Archived: Rosewood Practice

Updated 25 October 2017

The Rosewood Practice is located between Stoke Newington and Clapton in the London Borough of Hackney. The practice serves approximately 2100 people living in the local area. People living in the area speak a range of different languages and express a range of cultural needs. The practice population has higher numbers of young people (aged 25-29 years) compared to the national average.

The practice operates from a single site. It is situated on the ground floor of the purpose-built Fountayne Road Health Centre, which also houses a range of other health and social care services. There are three consulting rooms on the ground floor. The premises are fully wheelchair accessible with level access at the entrance. There is also a disabled toilet on site.

The practice is led by a female GP; there is also a long-term locum, male GP. There is also a practice nurse and a healthcare assistant. Overall the practice provides 11 GP sessions each week. The practice also employs a range of non-clinical support staff comprising of a practice manager and three receptionists.

The practice offers appointments on the day and books appointments up to two months in advance. The practice has appointments from 9.00 am to 6.30pm on Mondays, Tuesdays, Wednesdays and Fridays. They are open form 9.00am to 1.00pm on Thursdays. The practice provides extended opening hours on Mondays between 6.30 and 7.30pm. Patients who need attention outside of these times are directed to call the 111 service for advice and onward referral to other GP out-of-hours services.

The practice hosts a range of additional clinics comprising: a Diabetic Specialist Nurse clinic from 9.30 to 4.00pm every Wednesday; a Dietician clinic once a month on a Friday between 2.00pm and 4.00pm; a Family Welfare clinic twice a month on Thursdays between 10am and 1pm; and a Social Prescribing clinic every Friday between 2.00pm and 5.00pm. The practice also acts as a phlebotomy hub for the local area, with other practices referring patients to the practice for phlebotomy services.

The Rosewood Practice is contracted by NHS England to provide General Medical Services (GMS). They are registered with the Care Quality Commission (CQC) to carry out the following regulated activities: Diagnostic and screening procedures; Family planning; Maternity and midwifery services; Treatment of disease, disorder or injury.

Updated 25 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Rosewood Practice on 11 September 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence-based guidance. Staff had been trained to implement the guidance; they had the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey had improved year on year. The results showed patients were treated with compassion, dignity and respect; they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and that there was continuity of care. They told us that urgent appointments were available on the same day.
• The practice had good facilities and was well equipped to treat and meet the needs of their patients.
• There was a clear leadership structure and staff felt supported by the management team. The practice proactively sought, and acted on, feedback from staff and patients.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

There was one area where the provider should make an improvement:

• Review arrangements for monitoring the timely collection of repeat prescriptions.

• Consider ways to increase the number of carers identified and supported by the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 October 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 were similar to, and occasionally higher than, the CCG and national averages. For example, 98% of patients with diabetes had recorded acceptable average blood pressure reading, compared to the national average of 77%. However, the practice was aware of a need to focus on improving blood sugar readings in this patient group; 68% of diabetic patients had an acceptable, average blood sugar reading compared to the CCG and national average of 78%.

• 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 25 October 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.

• Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• The practice provided support for premature babies and their families following discharge from hospital. For example, the practice was situated in a health centre where the local midwifery and health visiting teams were also based. This allowed for the timely sharing of information and regular case review meetings.

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

• The practice provided 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.

• The practice hosts a Family Welfare clinic twice a month where patients are able to access advice about housing and other social care needs.

Updated 25 October 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. For example, the practice had a system to ensure that they shared information around medicines management with hospitals and local care homes.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, the practice ran a social prescribing clinic every Friday to facilitate patients’ inclusion in local community activities.

Updated 25 October 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, through offering extended opening hours.

• 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 25 October 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.

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  The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice kept a record of patients who were currently identified with needing extra support because of their mental health. They ensured that these patients were offered an appointment on the same day that they contacted the practice.

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

• 96% of patients with a serious mental health condition had a care plan review within the past 12 months. The practice also ensured that these patients had regular physical health checks with 96% having had their blood pressure checked in the past year.

• 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 25 October 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.
• 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.