The Whitehouse Surgery

Updated 15 September 2017

The Whitehouse Surgery is located in the Petts Wood area of Orpington in the London Borough of Bromley. The practice provides a general practice service to around 3500 patients.

The practice is registered with the Care Quality Commission (CQC) as a partnership to provide the regulated activities of: diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures, and treatment of disease, disorder or injury.

The practice has a Personal Medical Services (PMS) contract and provides a full range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning, sexual health services and minor surgery.

The practice has two GP partners, one male and one female. There is also a female practice nurse. They also employ two long term locum GPs, one male and the other female; and two regular locum nurses covered any periods the practice nurse was away. The practice has a part time practice manager and a team of nine administrative staff including an assistant practice manager, a medical secretary, reception staff, and an admin assistant. The practice provides 17 GP sessions per week.

The practice was a GP undergraduate teaching practice, taking medical students throughout their time at a local NHS Foundation Trust.

The Whitehouse Surgery is currently open Monday, Tuesday, Thursdays and Friday from 8.30am to 6.50pm; on Wednesday they are open 8.30am to 12.50pm. Consultation times are from 8.30am to 12.30pm and from 2pm in the afternoon. The practice provides extended hours from 6.30pm to 7.30pm on Tuesdays, Thursdays and Fridays. These extended hours are telephone consultations only. The practice is not open at weekends. Although the surgery is closed at present on Wednesday afternoons, a doctor is available (on-call) to provide any necessary assistance. At all other times when the practice is closed, the telephone answering service directs patients to contact the out of hours provider.

As part of its 2017/18 contract, the Whitehouse Surgery will be opening from 8am to 6.30pm from Monday to Friday each week. This new arrangement will commence on 1st October 2017.

Updated 15 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Whitehouse Surgery on 13 February 2015. The practice was rated as requires improvement for providing safe, responsive and well-led services. It also required improvement for providing services to people whose circumstances may make them vulnerable, and working age people (including those recently retired and students). The full comprehensive report on the February 2015 inspection can be found by selecting the ‘all reports’ link for The Whitehouse Surgery on our website at www.cqc.org.uk.

This inspection was undertaken as an announced comprehensive inspection on 17 July 2017. Overall the practice is now rated as Good.

Our key findings were as follows:

• The areas we identified at our last inspection as in need of improvement have now all been addressed
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However the practice had identified a relatively low number of carers in their patient population.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they were satisfied with the care and treatment received at the practice
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were also areas of practice where the provider should make improvements.

The provider should:

• Review procedures for identifying a greater proportion of patients with caring responsibilities so they can provide and signpost them to appropriate support

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 15 September 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice agreed care plans with patients and/ or their carers, which included details of otheragencies and professionals involved in their care

• Where appropriate these patients were referred to the community matron or other community services

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• All these patients had a named GP and there was a system to recall patients for 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 followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• The practice maintained clinical registers of their patients with long term conditions including diabetes, chronic obstructive pulmonary disease (COPD), asthma, heart problems, thyroid disorders, hypertension, cancer, arthritis and stroke.  All patients within these groups were routinely invited to the practice for appropriate consultations, including treatment by intervention or education.

Updated 15 September 2017

The practice is rated as good for the care of families, children and young people.

• Immunisation rates were higher than national averages for the standard childhood immunisations

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives and health visitors to support this population group, such as in the provision of ante-natal, post-natal and child health surveillance clinics.

• For women aged between 24 and 65, the practice offered the cervical screening programme, in line with national guidance, which included providing advice on sexual health and contraception. 

Updated 15 September 2017

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

• All patients over the age of 75 had a named GP

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

Updated 15 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, by the provision of extended opening hours and telephone consultations.

• 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.

Updated 15 September 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 15 September 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, and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• Vulnerable patients were referred to appropriate community services as required

• Patients were referred to the local food banks as required

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.