Archived: The Great West Surgery Also known as Greenbrook Great West Surgery

Updated 13 December 2016

The Great West Surgery provides GP primary care services to approximately 3400 people living in Hounslow, Middlesex. The local area is culturally diverse and the practice population comes from relatively deprived backgrounds.

The practice has a lead GP and a salaried GP, one male and one female who work a combination of full and part time hours totalling 16 sessions per week. Other staff included a business manager, practice support manager, a nurse, a health care assistant and five administrative staff. The practice holds a Alternative Provider Medical Services (APMS) contract and was commissioned by NHSE London. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury, surgical procedures, family planning and maternity and midwifery services.

The practice was open between 8.00am to 6.30pm on Monday to Friday. They had extended hours on Thursday from 6.30pm to 9pm. The telephones were staffed throughout working hours. Appointment slots were available throughout the opening hours. The out of hours services are provided by an alternative provider. The details of the ‘out of hours’ service were communicated in a recorded message accessed by calling the practice when closed and details can also be found on the practice website. Longer appointments were available for patients who needed them and those with long-term conditions. This also included appointments with a named GP or nurse. Pre-bookable appointments could be booked up to two weeks in advance; urgent appointments were available for people that needed them.

The practice provided a wide range of services including clinics for diabetes, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provided health promotion services including a flu vaccination programme and cervical screening.

Updated 13 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Great West Surgery on 15 September and 4 October 2016. Overall the practice is rated as Good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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.
• Feedback from patients about their care was consistently positive.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• High standards were promoted and owned by all practice staff and teams worked together across all roles.

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

• Continue to work to identify patients who are carers so their needs can be identified and met.

• Carry out regular fire evacuation drills to ensure patients and staff are clear about what to do in an emergency.

• Implement an action plan to address their relatively low scores for the caring questions on the GP survey

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 December 2016

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

• One GP was the lead for chronic disease management and patients at risk of hospital admission were identified as a priority. 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.
• Performance for diabetes related indicators was 85%, which was same as the CCG and 4% below national averages.
• Longer appointments and home visits were available when needed.

Updated 13 December 2016

The provider was rated as good for 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., They had a named administrative staff member who monitored paediatric non-attenders to hospital, out-patient and community services and passed this information to the safeguarding lead. 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. The GPs demonstrated an understanding of Gillick competency and told us they promoted sexual health screening.

• The practice’s uptake for the cervical screening programme was 78%, which was below the national average of 82%.
• The practice triaged all requests for appointments on the day for children under two when their parent requested the child be seen for urgent medical matters. 

Updated 13 December 2016

The provider was rated as good for care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Patients over 75 years had a named GP to co-ordinate their care.
• The practice was responsive to the needs of older people, and offered double appointments, home visits and urgent appointments for those with enhanced needs
• The practice had signed up to the avoiding unplanned admissions DES and the similar Out of Hospital service.
• They carried out risk profiling, using the electronic frailty index which identified patients at increased risk of unplanned hospital admissions. Patients at risk of admission with falls, mobility problems, poor social care support or needing respite were referred to the local multidisciplinary Integrated Community Response Service (ICRS) team for assessment.

Updated 13 December 2016

The provider was rated as good for 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 offered telephone and email consultations and they offered extended appointments on Thursday evenings.

• 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.

Updated 13 December 2016

The provider was rated as good for care of people experiencing poor mental health (including people with dementia)

• The practice had achieved 100% of the latest QOF points for patients with Dementia which was above both CCG and national averages. The practice had annual reviews for patients with dementia, which included early consideration of advance care planning. All dementia patients had a care plan which both they and carers had been involved in drafting.

• The practice had a register of patients experiencing poor mental health. These patients were invited to attend annual physical health checks and 30 out of 35 had been reviewed in the last 12 months.

• The practice worked closely with Primary Care Plus to support patients with mental illness transfer from secondary care back to primary care.

• 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.

• Reception staff we spoke with were aware of signs to recognise patients in crisis and to have them urgently assessed by a GP if they presented.

Updated 13 December 2016

The provider was rated as good for care of people whose circumstances may make them vulnerable

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and the homeless. Pop up alerts were placed on all computer notes to alert all members of staff of vulnerable patients.

• Learning Disability patients were given care plans that met their needs. Patients with learning disabilities were invited annually for a specific review with their named GP. We saw all 12 on the register had been reviewed in the last 12 months. Extended appointments were available for patients in this group.

• 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 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.