Archived: Dr Louise Miller

Updated 10 April 2017

Dr Louise Miller (also known as Boyne Avenue Surgery) is situated in Barnet, North London as is part of NHS Barnet Clinical Commissioning Group (CCG). The practice holds a General Medical Services contract (an agreement between NHS England and general practices for delivering primary medical services). The practice provides a range of enhanced services including adult and child immunisations, proactive support for people living with dementia, and identifying patients who are at high risk of avoidable unplanned admissions.

The practice is registered with the Care Quality Commission 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 had a patient list of approximately 2,000 at the time of our inspection.

The staff team at the practice includes one principal GP partner (female) working five sessions per week and one regular locum GP working one session per week (female). The practice is supported by additional locum staff who cover three sessions per week. There is one nurse practitioner (female) and one practice nurse (female) providing two sessions per week. To support the practice and patients there are three staff in its administrative team; including a practice manager. All staff work a mix of part time hours. The practice provides placements for undergraduate medical students.

The practice opening hours are:

Monday       8am to 6:30pm

Tuesday      8am to 7:30pm

Wednesday 8am to 6:30pm

Thursday     8am to 1pm

Friday          8am to 6:30pm

Saturday      Closed

Sunday        Closed

Urgent appointments are available each day and GPs also complete telephone consultations for patients. In addition, the practice is a member of the Pan Barnet federated GPs network; a federation of local Barnet GP practices which was set up locally to provide appointments for patients at eight local hub practices between 8am and 8pm, providing additional access out of hours. There is also an-out of hours service provided to cover the practice when it is closed. If patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on their circumstances. Information on the out-of-hours service is provided to patients on the practice leaflet as well as through posters and leaflets available at the practice.

The practice has a higher percentage than the national average of people with a long standing health conditions (58% compared to a national average of 54%). The practice has a higher than the national average percentage of patients under the age of 18 (44% compared to 38% nationally). The average life expectancy for both females (87%) and males (82%) is higher than both the CCG (81%) and national average (84%).

Updated 10 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Louise Miller on 20 April 2016. The overall rating for the practice was inadequate as safe and well led were rated inadequate and effective and responsive were rated as requires improvement; caring was rated good.The practice was placed in special measures for a period of six months.

The full comprehensive report on the 20 April 2016 inspection can be found by selecting the 'all reports' link for Dr Louise Miller on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 25 January 2017. Overall the practice is now rated as Good.

Our key findings were as follows:

• The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. However, formal business plans were yet to be developed to support the practice’s need to improve clinical capacity and key indicator performance had reduced since our last inspection.

• 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 told us that that they were involved in decisions about their care and treatment and that they were treated with compassion, dignity and respect.

• 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.

• With the exception of patient satisfaction on appointments access, we noted that performance was comparable or above local and national averages.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• 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.

The areas where the provider should make improvement are:

• Consider reviewing the infection control audit so that it is clear who is leading actions and by when so that they are followed up in a timely way.

• Review processes for recording water temperatures in line with the legionella risk assessment.

• Continue to develop the practice’s quality improvement programme by progressing from one cycle to two cycle clinical audit.

• Progress plans to purchase a hearing loop.

• Continue to improve access to appointments.

• Formalise business plans to support the practice’s need to improve clinical capacity and key indicator performance.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 10 April 2017

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

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

• Performance for diabetes related indicators was similar to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood sugar level is 64 mmol/mol or less in the preceding 12 months was 68% compared to a local CCG average of 77% and a national average of 78%.For the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 80% compared to 80% nationally.

• 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.

• 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.

Updated 10 April 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

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

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 10 April 2017

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

• 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 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.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 10 April 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, extended opening hours and Saturday appointments.

• 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 10 April 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.

• 86% of patients diagnosed with dementia had had their care reviewed in the preceding 12 months compared with a local CCG average of 85% and a national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for mental health related indicators were below the national average. For example, 75% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months compared with a local CCG average of 91% and a national average of 89%.

• 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 10 April 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.

• 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.