Archived: Woodside Group Practice

Updated 28 January 2016

Woodside Group Practice operates from a single location in Woodside; about two miles from Croydon town centre and has a list size of approximately 13,000 patients. The surgery is based at Woodside Health Centre, which also houses another GP practice, a community clinic run by Croydon Health Services NHS Trust as well as the district nursing teams.

The practice came into being in 2008 following a merger of two practices. The practice has undergone another merger in April 2014 where it took on the staff and patient list of another practice whose principal GP had retired. It is no longer a teaching practice for trainee GPs.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; family planning; maternity and midwifery services; surgical procedures; and diagnostic and screening procedures at one location.

The practice has a PMS contract (Personal Medical Services(PMS) agreements are locally agreed contracts between NHS England and a GP practice) and provides a range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning clinic, contraception services, minor surgery and substance misuse management. The surgery is also a registered yellow fever vaccination centre.

The practice is currently open five days a week, Monday to Friday from 8:00am to 6:30pm. In addition, the practice offers extended opening hours from 7:30am to 8:00am and 6:30pm - 8:00pm every Wednesday.

The practice had a higher than average percentage of patients under 18 years of age and in the 45-49 year age group. The Croydon general practices data 2012 showed that the practice also had a higher proportion of patients from Other Black ethnic backgrounds than Croydon as a

whole (2011 census data for the Croydon borough).

 Woodside Group Practice has three partners and two salaried GPs, four long term locum GPs, two practice nurses and a health care assistant. The practice also has a practice manager, an assistant practice manager, and a reception team of 10 whole time equivalent staff along with administrative staff.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodside Group Practice on 02 September 2015. Overall the practice is rated as requires improvement.

We previously inspected Woodside Group Practice in October 2014, and rated it overall as inadequate. The practice was found inadequate for providing safe, effective, responsive and well-led services. They were rated good for providing caring services.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• We found the practice had made improvements since our last inspection on 06 October 2014 and they were meeting regulations relating to the protection of people against the risks of unsafe or inappropriate care, identifying, assessing and managing risks, the management of complaints, and the secure storage of paper based patient records. However, the improvements made were insufficient and on-going partnership issues were significantly impacting on the practice’s ability to provide effective and responsive care.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Risks to patients were assessed and well managed.

• Data showed that clinical outcomes for patients with long-term conditions was below local and national averages and there had been a deterioration in QOF performance between 2013/2014 and 2014/2015. There was no action plan in place to address these shortfalls.

• Clinical audits had been carried out and the practice was able to demonstrate they had led to improvements in some patients’ health outcomes.

• Patients said they were treated with compassion, dignity and respect but respondents to the national GP survey stated they did not always feel involved in their care and decisions about their treatment.

• Information about services provided was available; however information on the provider’s formal complaints process was not easily accessible to patients.

• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments, and they often experienced delays waiting to be seen for their booked appointments.

• The practice had a number of policies and procedures to govern activity.

• The practice had started holding meetings with various areas of focus, such as significant events, complaints reviews and multi-disciplinary clinical meetings, but these were not being held at the regularity the practice had planned.

Whilst the practice had made improvements since our last inspection, there are still areas where further improvements are needed. The provider must:

• Ensure there are systems in place to monitor and improve the quality of services provided and mitigate against any risks, including the impact of the on-going partnership issues.

• Review and improve the current telephone system and accessibility to ensure patients can access appointments in a timely manner.

• Ensure plans are put in place to improve outcomes relating to asthma, chronic heart disease, chronic kidney disease, diabetes and flu vaccinations for at risk groups.

The provider should:

• Ensure complaints information is readily available.

• Ensure patients are involved in decisions about their care, and that treatments and tests are explained.

• Ensure carers are identified and appropriately supported.

 The provider was rated as inadequate overall and for all population groups at our previous inspection in October 2014. At this inspection, we found that the provider had failed to make sufficient improvements in all areas and has been rated as inadequate for well-led and for patients with long-term conditions. Where a practice has previously been rated as inadequate and continues to be rated as inadequate for any key question or population group, they are placed into special measures. Therefore, we will place this provider into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 28 January 2016

The practice is rated as inadequate for the care of people with long term conditions.

Clinical outcomes for conditions such as asthma, coronary heart disease, chronic kidney disease and diabetes were significantly below average and needed to be improved. Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments, telephone consultations and home visits were available for patients who needed them.

All these patients had a named GP, however not all of them had a personalised care plan or structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice ran regular diabetes clinics, planned annual influenza vaccination clinics and a dedicated weekly smoking cessation service. It arranged for district nurses to visit housebound patients to administer flu vaccinations.

Updated 28 January 2016

The practice is rated as requires improvement for families, children and young people. We found the practice to require improvement for providing effective and responsive, and inadequate for providing well led services. The issues identified affected all patients including this population group.  There were, however, examples of good practice.  

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. The practice ran an enhanced service for childhood immunisation and vaccination. Immunisation rates were good 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. The premises were suitable for families. Baby changing facilities were available in one of the female toilets. Young patients with enhanced needs were referred to the appropriate external services.

Appointments were available outside of school hours and the premises were suitable for children and babies. Family planning was available to families, alongside prenatal and postnatal care. The practice was engaged in joint working with community midwives.

Updated 28 January 2016

The practice is rated as requires improvement for the care of older people. We found the practice to require improvement for providing effective and responsive, and inadequate for providing well led services. The issues identified affected all patients including this population group.  There were, however, examples of good practice.  

Nationally reported data showed that outcomes for patients were slightly higher than national averages for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and provided a range of enhanced services including dementia care.

Prompt access, home visits, telephone consultations and longer consultations were available for older patients with enhanced needs. Patient needs were assessed through regular health screening and medication reviews. We saw that regular multi-disciplinary team meetings were held with healthcare professionals such as district nurses, hospice workers and social services representatives, where individual patients were discussed and care packages agreed for them.

There were named GPs for patients aged over 75. The practice was proactive in preventing disease by providing influenza and shingles immunisations for older patients, and by invitations for health checks. Patients we spoke with told us that they had received written invitations for health checks.

Updated 28 January 2016

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). We found the practice to require improvement for providing effective and responsive, and inadequate for providing well led services. The issues identified affected all patients including this population group.  There were, however, examples of good practice.  

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 and flexible.

For example, the practice had extended its opening hours on Wednesdays due to patient demand. The practice was proactive in offering telephone consultations, online services such as appointment booking and ordering repeat prescriptions. There was a good range of accessible health promotion material available throughout the practice.

The practice offered travel, Hepatitis and influenza vaccinations and carried out screening which reflected the needs of this group. There was a good uptake for health screening, with 83% of eligible patients receiving cervical screening in the previous 6 months.

Updated 28 January 2016

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

The practice held a register of patients with poor mental health but not all of these people had received an annual physical health check and review. For the year ending 31 March 2015, QOF indicators relating to the care of people with dementia showed that 68% of eligible patients had had their care reviewed in the preceding 12 months. In addition, only 50% of patients with a new diagnosis of depression in the preceding 12 months had received a review within 10 to 56 days of their diagnosis. In the same period, 48% of patients on the mental health register had had a comprehensive care plan documented in the preceding 12 months.

However the practice was performing well in the cervical screening of women with mental health needs, as 83% had had a cervical screening in the preceding five years.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice informed patients experiencing poor mental health about how to access various support groups and voluntary organisations and referred patients to secondary care mental health services where needed. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 28 January 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. We found the practice to require improvement for providing effective and responsive, and inadequate for providing well led services. The issues identified affected all patients including this population group.  There were, however, examples of good practice.  

The practice held a register of patients living in vulnerable circumstances such as those with a learning disability. It had carried out annual health checks for people with a learning disability but not all these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met. Longer appointments were available for patients with learning difficulties.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.