Southfields Group Practice

Updated 18 July 2016

Southfields Group Practice provides primary medical services in Wandsworth to approximately 12,500 patients and is one of 44 member practices in the NHS Wandsworth Clinical Commissioning Group (CCG). The practice operates under a Personal Medical Services (PMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

Wandsworth has 50% more 20 to 40 year olds, but 33 per cent fewer older people than other south west London boroughs, reflected in the patient demographics for the practice with 12% of patients aged 65 or over, 75% of patients aged 18-65 years old and 13% aged 18 or younger.

The practice population is in the second least deprived decile with income deprivation affecting children and adults lower than national averages. Ethnicity data shows that 79% of patients are white, 11% Asian, 4% black, 4% have mixed ethnicity and 2% are from other non-white ethnic backgrounds.

The practice operates from a purpose built property with patient facilities including reception and waiting areas on both the ground and first floors as well as practice management facilities on the second floor, all of which are accessible by lift or stairs. The building is wheelchair accessible with disabled access facilities including dropped height reception desks and hearing loops in both reception areas.

The practice clinical team is made up of four GP partners, four salaried GPs, three nurses and two healthcare assistants. Three of the doctors are male and five doctors are female. All other clinical staff are female. The practice doctors provide 63 sessions per week. The non-clinical team consists of one practice manager, one deputy practice manager, four administrative staff and 10 receptionists.

The practice opens between 8.00am and 6.30pm Monday to Friday and offers appointments during these same times. Telephone lines are operational between the hours of 8.00am and 6.30pm. Extended hours are available Monday to Friday from 7.30am to 8am and Monday to Thursday from 6.30pm to 8.00pm. Appointments during extended hours are prebookable only. The practice also opens between 8.00am and 10.30am on Saturdays for pre-booked appointments with a GP, Nurse and Health Care Assistant.

The provider has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8.00am when the practice directs patients to seek assistance from the locally agreed out of hours provider.

The practice is registered with the Care Quality Commission to provide the regulated activities of Diagnostic and Screening Services, Maternity and Midwifery Services, Surgical Procedures and Treatment of Disease, Disorder and Injury.

Updated 18 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Southfields Group Practice on 16 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.
• 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.
• 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 one area of outstanding practice:

• The practice had identified a number of patients who were in need of regular medical support and monitoring for their health conditions, but were frequently not attending appointments. On investigation, these patients were not able to make their own way to the practice and would instead use the ambulance service to attend the local hospital accident & emergency (A&E) department. A practice funded trial of booking identified patients a return taxi journey for their appointment was successful in increasing attendance for routine appointments at the surgery and reducing the need for these patients to use A&E and ambulance services. This scheme is predominantly used by elderly patients with multiple healthcare needs but GPs can provide this service to any patient where needed. The local Clinical Commissioning Group (CCG) were unable to find funding for this scheme but due to the impact on improved patient outcomes and the reduced impact on other NHS services, the practice continued to fund the scheme themselves.

The areas where the provider should make improvement are:

• The practice should consider reinstating formal governance meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 July 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. There was also a lead GP for diabetes management.
• Performance for diabetes related indicators was lower than or similar to the Clinical Comissioning Group (CCG) and national average, for example; the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured within the preceding 12 months) is 140/80mmHg or less was 61%, lower than the CCG average of 74% and the national average of 78%. The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 78%, comparable to the CCG average of 77% but lower than the national average of 80%.The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 80%, lower than the CCG average of 87% and the national average of 88%. However the practice demonstrated improvement in performance for these indicators in 2015/16.
• 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.
• The practice carried out advance care planning for patients with long term conditions, including using the Planning All Care Together (PACT) service which included an annual health review and screening.

Updated 18 July 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 department (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 66%, compared to the Clinical Comissioning Group (CCG) average of 74%.
• 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.
• The percentage of eligible patients who had had a cervical smear test in the preceding 12 months was 82%, compared to the CCG average of 77%.
• 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, including health visitors attending monthly multi-disciplinary team (MDT) meetings and midwives conducting weekly clinics in practice.

• The practice sent new mothers letters of congratulations which included booking arrangements for a six week post-natal appointment.
• For young people with mental health conditions, referrals were made to a local service specifically designed for young people.

Updated 18 July 2016

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 carried out advance care planning for older patients, including using the CCG led Planning All Care Together (PACT) service which gave patients an annual review including screening for depression, dementia, and osteoporosis. The annual review also included a medicinesreview, a house warmth review (for housebound patients) and a falls risk assessment as well as a general health check.
• The practice also offered a taxi service for patients who were unable to make their own way to the practice or hospital for appointments. This service was used predominantly by older people with multiple healthcare needs.

Updated 18 July 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 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, including an HIV testing facility.

• We saw evidence of the practice encouraging and supporting people back to work following illness or injury for example through suggesting adaptations in the patients’ workplace.
• The practice offered daily extended hours appointments with the GPs, nurse appointments were available two evenings a week and there were GP, nurse & HCA appointments every Saturday morning, increasing access for working-age patients.  

Updated 18 July 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 80%, comparable to the Clinical Commissioning Group (CCG) average of 86% and a national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the preceding 12 months was 87%, comparable to the CCG average of 91% and national average of 88%
• The percentage of patients diagnosed with mental health conditions who had their smoking or alcohol consumption recorded in the preceding 12 months was below CCG and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia, including using the Planning All Care Together (PACT) service.
• 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 18 July 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, elderly people and those with a learning disability. The practice also held a list of the most vulnerable patients from all of the registers.
• The practice offered longer appointments for patients with a learning disability and had a weekly presence at a local residential home forpeople with learning disabilities. .
• The practice had completed annual helath reviews for 81% of their patients registered with learning disabilitites.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice carried out advance care planning for vulnerable patients, including using the Planning All Care Together (PACT) service.
• 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.