Archived: Green Wrythe Surgery

Updated 1 June 2017

Green Wrythe Surgery provides primary medical services in Carshalton to approximately 10,700 patients and is one of 26 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the fourth most deprived decile in England.

The practice population has higher than CCG and national average representation of income deprived children and older people. The practice population of children is higher than the local and national averages. The practice population of working age people is in line with the local and national averages; the practice population of older people is below the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded, 75% are British or mixed British, 12% are Asian and 8% are African or Caribbean.

The practice operates in purpose built premises. Patient facilities are wheelchair accessible on the ground floor. The practice has access to six doctors’ consultation rooms, three nurses’ consultation rooms and one treatment room on the ground floor.

The clinical team at the surgery is made up of one full-time male lead GP, six part-time salaried GPs (five female and one male),one part-time regular male locum GP, two full-time and one part-time female practice nurses and one part-time female healthcare assistant. The non-clinical practice team consists of practice manager, assistant practice manager, eight administrative and reception staff members. The practice provides a total of 50 GP sessions per week.

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 reception and telephone lines are open from 8:00am till 6:30pm Monday to Friday. Appointments are available from 8:00am to 12:30pm and from 1:30pm to 6:30pm Monday to Friday. Extended hours surgeries are offered on Tuesdays to Fridays from 7:00am to 8:00am and on Saturdays from 8:30am to 10:30am.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8am and directs patients to the out-of-hours provider for Sutton CCG. Sutton GP services provide additional GP and nurse appointments seven days a week through Primary Care hubs which could be booked in advance. (Primary Care hubs provide patients’ with access to a GP seven days per week, where the clinician has, with patients’ consent, full access to their GP records which allows a full general experience.)

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services, family planning and surgical procedures. The practice currently has only one partner as a partner recently retired; they informed us that are actively looking to recruit a new partner and have informed the CCG regarding this. 

Updated 1 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Green Wrythe Surgery on 8 January 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2015 inspection can be found by selecting the ‘all reports’ link for Green Wrythe Surgery on our website at www.cqc.org.uk.

This announced comprehensive inspection was undertaken on 26 April 2017. The provider had made improvements in all the areas where issues were identified in the inspection in January 2015. Overall the practice is now rated as good.

Our key findings 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 including appropriate recruitment checks for staff.
• 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. We reviewed a sample of patient records and found that the care was delivered in line with current evidence based guidance.
• 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.
• Seven out of eight patients we spoke to said they found it was difficult to get an emergency appointment and said they had to wait approximately a week to get an appointment with a named GP. However, we found that emergency appointments were available on the day of inspection.
• 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, however the Patient Participation Group felt that some of the suggestions they made were not acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Review practice systems to ensure there is a clear system in place to monitor the implementation of medicines and safety alerts.
• Ensure there are failsafe systems in place to monitor refrigerators where medicines are stored.
• Ensure the business continuity plan is up to date.
• Review how patients with caring responsibilities are identified to ensure information, advice and support can be made available to them.
• Review practice procedures to ensure all patients with a learning disability have regular health checks.
• Review the national GP patient survey results and address low scoring areas to improve patient satisfaction.
• Review practice procedures to ensure all policies and procedures were reviewed appropriately to ensure they are up to date.
• Consider documenting discussions from practice nurse meetings.
• Review practice procedures to ensure that the suggestions made by the PPG were acted on appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 June 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. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
• The national Quality and Outcomes Framework (QOF) data showed that 76% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. 96% of patients with diabetes had received a foot examination in the preceding 12 months which was above the CCG average of 87% and national average of 89%.
• The national QOF data showed that 83% of patients with asthma in the register had an annual review, compared to the CCG average of 73% and the national average of 76%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• 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 GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice was a hub for providing anticoagulation clinics. The practice patients and approximately 200 local patients from other GP practices attended the anticoagulation clinics which were held three days a week; this reduced the need for these patients to visit a hospital. 

Updated 1 June 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 urgent care and Accident and Emergency (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.
• The practice’s uptake for the cervical screening programme was 79%, which was in line with the Clinical Commissioning Group (CCG) average of 82% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 1 June 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. One of the practice nurses regularly visited housebound patients.
• Longer appointments and home visits were available for older people with long term conditions when needed.

Updated 1 June 2017

The practice is rated as good for the care of working age people.

• 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 offered extended hours appointments with GPs which suited working age people.

Updated 1 June 2017

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

• 91% of 100 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was in line with the CCG average of 91% and national average of 89%.
• 92% of patients with dementia had received an annual review which was above the Clinical Commissioning Group (CCG) average of 86% and national average of 84%.
• 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.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 1 June 2017

The practice is rated as good for the care of people experiencing whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability. The practice GPs provided care for two local care homes for patients with severe learning disabilities supporting the needs of 12 residents. Only 30% (14 patients) out of 43 patients with a learning disability had received a health check in the last year.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.
• The practice had alerts set up for vulnerable children and families on their electronic patient management system.