Background to this inspection
Updated
27 August 2015
Boundary Court Surgery is located in Upper Edmonton, in the London Borough of Enfield in North London. The practice has approximately 3,000 registered patients. Its opening hours are:
- Monday – 8.00am to 8.00pm (extended opening hours)
- Tuesday to Friday – 8.00am to 6.30pm
Since 01 October 2014 GP services have been provided by a registered Organisation, Evergreen Surgery Limited, under a General Medical Services (GMS) contract with NHS England on a caretaking basis.
Prior to this arrangement GP services at Boundary Court Surgery had been provided by a registered Partnership. Both GPs in the Partnership suffered ill health before retiring from the practice in 2014, and patient care suffered in their absence. When we inspected the practice in July 2014 we found improvements were required in respect of regulations relating to Care and welfare of people who use services, Safeguarding service users from abuse, Cleanliness and infection control, Management of medicines, Staffing, Assessing and monitoring the quality of service provision, and Complaints (HSCA 2008 (Regulated Activities) Regulations 2010).
At our inspection on 01 July 2015 we found shortfalls had been remedied and that the new provider, Evergreen Surgery Limited, was providing services that are safe, effective, responsive, caring and well-led.
Services are provided by two male GPs, one full time and one part time; and by one part time female GP. The full time GP is the GP Lead for the practice and is on secondment from the provider’s other GP practice in Enfield, Evergreen Surgery Limited. The others are long term locum GPs. The practice also employs a part time female practice nurse on a long term locum basis and receptionist and administrative staff. Further support for the practice is provided by Evergreen Surgery Limited’s clinical director, medical director, practice manager, deputy practice manager and childhood immunisations and cervical smears coordinators.
The caretaking arrangement was in place initially until 30 June 2015 and was recently extended to 31 December 2015. NHS England has judged the premises in which the practice is housed unfit for purpose and suitable alternative premises are being looked for.
Boundary Court Surgery serves a deprived population. It is located in the most deprived ward in Enfield and falls within the most deprived ten per cent of all areas in England. It serves a highly mobile and ethnically diverse population, and a significant number of patients speak English as an additional language. The population in Enfield overall is younger than the England average, yet there is a comparatively high prevalence of long term conditions such as diabetes, hypertension and severe enduring mental illness. Childhood immunisation rates and participation in national cancer screening programmes in Edmonton are lower than the Enfield and London averages. Life expectancy in Edmonton is 8.65 years less than life expectancy in the more prosperous areas in the borough.
Evergreen Surgery Limited is registered with the Care Quality Commission to carry on the following regulated activities at Boundary Court Surgery, 1-2 Boundary Court, Snells Park, Upper Edmonton, London N18 2TB: Treatment of disease, disorder or injury; Diagnostic and screening procedures; Maternity and midwifery service.
Patients are cared for by an external out of hours GP service when Boundary Court Surgery is closed.
Updated
27 August 2015
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Boundary Court Surgery on 01 July 2015. Overall the practice is rated as good.
Specifically, we found the practice to be good for providing well-led, safe, effective, caring and responsive services. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people whose circumstances make them vulnerable; and people experiencing poor mental health (including people with dementia).
Our key findings across all the areas we inspected were as follows:
- Shortfalls we identified at our last inspection of the practice in July 2014 had been remedied by the new provider since it took over Boundary Court Surgery on 01 October 2014.
- There was a clear leadership structure and revised operational policies and procedures in place. Staff felt supported by the new management team. The practice proactively sought feedback from staff and patients, which it acted on.
- Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
- Risks to patients were assessed and well managed, including safeguarding, infection control, medicines management and staffing.
- Patients’ needs were assessed and care was planned and delivered following best practice guidance. The provider had increased staffing levels. Staff had received training appropriate to their roles and were supported to continue their professional development and training.
- Patients were treated with courtesy and respect and they said they were involved in their care and decisions about their treatment.
- Information about services and how to complain was available and easy to understand. Complaints were dealt with in a timely manner and the practice took learning points from complaints to improve the service.
- Patients said they found it much easier to make an appointment since the new provider took over the practice; that urgent appointments were available the same day; and that there was continuity of care.
- The practice was well equipped to treat patients and meet their needs.
We saw one area of outstanding practice:
- Since the new provider took over Boundary Court Surgery on 01 October 2014 there had been marked improvements in the practice’s patients’ access to primary care resulting in fewer A&E attendances and emergency admissions to hospital, and more planned admissions. The practice achieved a Quality and Outcomes Framework (QOF) score of 92.7% in 2014-15 compared with a score of 90.2% in 2013-14, despite the new provider taking over the practice half way through the year. QOF is a voluntary incentive scheme for GP practices in the UK. It rewards practices for managing some of the most common long-term conditions and for the implementation of preventative measures.
However there were areas of practice where the provider needs to make improvements.
Importantly the provider should:
- Further raise patients’ awareness of the availability of the telephone translation service.
- Ensure the name of the designated Health and Safety representative for the practice is displayed.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
27 August 2015
The practice is rated as good for the care of people with long-term conditions (LTC). The practice was taking proactive action to identify patients with undiagnosed LTCs and patients at high risk of avoidable hospital admission. It was establishing a recall system to ensure regular and timely reviews of all patients with LTCs took place. The GPs and the nurse offered patients designated LTC appointments as part of the planned initiative to bring all patients’ reviews up to date. Longer appointments and home visits were available when needed. The practice worked with relevant health and care professionals to deliver a multidisciplinary package of care to those people with the most complex needs. It was taking part in borough wide initiatives, for example to improve services for people with diabetes.
Families, children and young people
Updated
27 August 2015
The practice is rated as good for the care of families, children and young people. The practice’s GP Lead was the Clinical Commissioning Group’s (CCG) clinical lead for maternity, children, young people and safeguarding children, and was a member of the CCG’s Safeguarding Board. He brought this experience and expertise to the development of systems at the practice 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 much improved and the practice was meeting the target for child immunisations for children aged 24 months, which had not been reached previously. This success was due to the practice’s Turkish speaking immunisations coordinator. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice was taking part in a borough wide public health project to address child poverty through improved engagement with health visitors.
Updated
27 August 2015
The practice is rated as good for the care of older people. Since taking over the practice, the number of A&E attendances for people aged over 65 years had reduced significantly. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example in dementia. It was responsive to the needs of older people, and offered home visits and telephone consultations to improve access to a GP. Longer appointments were available for patients with complex medical needs.
Working age people (including those recently retired and students)
Updated
27 August 2015
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. It had introduced extended opening hours. The practice was proactive in offering online services, including appointments, medication requests, and contact and summary care record updates. It was in the process of promoting health checks. Cervical screening rates were much improved and the practice was meeting the target, which had not been achieved previously. A full range of information about health conditions and diseases, and about the prevention of ill health was available on the practice website. The website allowed translation of this information in to 87 different languages.
People experiencing poor mental health (including people with dementia)
Updated
27 August 2015
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, for example Improving access to psychological therapies (IAPT) and the community mental health team. The practice was in the process of promoting regularised annual health checks to ensure people’s physical health needs were also met. There was a system in place for a GP to review the patient’s records if they did not attend for their appointment.
The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, for example MIND.
People whose circumstances may make them vulnerable
Updated
27 August 2015
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 for example those with a learning disability. It offered longer appointments for people with a learning disability and involved carers in decisions about their treatment and care when necessary. The practice was in the process of promoting health checks. There was a system in place for a GP to review the patient’s records if they did not attend for their appointment.
The practice regularly worked with other services in the case management of vulnerable people for example district nurses and health visitors, and the local alcohol and drug dependency service. It had told vulnerable patients about how to access various support groups and voluntary organisations, for example local support groups for Asian women and women affected by domestic and sexual violence.
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.