Winchmore Surgery

Updated 1 December 2022

Winchmore Surgery is located in the Enfield Local Authority. Services are provided from 808 Green Lanes, Winchmore Hill, London, N21 2SA. The premises are located in a residential area with good transport links. The practice is registered with the CQC to provide the regulated activities: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures; and treatment of disease, disorder or injury. The practice is situated within the North West London Clinical Commissioning Group (CCG) and provides services to approximately 21,675 patients. The practice is part of West Enfield Collaborative Primary Care Network (PCN). There are four GP partners, seven salaried doctors, three nurses, one healthcare assistant, four pharmacists, one paramedic, one physician associate, four GP trainees, a social prescriber, a practice manager, an operations manager, a reception manager and a team of administrative and reception staff. According to the latest data available, the ethnic make-up of the practice is 75.6% White, 9.7% Asian, 6.6% Black, 4.4% Mixed and 3.8% Other ethnic groups. Information published by the UK Health Security Agency (UKHSA) rates the deprivation within the practice population groups as nine, on a scale of one to ten. Level one represents the highest level of deprivation and ten the lowest.

Updated 1 December 2022

We carried out an announced focused inspection at Winchmore Surgery on 28 September 2022, with the remote clinical interview on 26 September 2022. Overall, the practice is rated as good, with the following ratings for each key question:

Safe – Good

Effective – Good

Caring – Not inspected, rating of good carried forward from previous inspection

Responsive – Not inspected, rating of good carried forward from previous inspection

Well-led – Good

Following our previous inspection on 18 May 2021, the practice was rated as requires improvement overall. We rated the practice as requires improvement for the safe and well-led key questions and good for the effective, caring and responsive key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Winchmore Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up on breaches of regulation from our previous inspection in May 2021.

This inspection was a focused inspection focusing on whether:

• Care and treatment was being provided in a safe way to patients.
• There were effective systems and processes in place to ensure good governance in accordance with the fundamental standards of care.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected.
• Information from our ongoing monitoring of data about services.
• Information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall.

We have rated this practice as Good for providing safe, effective and well-led services because:

• The practice had clear systems, practices and processes to keep people safe from abuse.
• The practice had addressed all concerns identified in our previous inspection in May 2021 in relation to the monitoring of high-risk medicines and now had a process in place to effectively monitor patients prescribed these medicines.
• The practice now had an effective system in place to implement patient safety alerts and to check that staff had read and understood alerts.
• The premises were well managed and there were effective systems for managing staff and training records.
• Emergency medicines and equipment on site were organised, in date and effectively managed.
• The practice had processes to ensure that patients with long-term conditions were managed and monitored appropriately.
• The practice’s uptake for cervical screening remained below the 80% coverage target for the national screening programme, however the practice had put in place systems to address barriers to the uptake of screening.
• The practice had not met the minimum 90% uptake for one of the childhood immunisation indicators. The practice had met the WHO based national target of 95% (the recommended standard for achieving herd immunity) in two of the childhood indicators, was close to meeting this target in two other indicators, and was below 90% in one of the indicators. The practice had put in place systems to address barriers to the uptake of childhood immunisations.
• The practice had worked towards providing effective care for patients during the Covid-19 pandemic.
• The practice had made improvements in providing well-led services in relation to good governance. It had implemented systems and processes in response to the findings of our previous inspection.
• The practice strongly encouraged personal and professional development and learning amongst staff and was supportive in staff undertaking appropriate learning for their roles and in their future aspirations.
• The practice had a strong focus on the well-being of its staff and encouraged feedback from staff, which it acted upon. Staff members spoke positively about their employment at the practice and felt supported.
• We received feedback from the Patient Participation Group (PPG) that the practice was responsive in listening to patients. We received feedback from a care home that used the services of the practice who told us that the practice provided a good service.
• The practice was working on initiatives to reduce its carbon footprint and become a more environmentally friendly service.

Whilst we found no breaches of regulations, the provider should:

• Take steps to summarise all medical records within four weeks of arriving on site, in accordance with practice policy.
• Continue to review and monitor patients with long-term conditions, including respiratory conditions and issue steroid warning cards where appropriate.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services