West Green Surgery

Updated 3 July 2019

West Green Surgery is a GP Training Practice located in Tottenham, North London within the NHS Haringey Clinical Commissioning Group. The practice holds a General Medical Services contract (an agreement between NHS England and general practices for delivering general medical services). The practice is registered with the Care Quality Commission to carry on the regulated activities of maternity and midwifery services, diagnostic and screening procedures and treatment of disease, disorder or injury.

The practice had a patient list size of 14,700 at the time of our inspection. The clinical team at the practice included two GP partners (male), five salaried GPs (three females and two males), two female practice nurses and one female healthcare assistant. The practice had nine members of non-clinical staff including the practice manager.

The practice is located in a deprived area (13th most deprived nationally and 6th most deprived within London). The practice is the 5th largest practice within NHS Haringey Clinical Commissioning Group (CCG). The practice has a history of innovative working and has been recognised nationally with more than 20 awards and nominations. The practice is one of the fastest growing surgeries within NHS Haringey CCG with close to a 300% growth since 2012 (5,500 registered patients) to date (14,700 registered patients). The patient population is highly mobile with an average annual turnover of 24%.

The patient population is much younger than the most GP practices nationally with the largest patient group falling into the ages of 20- 49 years old. The practice serves complex patients with 1,148 patients on five or more repeat prescriptions. The practice supports multiple ethnicities with only 25% of patients registered at the practice born in England with the remaining 75% outside of the United Kingdom. Twenty percent of patients registered at the practice require an interpreter.

The practices opening hours are Monday to Friday 8.00am to 6.30pm. Extended hours access appointments were available locally through the Haringey GP Federation. To assist patients in accessing the service there is an online booking system, and a text message reminder service for scheduled appointments. Urgent appointments are available daily and GPs also complete telephone consultations for patients.

Updated 3 July 2019

We carried out an announced comprehensive inspection at West Green Surgery on 28 March 2019 as part of our inspection programme.

At the last inspection in October 2016 we rated the practice as good overall and good for all domains.

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

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

We have rated this practice as outstanding overall.

We rated the practice as good for providing Safe services because:

• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.
• The practice had used technology to develop innovative ways to ensure staff had the information they needed to deliver safe care and treatment.

We rated the practice as good for providing Effective services because:

• The practice had developed additional protocols to ensure peoples’ needs were assessed, and care and treatment delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and protocols.
• Staff had the skills, knowledge and experience to carry out their roles and were supported by the practice to identify and undertake additional training or learning to improve how services were delivered.
• Staff were consistent and proactive in helping patients to live healthier lives and had developed systems to improve patients’ understanding and involvement in managing their own health.

We rated the practice as good for providing Caring services because:

• The practice had taken additional measures to help patients to be involved in decisions about care and treatment, for instance by translating personal care plans into a patient’s preferred language.
• The practice used a mobile tablet device to provide patients who used British Sign Language to access a face-to-face translation.

We also rated the practice as outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
• There were innovative approaches to providing integrated person-centred care.
• The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

We rated the practice as outstanding for providing Well-led services because:

• The culture of the practice and the way it was led and drove the delivery and improvement of high-quality, person-centred care.
• Governance systems were supported by innovative solutions to ensure priorities were achieved.

These outstanding areas benefitted all population groups and so we rated all population groups as outstanding with the exception of ‘working age people (including those recently retired and students)’. Although we saw areas of good practice for ‘working age people’, we have rated this population group requires improvement as cancer screening performance was significantly lower than local and national averages.

There were some areas where the practice should make improvements:

• The practice should continue to review their diagnosis and prescribing for urinary tract infections and ensure they are in line with national guidance.
• The practice should review and improve their processes for cancer screening and ensure they are in line with national guidance.
• The practice continue with efforts to identify and provide support patients who identify themselves as carers.

We saw several areas of outstanding practice including:

• The use of technological solutions to provide clinicians with best opportunity to improve the care and treatment of patients. We saw many examples where these solutions had been shared with the wider health economy.
• The practice created and embedded a computer process which alerted prescribers how many times antibiotics had been prescribed to the patient within the last year and this information was available during the consultation. The alert included a link to a patient care plan which meant the clinician had an opportunity to discuss treatment options with the patient. This had helped reduce inappropriate antibiotic prescribing by 30% between March 2015 and December 2017. The enhanced alert and care plan were supported by the Haringey Clinical Commissioning Groups (CCG) Medicine Management Team and was rolled out to all practices within the borough.
• The practice had developed a strategy to support patients take greater control of their own health by including a self-management and self-referral portal on the practice website which encouraged patients to submit health information such as blood pressure.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.

Updated 3 July 2019

Updated 3 July 2019

Updated 3 July 2019

Updated 3 July 2019

Updated 3 July 2019

Updated 3 July 2019