Archived: The Penrhyn Surgery

Updated 18 April 2018

The Penrhyn Surgery is located in a converted house in Waltham Forest within a residential area, which has good transport links. The practice is part of Waltham Forest Clinical Commissioning Group (CCG). There are approximately 7,600 patients registered at the practice, 62% of whom are from an ethnic minority group and 59% of patients have a long standing health condition compared to the CCG average of 49%. The practice is in the fourth most deprived decile which is rated on a scale of one to 10 with one being the most deprived.

The practice has one male GP and three female salaried GPs who complete a combined total of 22 sessions per week; there is a full time advanced nurse practitioner and two part time female practice nurses. The practice also has a health care assistant, a practice manager, an assistant practice manager and 10 reception/administration staff members.

The practice operates under a Personal Medical Services (PMS) contract (a locally agreed alternative to the standard GMS contract issued when services are agreed locally with a practice which may include additional services beyond the standard contract).

The practice is open Monday to Wednesday between 8am and 6:30pm and Thursday and Friday between 7:30am and 6:30pm. The practice also opened once a month on a Saturday between 9am and 12pm. Phone lines are answered from 8am and appointment times are as follows.

• Monday 8am to 12pm and 2:30pm to 5:30pm

• Tuesday 8:30am to 1:30pm and 3pm to 6pm

• Wednesday 8:30am to 12:30pm and 2:30p m to 6pm

• Thursday 7:30am to 1pm

• Friday 7:30am to 12pm and 1pm to 6pm

The locally agreed out of hours provider covers calls made to the practice whilst is closed and the practice is a part of the local HUB which provides GP and nurse appointments to patients on weekday evenings and on weekends when the practice is closed.

The Penrhyn Surgery operates regulated activities from one location and is registered with the Care Quality Commission to provide treatment of disease, disorder or injury, diagnostic and screening procedures and maternity and midwifery services.

Updated 18 April 2018

This practice is rated as Good overall. (Previous inspection 01 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

We carried out an announced comprehensive inspection at The Penrhyn Surgery on 14 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• There was evidence of quality improvement and the practice made good use of clinical audits.

• Clinical guidelines and patient safety alerts were discussed in clinical meetings where learning was shared.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• The practice had clear systems for acting on responding to and learning from complaints.

• The practice carried out annual risk assessments including infection prevention and control, health and safety and fire safety.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 2 August 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.

• The percentage of patients on the diabetes register with a record of a foot examination and risk classification in the preceding 12 months was 87% compared with a national average of 88%.

• 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 2 August 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.

• 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 cervical screening test has been performed in the preceding five years was 80% compared with the national average of 82%

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• Chlamydia screening was available for patients aged 16 to 25 years old.

Updated 2 August 2016

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.

Updated 2 August 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 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.

• A Saturday morning walk in appointments were available for patients who could not attend the practice on a week day.

Updated 2 August 2016

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

• 82% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive agreed care plan in the record in the preceding 12 months was 91% compared with the national average of 88%.

• 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 2 August 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 and those with a learning disability.

• 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.