Archived: White Lodge Medical Practice

Updated 14 February 2017

White Lodge Medical Practice is located in a commercial area of the London Borough of Enfield. The practice is located in a privately owned two-storey Grade II listed building. The practice has recently added a treatment centre at the rear of its premises as part of a programme to modernise and maximise facilities at the practice. The treatment centre has a room for minor surgery and is used to hold ante-natal clinics. There is limited parking on the streets nearest to the practice, but there are bays for parking for disabled patients near the front of the practice. The nearest bus stop is approximately three minutes’ walk from the practice.

There are approximately 11,500 patients registered at the practice. Statistics shows moderate income deprivation among the registered population. The registered population is slightly higher than the national average for those aged between 0-9 and 30-54. Patients registered at the practice come from a variety of backgrounds including Asian, Western European, Eastern European and African Caribbean.

Care and treatment is delivered by twelve GPs (seven female and five male) including five partners and seven salaried GPs who conduct thirty five clinical sessions weekly. There are three practice nurses (female) including one nurse prescriber. Thirteen administrative and reception staff work at the practice and are led by a practice manager. The practice is also a training and teaching practice, and was hosting one GP trainee doctor on the day of the inspection.

The practice is open from the following times:-

• 8:30am - 8:00pm (Monday)
• 8:30am - 6:30pm (Tuesday to Friday)

Clinical sessions are as follows:-

• 8:30am-12:00pm (Monday, Tuesday, Wednesday, Thursday)
• 9:00am-12:00pm (Friday)
• 2:30pm-5:50pm; 6:30pm - 7:20pm (Monday)
• 2:45pm-5:55pm (Tuesday)
• 2:30pm-5:55pm (Wednesday, Thursday, Friday)

Extended hours surgery is conducted on Monday evenings between 6:30pm and 7:20pm. Patients can book appointments in person, by telephone and online via the practice website.

Patients requiring a GP outside of practice opening hours are advised to contact the NHS GP out of hours service on telephone number 111.

The practice has a Personal Medical Services (PMS) contract. PMS contracts are nationally agreed between the General Medical Council and NHS England. The practice is registered to provide the following regulated activities:-

- Diagnostic and screening procedures

- Treatment of disease, disorder or injury

- Maternity and midwifery services

- Surgical procedures

- Family planning

Enfield Clinical Commissioning Group (CCG) is the practice’s commissioning body.

White Lodge Medical Practice was inspected under our previous inspection system in May 2014 and was found to be compliant with all the required standards.

Updated 14 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at White Lodge Medical Practice on 16 August 2016. Overall the practice is rated as Good.

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

• 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.
• 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.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• However, systems were not in place to monitor the security of blank prescription forms and there were no systems in place which monitored their usage. .
• 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.
• 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.

The areas where the provider should make improvement are:-

• To identify ways in which to improve patient satisfaction scores.
• To ensure that prescription pads usage is monitored and recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 February 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 Quality Outcomes Framework (QOF) recorded the practice as scoring higher than the national average on two of the five diabetes indicators.
• Longer appointments and home visits were available when needed.
• 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.

Updated 14 February 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 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.
• 81% of women aged 25-64 notes record that a cervical screening test has been performed in the preceding 5 years which was comparable the CCG average of 81% and the national average of 82%.
• 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 and health visitors.

Updated 14 February 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.
• Longer appointments for this population group were available when needed

Updated 14 February 2017

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 offered extended hours surgery once a week to meet the needs of this population group.
• Telephone consultations with clinicians were available to meet the needs of this population group.

Updated 14 February 2017

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

• 71% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84%
• 84% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in their record in the preceding 12 months, which is comparable to the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 14 February 2017

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 and those with a learning disability.
• 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.
• 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.