The Wrythe Green Surgery

Updated 19 October 2016

The Wrythe Green Surgery provides primary medical services in Carshalton to approximately 14000 patients and is one of 27 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the third less deprived decile in England.

The practice population has similar to CCG and lower than national average representation of income deprived children and older people. The practice population of children and working age people is in line with the CCG and national averages; the practice population of older people is in line with the local average and lower than national average. Of patients registered with the practice for whom the ethnicity data was recorded, 67% are white British or mixed British, 7% are other White and 2% are Indian or British Indian.

The practice operates in purpose built premises. All patient facilities are wheelchair accessible. The practice has access to thirteen doctors’ consultation rooms, three nurse consultation rooms, one healthcare assistant consultation room and one minor surgery/treatment room on the ground floor.

The clinical team at the surgery is made up of one full-time male GP and four part-time GPs (two male and two female) who are partners, six part-time female salaried GPs, one full-time female nurse practitioner, four part-time female practice nurses and two part-time female healthcare assistants. The non-clinical practice team consists of general manager, deputy practice manager and 14 administrative and reception staff members. The practice provides a total of 64 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 is a training practice for trainee doctors, medical and nursing students; and they have recently become part of the National Apprenticeship Scheme.

The practice reception and telephone lines are open from 8:00am till 6:30pm Monday to Friday. Appointments are available from 8:30am to 11:30am and 3:30pm to 6:30pm every day. Extended hours surgeries are offered on alternate Mondays or Wednesdays from 6:30pm to 9:00pm and on alternate Saturdays from 8:30am to 11:30am.

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.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services, treatment of disease, disorder or injury, family planning and surgical procedures.

Updated 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wrythe Green Surgery on 13 September 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.

There were areas of practice where the provider should make improvements:

• Review practice procedures to ensure there is a system in place to monitor implementation of medicines and safety alerts.
• Review practice procedures to ensure all staff receive annual basic life support and Infection control training.
• Review practice procedures to ensure all the recommendations from the legionella risk assessment are actioned.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 19 October 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. 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 72% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 78%. The number of patients who had received an annual review for diabetes was 84% which was in line with the CCG average of 86% and national average of 88%.
• The national QOF data showed that 68% of patients with asthma in the register had an annual review, compared to the CCG average of 73% and the national average of 75%.
• 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.
• All patients with a long term condition who become terminally ill were considered for end of life care planning and were discussed at multidisciplinary team meetings.
• The practice provided electrocardiography and ambulatory blood pressure monitoring to improve monitoring of patients with long term conditions.

Updated 19 October 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 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 83%, which was in line with the Clinical Commissioning Group (CCG) average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice patients had access to antenatal care through weekly midwife and GP led clinics.

Updated 19 October 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 GPs provided care for two local nursing/residential homes supporting the needs of seven residents.
• The practice offered annual flu vaccine and pneumococcal vaccine for all patients over the age of 65. The practice notified patients regarding shingles vaccine by text message and telephone calls.
• Elderly patients in the admission avoidance group were offered 30 minute appointments to go through their medical and social needs and were contacted within two working days if they attend accident and emergency and their care plans were updated.
• The practice added alerts for patients who require more support. For example ‘patient needs appointment in daylight hours’.
• The practice had a dedicated wheel chair for frail patients to use.

Updated 19 October 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. The practice recently sent a text message to all the patients which encouraged patients to register for online services. All newly registered patients were automatically registered for online access.
• The practice offered extended hours appointments with GPs and nurses which were suitable for working people.
• The practice had a call back system for patients who require advice; the patients were usually called within two hours and were provided an appointment if necessary.

Updated 19 October 2016

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

• The number of patients with dementia who had received annual reviews was 78% which was in line with the Clinical Commissioning Group (CCG) average of 81% and below the national average of 84%.
• 76% of 116 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was below the CCG average 87% and national average of 88%.
• 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.
• 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.
• The practice GPs had given a presentation to members the Patient Participation Group about mental health problems to help reduce the stigma of mental health disease.
• One of the practice GPs was a Mental Health lead for the local Clinical Commissioning Group (CCG) which enabled good communications with the local mental health team and to address issues for patients experiencing mental health crisis.

Updated 19 October 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, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; All 40 patients with 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.
• Patients who found it difficult to wait in a busy waiting room were offered to wait in a second waiting area which was usually less busy.
• The practice had alerts in place for patients who were vulnerable, terminally ill and for family members who have had a recent bereavement.
• 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.