Archived: The Practice Furzedown

Updated 17 July 2017

The Practice Furzedown provides services to approximately 3084 patients under a Personal Medical Services contract (an agreement between NHS England and general practices for delivering personal medical services). It sits within the Wandsworth Clinical Commissioning Group (CCG). The practice provides a number of enhanced services including Childhood Vaccination and Immunisation Scheme; Facilitating Timely Diagnosis and Support for People with Dementia; Influenza and Pneumococcal Immunisations; Learning Disabilities and Patient Participation.

The practice staff includes a lead female GP, completing five sessions a week, two long term female locum GPs, completing seven sessions in total, a female independent nurse prescriber, completing two sessions a week, a female practice nurse completing 10 sessions a week, a health care assistant completing 25 hours a week and a team of reception/administrative staff.

The practice was open from 7am to 7pm on Monday, Thursday and Friday, from 8am to 8.30pm on Tuesday, from 7.30am to 7pm on Wednesday and from 8am to 1pm on Saturday. Outside of these hours, cover was provided by the out of hours GP service which operated from 6.30pm to 8am seven days a week and the NHS 111 service.

The provider is registered with the Care Quality Commission as an individual, 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 has significantly more females aged between 30 to 35 than national average and less males over 85.

We previously inspected the practice on 19 March 2015. CQC gave the practice an overall rating of requires improvement.

Updated 17 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Practice Furzedown on 16 January 2017.

The practice was originally inspected on the 19 March 2015 and the overall rating for the practice was requires improvement and the full comprehensive report can be found by selecting the ‘all reports’ link for The Practice Furzedown on our website at www.cqc.org.uk.

This inspection was undertaken to establish whether or not the practice had made sufficient

improvement and was an announced comprehensive inspection on 16 January 2017. Overall the practice is now 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.
• There was now a system for monitoring fridge temperatures and clear protocols for staff to follow if the minimum temperature exceeded. All staff had received training in managing fridge temperatures and medicines management.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes had improved since the inspection in March 2015, and were comparable to the CCG average and England average.
• 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 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.

• 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.
• 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 practice had implemented an overarching governance framework to support the delivery of the strategy and good quality care. We saw that structures and procedures had been put into place and work was continuing to make the framework comprehensive and sustainable.

The areas where the provider should make improvements are:

• Improve the identification of carers to ensure their needs are known and can be met.

• Improve practice activities to improve performance data.

• To complete an up to date Legionella risk assessment.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 17 July 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.

• There were alerts for long term conditions on patient records.

• At 67%, the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was comparable to the CCG average of 73% and national average of 78%. There had been an improvement in the practice’s achievement and figures collated on 31/3/16 showed the practice’s current achievement was 78%.

• The practice had recruited a nurse in the last 12 months. The existing nurse practitioner held a tier two clinic once a month, reviewing patients who had poor management of diabetes, looking at their diet and their understanding of their long term condition. There was also a recall system in place where patients were invited in for checks and offered appointments to increase performance. 

• Longer appointments and home visits were available when needed.

• 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.

• The practice had online appointment booking and prescription requests.

• The practice had a palliative care register with monthly reviews taking place.

Updated 17 July 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.

• 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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 83% above the CCG and national averages of 79% and 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Children and babies were prioritised for same day appointments.

• We saw positive examples of joint working with health visitors.

• A range of family planning services were provided including hormone implants.

Updated 17 July 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.

• All patients over the 75 and over and a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• An alert on patient records highlighted elderly patients who were particularly vulnerable.

Updated 17 July 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.

• Same day appointments were available.

• The practice was open from 7am to 7pm on Monday, Thursday and Friday, from 8am to 8.30pm on Tuesday, from 7.30am to 7pm on Wednesday and from 8am to 1pm on Saturdays to accommodate working people.

• Telephone consultations were available.

• Online appointment booking and prescription requests were available.

Updated 17 July 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 85%, which was comparable to the CCG average of 89% and the national average of 88%.

• Patients with severe mental health conditions were offered weekly appointments with a named GP.

• 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.

• 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 17 July 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 those with a learning disability. There was also an alert on the patient records where a patient was identified as vulnerable.

• 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.

• 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.