Archived: The Wilson Health Centre

Updated 15 March 2017

The Wilson Health Centre provides primary medical services to 7,096 patients from its Health Centre at Cranmer Road, Mitcham, Surrey, CR4 4TP. The service is provided by Concordia Health limited under a general medical services contract with NHS England. The practice is part of the NHS Merton Clinical Commissioning Group (CCG).

There are five salaried GPs providing 28.5 sessions per week, three male, two female; one female nurse practitioner, one female practice nurse, and two health care assistants. Vacancies in the clinical team for one GP and three nurse practitioners are filled by agency staff and locums. The clinical staff are supported by a practice manager, two supervisors and seven administrative staff known as customer service officers.

The practice provides a walk in centre contracted by Merton CCG as well as GP surgery services and is open from 8am until 8pm seven days a week 365 days a year. When the practice is closed, patients are able to contact the locally contracted out of hours provider via NHS 111.

The practice is easily accessible to patients with limited mobility with automatic doors and wide corridors.

Information published by Public Health England rates the level of deprivation within the practice population group as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The average life expectancy of the practice population is comparable with both CCG and national averages number for males at 78 years (compared to national average 79 years). Life expectancy for females is also comparable with the national average at 82 years (national average 83 years). The practice population consists of higher numbers of patients aged 0 – nine and 20 – 38 than average with a lower proportion of patients aged 50 upwards.

• 56% of patients have a long standing health condition (48% CCG)

• 74% are in paid work or full time education (68% CCG)

• 7% are unemployed (8% CCG)

The practice population is also varied in ethnicity, with around 45% white British; 5% Asian and Asian British and a range of mixed ethnicities and backgrounds with a range of languages.

Updated 15 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wilson Health Centre on 1 November 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 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, however, the practice was not using care plans for patients with long-term conditions.
• 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 areas where the provider should make improvements are:

• Consider the use of care plans for patients with long term conditions, to improve care and document how the needs of these patients are being met.

• Review how they identify carers so they are able to offer appropriate support.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 15 March 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.

• Care plans were not in place for all patients with long-term conditions.

• 93% of patients with diabetes had a recent blood pressure test which was within a normal range, which was above the clinical commissioning group (CCG) average of 85% and the national average of 91%.

• 97% of newly diagnosed diabetic patients had been referred to a structured diabetes programme within nine months of diagnosis which was above the CCG and the national averages of 92%.

• 100% of patients with heart failure were treated with medication in line with guidance which was above the CCG and national average of 73%.

• 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.

Updated 15 March 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.

• 77% of eligible women had attended cervical screening in the last five years which was below the Clinical Commissioning Group and national averages of 81%.

• The practice as open from 8am until 8pm seven days a week and the premises were suitable for children and babies.

• The practice introduced a new mothers’ patient participation group during October 2016 to help develop services for this patient group.

• We saw positive examples of joint working with midwives, health visitors and school nurses, including quarterly meetings between the practice and local health visitors.

• The practice signposted patients regarding reversible long-lasting contraception and gave them details of local family planning clinics.

Updated 15 March 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.

• Older patients were offered and booked double appointments to ensure there was adequate time for their needs when they attended the practice.

• The walk-in centre provided immediate support and data provided by the practice showed that 5.7% of access to this service was by older people.

• The district nursing team was collocated in the practice giving good shared care for these patients.

Updated 15 March 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 services from 8am until 8pm which ensured good access for working aged people.

• The practice also offered a range of telephone appointments to support people who could not attend the surgery due to work commitments.

Updated 15 March 2017

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

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.

• 95% of patients with complex mental health conditions had their care reviewed in the last 12 months which was above the CCG average of 90% and the national average of 89%.

• 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 15 March 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, travellers and those with a learning disability.

• The practice supports patients in two local homes for people with learning disabilities.

• Walk in services were accessible to patients including those not registered and homeless patients.

• The practice had 17 patients on the learning disability register and offered longer appointments and annual health reviews for these patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice participated in the national directed enhanced service for patients at risk of unplanned admission to hospital.

• The practice worked closely with a local hospice for patients who were in need of end of life care.

• 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.