Archived: Whyteleafe Surgery

Updated 6 March 2017

Whyteleafe Surgery is situated in Surrey within purpose built premises. All patient services are offered on the ground and first floors. The practice comprises of four consulting rooms, one treatment room, one phlebotomist room, a patient waiting area, a reception area, administrative and management office.

The practice has core opening hours from 8.30am to 6.30pm Monday to Friday. Out of hours GP service was available from 8am to 8.30am Monday to Friday (this out of hours service was managed by IC24 out of hours). The practice offers a range of scheduled appointments to patients every weekday from 8.30am to 6.20pm including open access appointments with a duty GP throughout the day. The practice offers extended hours appointments every Monday and Wednesday from 6.30pm to 7.30pm at the premises.

The practice has a patient population of approximately 6,130 registered patients. The practice population of patients aged between 5 to 9 and 25 to 54 years old is higher than the national average and there are a lower number of patients between 15 to 24, 60 to 64 and 75 to 84 years old compared to national average.

Ethnicity based on demographics collected in the 2011 census shows the patient population is predominantly White British and 12% of the population is composed of patients with an Asian, Black or mixed background. The practice is located in a part of Surrey with the low levels of income deprivation in the area. However, the practice informed us there are some pockets of deprivation.

There are three GP partners, and three salaried GPs at the practice. Three GPs are male and three female. The practice employs two practice nurses, two health care assistants and a phlebotomist. The practice manager is supported by a team of administrative and reception staff. Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS).

Services are provided from following location:

19 Station Road

Whyteleafe

Surrey

CR3 0EP

The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the practice is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided during protected learning time and between 8am and 8.30am by IC24 out of hours service and after 6:30pm each weekday, at weekends and bank holidays by calling NHS 111.

Updated 6 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whyteleafe Surgery on 12 January 2017. Overall the practice is rated as good.

Specifically, we found the practice good for providing safe, effective, caring, responsive and well led services.

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.
• Data showed patient outcomes were high compared to the national average. The practice had carried out some clinical audits. However, not all audits were of full or repeat cycles.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However, a hearing induction loop was not available.
• There was an anti-coagulation clinic (an anti-coagulant is a medicine that stops blood from clotting) offered onsite, resulting in 74 patients who required this service not having to travel to local hospitals.
• The practice had worked closely with a health visitor for the homeless. The health visitor had a direct access to lead safeguarding GP and attended regular monthly meetings at the practice. These arrangements had enabled the practice to identify potential safeguarding issues and organise urgent clinical care by offering easy access and registration with the practice.
• The practice had offered weekly well-being clinics at the premises. Patient’s who required social, financial and other non-clinical support were referred to an in-house ‘well-being advisor’, who had access to other services which might benefit these patients. This had resolved patient’s non-clinical issues and also resulted in saving clinical time for GPs because patient’s need were met during consultation with the well-being advisor.
• 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.

The areas where the provider should make improvements are:

• Review and establish a system of clinical audit cycles to identify improvement areas and monitor continuous progress effectively.
• Consider installing a hearing induction loop or provide alternative form of communication at the reception.
• Review and monitor the system in place to promote the benefits of smoking cessation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 March 2017

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

• There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All patients with long term conditions had a named GP and the practice carried out a structured annual review to check that 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 6 March 2017

The practice is rated as good for the care of families, children and young patients.

• 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 patients who had a high number of A&E attendances.
• Immunisation rates were comparable 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.
• The practice’s uptake for the cervical screening programme was 81%, which was similar to the national average of 82%.
• The practice offered smoking cessation clinic at the premises. However, data showed patient outcomes were low compared to the local and national averages. The practice was required to review and monitor the system in place to promote the benefits of smoking cessation.
• 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.

Updated 6 March 2017

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• There was a register to effectively support patients requiring end of life care.
• There were good working relationships with external services such as district nurses.
• The premises was accessible to those with limited mobility.
• The practice was performing an electrocardiogram (ECG) and blood tests on demand when needed rather than having to ask elderly and frail patients to come back.

Updated 6 March 2017

The practice is rated as good for the care of working-age patients (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 offered extended hours appointments every Monday and Wednesday from 6.30pm to 7.30pm at the premises. The practice was in discussion with a network of local practices about increasing extended hours.
• 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.
• We noted the practice was offering telephone consultations.

Updated 6 March 2017

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

• Data from 2015-16 showed, performance for dementia face to face reviews was above the CCG and national averages. The practice had achieved 83% of the total number of points available, compared to 84% locally and 84% nationally.
• Patients experiencing poor mental health were involved in developing their care plan and health checks.
• The practice was working towards to become a dementia friendly service. Non-clinical staff had undertaken dementia awareness training.
• The practice was calling patients with dementia to remind them of their appointment time if they had previously forgotten appointments.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.
• Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 March 2017

The practice is rated as good for the care of patients 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 was working closely with a health visitor for the homeless. Health visitor had a direct access to the lead safeguarding GP at the practice. During monthly meetings health visitor was sharing background and safeguarding concerns with the practice which had enabled the practice to organise clinical care within short time. The practice had taken necessary steps to enable easy access and registration for vulnerable homeless patients who were at potential risk of safeguarding issues.
• Well-being advisor had offered weekly well-being clinics at the premises since the last one year. Patients had received required social, financial and other non-clinical support and longer appointments with well-being advisor. This had resulted in saving clinical time for GPs as well because patient’s need were met during consultation with the well-being advisor.
• Annual health checks and care plans were completed for patients on the learning disability register. Lead GP had completed an enhanced training course and a plan was in place to carry out health checks and care plans for all patients on the learning disability register by end March 2017.
• 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 had undertaken training in understanding the impact and considerations for patients who had been subject to domestic abuse.
• 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.