Dr AM Hogarth's Practice

Updated 19 October 2016

Dr AM Hogarth's Practice (also known as The Harefield Practice) is a well-established GP practice situated within the London Borough of Hillingdon. The practice lies within the administrative boundaries of NHS Hillingdon Clinical Commissioning Group (CCG) and is a member of the Metro health Network in the Hillingdon locality. The practice is an approved training practice for GP specialist trainees (GP Registrars) and foundation year two doctors.

The practice provides primary medical services to approximately 9,350 patients living in Harefield and some areas of Northwood, Ruislip, Ickenham, Denham and Rickmansworth. The practice holds a General Medical Services (GMS) contract and Directed Enhanced Services contracts. The practice is located at Harefield’s Health Centre, Rickmansworth Road, Harefield, Uxbridge with good transport links by bus services.

The practice operates from a purpose built health centre owned and managed by NHS Property Services. The practice shares the premises with two other health care organisations and operates from the ground floor of the building renting six consultation rooms, two treatment rooms, reception, waiting area and administration offices. There is open unaided wheelchair access to the building and a toilet for disabled people. There are public car parking facilities on site and in the surrounding residential areas.

The practice population is ethnically diverse and has a lower than the national average number of patients between 20 and 34 years of age and higher than the national average number of patients between 45 and 59 years of age. There is a similar to the national average number of patients 65 years of age plus. The practice area is rated in the fourth less deprived decile of the national Index of Multiple Deprivation (IMD). People living in more deprived areas tend to have greater need for health services. Data from Public Health England 2014/15 shows that the practice has a higher percentage of patients with a long-standing condition compared to CCG and England averages (65%, 50%, and 54% respectively).

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic & screening procedures, family planning, maternity & midwifery services, surgical procedures and treatment of disease disorder & Injury.

The practice team comprises of two male and two female GP partners, two female salaried GP’s and one female GP Registrar, who all collectively work a total of 43 clinical sessions per week. They are supported by three practice nurses, one health care assistant, practice manager, deputy practice manager, two administrators and 14 administrators/receptionists.

The practice opening hours are from 8.30am to 12.30pm and 1.30pm to 6.30pm Monday, Tuesday and Wednesday, 8.30am to 5.00pm Thursday and 8.30am to 6.00pm Friday. Consultation times in the morning are from 8.30am to 12.10pm Monday and Tuesday and 8.30am to 12.15pm Wednesday, Thursday and Friday. Consultation times in the afternoon are from 1.30pm to 5.50pm Monday, 1.30pm to 6.00pm Tuesday, 1.30pm to 5.30pm Wednesday and 1.30pm to 5.00pm Thursday and Friday. Extended hours pre-bookable appointments are offered form 7.00am to 8.00am on Tuesday morning and on two Saturday mornings each month. The out of hours services are provided by an alternative provider. The details of the out-of-hours service are communicated in a recorded message accessed by calling the practice when it is closed and on the practice website.

The practice provides a wide range of services including chronic disease management, minor surgery and health checks for patients 40 years plus. The practice also provides health promotion services including, cervical screening, childhood immunisations, contraception and family planning.

Updated 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr AM Hogarth’s Practice (also known as The Harefield Practice) on 31 May 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.
• Most 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 felt the practice provided excellent care and staff were helpful, caring, kind, professional and treated them with 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.
• 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 areas where the provider should make improvement are:

• Review significant event recording forms to support the recording of notifiable incidents under the duty of candour.

• Ensure a consistent pre-employment check process is practised for all staff groups including those employed as locums.

• Ensure that concerns relating to the maintenance of the premises are progressed with the landlord.

• Review the system for monitoring blank prescription forms.

• Review the disaster prevention and recovery policy to ensure it covers for incidents and emergencies that may impact on the daily operation of the practice.

• Display notices informing patients of the translation services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 October 2016

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

• The practice offered GP and nurse led annual health checks for patients with long term conditions including mediation review.

• QOF data from 2014/2015 showed the practice performance for indicators related to long term conditions, such as diabetes and high blood pressure, was comparable to local and national averages.

• In response to the increasing incidence of diabetes, the practice had recently employed a practice nurse with a specialist interest in diabetes to improve management and support of these patients.

• Home visits and longer appointments were available as required for patients with long term conditions.

• The practice engaged in local admission avoidance services that identified patients with long term conditions at risk of hospital admission and created integrated care plans aimed at reducing this risk.

• Monthly multi-disciplinary team meetings were held with members of the community palliative care team, district nurses and community matron to discuss management of patients with complex medical needs.

• The practice offered nurse-led in house spirometry for patients with chronic lung disease. Smoking cessation clinics were offered at the practice.

Updated 19 October 2016

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

• There was a named GP lead for safe guarding children, staff had received role appropriate training and were aware of their responsibilities to raise concerns.

• The practice had systems in place to follow up on patients who do not attend six week checks and immunisation appointments.

• The GP safeguarding lead attended six weekly meetings with the health visitor team to discuss any families of concern.

• Staff demonstrated an understanding of Gillick competency and there were posters displayed in the waiting room reminding young people they can speak to clinical staff confidentially without a parent.

• Same day appointments were available for unwell children as well as access to telephone consultations for parents/guardians.

• The practice offered routine GP led ante-natal and post-natal care.

• Family planning advice was available from the GPs and practice nurses and there was a sexual health clinic held at the practice once a month.

Updated 19 October 2016

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

• There was a named GP lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.

• The practice provided primary care services to a local residential and nursing home. Each home had a named GP to promote continuity of care and visits were provided as required.

• Home visits, including those for immunisations, were available for patients unable to attend the practice due to illness or immobility.

• The practice was part of a local integrated care pilot scheme which invited older patients with complex medical needs for review to create integrated care plans. Patients identified as risk of admission or those recently discharged were discussed weekly with the local network guided care nurse to review and update care plans accordingly.

• Monthly multi-disciplinary team meetings were held with members of the community palliative care team, district nurses and community matron to discuss management of older patients with complex medical needs.

• As part of the local GP network, the practice provided a home visiting service for patients over the age of 75.

Updated 19 October 2016

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

• Extended hour appointments were available on Tuesday mornings and Saturdays for patients unable to attend the practice during normal working hours. Telephone consultations were also available daily.

• There was the facility to book appointments and request repeat prescriptions online.

• The practice offered new patient and NHS Health checks and any abnormalities identified at these checks were followed up appropriately.

• The practice supported students who had left the area to study by allowing them to register as temporary patients during term breaks and sending brief summaries with them when they returned to update their local GP on any medical issues.

Updated 19 October 2016

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

• Screening for dementia was offered opportunistically as well as to those at high risk with referrals to local memory services as appropriate.

• QOF data from 2014/2015 showed the practice performance for mental health related indicators was comparable to local and national averages.

• An in house relaxation service was provided by a local charity for patients experiencing stress or mental health related problems.

• Patients had access to an in-house counselling service for patients suffering with issues such as anxiety or depression.

• The practice had support from the local mental health coordinator and community mental health nurse who used consultation space to review patients transitioning from secondary to primary mental health services.

• Three reception staff had received training from a mental health charity service and shared learning with the other administration staff to help them identify patients in crisis.

Updated 19 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There was a named GP lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.

• The practice maintained a register of patients with learning disabilities and these patients were invited for annual health checks with longer appointments if required.

• The practice identified patients who were also carers and offered them additional support, such as annual health checks and referral to local support services.