice used audit to make improvements to safety; however, practice policies were not always updated to reflect the changes made.
• The practice identified patients with caring responsibilities and information was available to direct these patients to support organisations; however, only nine carers had been identified, which represented less than 1% of the practice’s patient list.
• 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, the practice’s complaints leaflet did not contain accurate sign-posting information to enable patients to escalate their complaint if they were unhappy with the practice’s response. 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.
• 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 had recently set up a Patient Participation Group (PPG), and this was in the process of becoming established.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• They should ensure that all staff are aware of the identity of the practice safeguarding lead.
• They should ensure that they provide contact details for the Parliamentary and Health Service Ombudsman in their complaints leaflet and in complaint response letters.
• They should ensure that changes to process are reflected in updated practice policies.
• They should continue to develop the PPG in order to ensure that they are able to gather feedback from patients about the service provided.
• They should continue to work on identifying patients with caring responsibilities in order to ensure that these patients can receive support.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 15 March 2017

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.
• Performance for diabetes related indicators were mixed. Overall the practice achieved 100% of the total QOF points available for diabetes indicators for the 2015/16 reporting year, compared with an average of 84% locally and 90% nationally; however, their overall exception reporting rate for diabetes was 17% compared the CCG average of 10% and national average of 12%. The provider had been focussing on addressing the exception reporting rate since they took over the practice in 2015, and we saw evidence that the exception reporting rate for diabetes indicators for the 2016/17 reporting year to date was 4%.
• 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. 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.

Updated 15 March 2017

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 relatively high 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.
• Cervical screening had been carried-out for 80% of women registered at the practice aged 25-64, which was comparable to the 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 and health visitors.

Updated 15 March 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 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’s rate of unplanned hospital admissions was lower than the CCG average.
• The practice’s achievement for the management of conditions typically found in older people was comparable to local and national averages; for example, the percentage of patients with hypertension who had well controlled blood pressure was 78% compared to a CCG average of 80% and national average of 83%.

Updated 15 March 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.

Updated 15 March 2017

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

• The practice had 8 patients diagnosed with dementia and all had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 85% and national average of 84%; they had not excepted any patients for this indicator, compared to an average exception reporting rate of 4% for the CCG and 7% nationally.
• The practice had 21 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for all of these patients, compared to a CCG average of 90% and national average of 89%; their exception reporting rate for this indicator was 14% compared to a CCG average of 6% and national average of 10%.
• 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.

Updated 15 March 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 people, travellers and those with a learning disability. The practice had registered patients who lived in a local women’s refuge, and could give examples of tailored care they had provided to these patients.
• 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; however, some staff were unaware of who the practice’s safeguarding lead was.