Andover Medical Centre

Updated 30 March 2017

Andover Medical Centre is a well-established GP practice situated within the London Borough of Islington. The practice lies within the administrative boundaries of NHS Islington Clinical Commissioning Group (CCG) and is a member of the Islington GP Hub.

The practice provides primary medical services to approximately 5,600 patients living within its catchment area in Islington, situated between Holloway police station and Holloway fire station in Hornsey Road. The practice is in relatively close proximity to Seven Sisters Road and Finsbury Park station. The practice is located at Andover Medical Centre, 270-282 Hornsey Road, London N7 7QZ with good transport links by bus and rail services.

The building has step free access and provides wheelchair access to the entrance of the building, reception and waiting area. Additionally there is an accessible toilet and an induction loop facility for those with hearing impairments. There is limited parking on site and no disabled parking is provided.

The practice population is ethnically diverse and in terms of deprivation is in the most deprived decile with a score of 1 out of 10, people living in more deprived areas tend to have a greater need for health services. For instance 46% of older people live in income deprived households compared to a local average of 36% and a national average of 16%.

The practice catchment area encompasses a large housing estate (Andover Estate), which has a significant area of deprivation. There is a lower than average number of patients in the age bands 65+ compared to the national average, with the majority of patients between 20 and 40. Additionally the percentage of patients with a long standing health condition (27%) is significantly less than both the CCG average of 45% and national average of 54%.

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

The practice is an accredited teaching practice under the London Deanery that teaches healthcare staff and persons intending to be healthcare professionals. The practice holds a General Medical Services (GMS) contact (this is the contract between practices and NHS England for delivering primary care services to local communities. The practice provides a full range of general medical services including chronic disease management, GP/nurse triage and NHS health checks. The practice also provides health promotion services including, cervical screening, childhood immunisations, contraception and family planning.

The practice team comprises of one female managing partner, one female and one male GP partner, one female salaried GP Registrar and a regular female locum GP. Collectively the GPs work a total of 27 clinical sessions per week, which includes four unallocated sessions picked up within the current staff group. They are supported by one full time and one part time practice nurse, a full time health care assistant, a practice manager who works nearly full time (0.9 of while time equivalent) , one full time operational manager, a part time administrative manager, one part time IT administrator, two full time and two part time reception staff.

The practice is open 8.30am to 12.30pm and 1.30pm to 6.30pm Monday to Friday, except Thursdays when the practice is only open 8.30am to 12.30pm. Additionally extended hours surgery is provided on a Monday from 6.30pm to 8pm.

Consultation times in the morning are from 8.30am to 12.00 noon Monday to Friday, afternoon consultations are from 3pm to 6pm Monday, Tuesday, Wednesday and Friday.

Andover Medical Centre is part of Islington GP Hub service (i-Hub), which runs at three GP practices in Islington and provides out of hours appointments to patients living in the area from 6.30pm to 8pm, Monday to Friday and from 8am to 8pm on a Saturday and Sunday. Patients are informed about out of hours services via a recorded message accessed by calling the practice when it is closed, the practice website and on the practice notice board. The out of hours service is provided by the locally agreed provider when the practice and i-Hub are closed.

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Andover Medical Centre on 13 July 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.
• 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 were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. While the practice identified carers, they only had 49 patients on the list which is less than 1% of the population.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review how carers are identified so they can receive advice and support.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 30 March 2017

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 practice had a dedicated chronic disease administrator.

• Performance for diabetes related indicators was similar to the CCG and national average. An example taken from these indicators related to patients on the diabetic register with a record of a foot examination and risk classification within the preceding 12 months. This showed the practice achieved 92% compared to the CCG average of 89% and the 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. The practice nurse visits housebound patients who need a chronic disease review.

• Smoking cessation clinics, weight management clinics and referral for exercise programmes were available to support people with long term conditions.

• Education events with consultants were held at the practice annually as part of the locally commissioned service, for example diabetes and chronic obstructive pulmonary disease (COPD).

Updated 30 March 2017

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.

• We saw the practice had a female genital mutilation (FGM) register and daughters of mothers who had a history of FGM were flagged on the practices computer records.

• The practice uptake for the cervical screening programme was 76%, which was comparable to the CCG average of 79% although lower than 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 and health visitors, which included bi-monthly meetings and interim email/telephone contact. Meetings included discussion of children on the child protection register.

• The practice provided contraception counselling, including intrauterine devices (IUD) or coil and intrauterine system (IUS) or hormonal coil clinics.

• Children specific multidisciplinary team meetings held monthly to discuss complex cases.

The practice provided postnatal reviews and 6-8 week baby checks with active invites and recall systems.

Updated 30 March 2017

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. We saw that the practice had detailed and personalised care plans and had developed a summary record sheet to record problems/issues, progress made against the plan and any outstanding issues.

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

• The practice offered health checks to patients aged over 75.

• The practice triaged all home visit requests and worked in conjunction with other multidisciplinary professionals to facilitate earlier intervention and did joint visits where hospital admission may be an outcome.

• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.

• The practice had a “housebound list” with named GP’s. These patients were reviewed every 6-12 months by a GP or a nurse and more frequently based on clinical need.

The practice engaged with local services, including local community navigators and voluntary sector organisations to provide further support and signposting.

Updated 30 March 2017

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.

• The practice offered Meningitis vaccinations for students and was proactive in addressing this by sending text messages to students who had mobile phones and letters to those without.

Updated 30 March 2017

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

• 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 85% and the national average of 84%.

• 83% of patients experiencing poor mental health had a comprehensive care plan documented in the last 12 months, which was below the CCG average of 89% and 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.

• They carried out advance care planning for patients with dementia.

• They had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• There was 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 30 March 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, travellers and those with a learning disability. The practice computer system alerted staff to vulnerable people.

• 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.