Archived: Willow House Surgery

Updated 14 April 2016

Willow House Surgery is situated in North London within the NHS Enfield Clinical Commissioning Group (CCG). It is located within a converted residential property which has recently undergone significant refurbishment. The practice holds a General Medical Services contract (an agreement between NHS England and general practices for delivering general medical services). The practice provides a range of enhanced services including adult and child immunisations, facilitating timely diagnosis and support for people with Dementia, and minor surgery.

The practice is registered with the Care Quality Commission to carry on the regulated activities of Maternity and midwifery services, Treatment of disease, disorder or injury, Family planning, Surgical procedures and Diagnostic and screening procedures.

The practice had a patient list of just over 3700 at the time of our inspection.

The staff team at the practice includes two partner GP’s (2 male), one female salaried GP and one female practice nurse. At the time of our visit the practice nurse was on maternity leave and two locum nurses both female were providing locum cover. The practice has four administrative staff members; including a practice manager. All staff work a mix of full time and part time hours. The practice is not a designated training practice.

The practice is open between 8.00am and 6.45pm Monday to Friday. Extended hours surgeries are offered on a Thursday from 6.45pm to 8.00pm. The surgery is closed on Saturday and Sunday. To assist patients in accessing the service there is an online booking system, and a text message reminder service for appointments. Urgent appointments are available each day and GPs also complete telephone consultations for patients. An out of hour’s service provided by a local deputising service covers the practice when it is closed. If patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on their circumstances. Information on the out-of-hours service is provided to patients on the practice website as well as through posters and leaflets available at the practice.

There are approximately 240 GP appointments available per week. The practice nurses have 66 appointments available per week. (These exclude telephone consultations and home visits which are additional).

The practice patient list was comparable to the national average of people with a long standing health conditions (54% compared to a national average of 54%). The average male and female life expectancy for the Clinical Commissioning Group area was above the national average for males and in line with the national average for females.

Updated 14 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Willow House Surgery on 3 February 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.

We saw one area of outstanding practice:

The practice provides primary care to all the residents of a 76 bedded nursing home which specialises in supporting people with very complex health needs (multiple co-morbidities which is the presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases). These needs include advanced dementia and end of life care. In supporting these patients, the practice has developed a model alongside the staff of the nursing home and the London borough of Enfield Care Homes Assessment Team (CHAT), a team which supports GP’s and care homes that have complex residents. This model promotes integrated working across primary care, community care and secondary (specialist hospital care) and social care. Outcomes have included improved care planning with specialist service input and a reduction in hospital admissions including to A&E. The model was shortlisted for patient safety award in 2015 and this model is being adopted across London borough of Enfield’s nursing homes and being considered for implementation by neighbouring local authorities.

The areas where the provider should make improvement are:

• Improve systems to identify and support carers in line with published guidelines.
• Include information on how to make a complaint on the practice’s website.
• Develop a clear terms of reference for the patient participation group (PPG) which focuses on improving health and wellbeing outcomes for its patient population.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 April 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.

• Performance for diabetes related indicators was similar to the national average. The percentage of patients with diabetes on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 79.1% compared to a national average of 78.%. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 86.5% compared to a national average of 88.3%.

• 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 April 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• For those patients suffering with asthma, 89% have had an asthma review in the preceding 12 months compared to 75% nationally.

• 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.

• For those female patients aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years, 75% have had a test performed compared to 82% nationally.

• Children and babies were offered appointments when they needed one. Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with health visitors who attend practice meetings to exchange information or discuss not only children but also families causing concern.

• Sexual health screening was available at the practice.

Updated 14 April 2016

The practice is rated as outstanding for the care of older people.

The practice had developed a model for supporting older people in a nursing care setting. The practice provided primary care to all the residents of a 76 bedded nursing home which specialises in supporting people with very complex health needs. This model promotes integrated working across primary care, community care and secondary (specialist hospital care) and social care. Outcomes included improved care planning with specialist service input and a reduction in hospital admissions including to A&E. Results showed that since the model of care was put into place there has been 14% reduction in admissions to hospital between 2013 and 2014 and a further 8% reduction in admissions to hospital in 2014 to 2015. Therefore a total reduction in admission to hospital of 21%. There has also been a reduction in admittance to Accident and Emergency (A&E) year on year; 21% reduction in 2013 to 2014 and an 11% reduction 2014 to 2015. Therefore a total reduction of 30% from 2013 to 2015.

• 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.

Updated 14 April 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 offered an extended hour’s surgery on a Thursday evening to allow those patients commuting access to appointments.

• 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 telephone consultations should they be required as well as follow up.

• The practice offered a results text message service for normal results to alleviate any anxieties about waiting for results to be issued.

Updated 14 April 2016

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

• 92.3% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months compared with a national average of 88.4% and the percentage of those patients who had a record of their alcohol consumption in the preceding 12 months was 96% compared with a national average of 89.5%.

• 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

• Performance for mental health related indicators was above the national average.

• 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.

Updated 14 April 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• 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.

• 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.

• The practice has begun to identify carers through its records. of the practice list.