The Junction Medical Practice

Updated 19 July 2017

The Junction Medical Practice provides GP primary care services to approximately 5,800 people living in Tufnell Park, London Borough of Islington. The practice has a General Medical Services (GMS) contract for providing general practice services to the local population. A General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the very highest levels of deprivation and level ten the lowest.

There are currently two GP partners, one male and one female. There are also four sessional GPs, three female and one male, all of whom work part-time. The practice provides a total of 18 GP sessions per week.

The clinical team is completed by three practice nurses and a health care assistant all of whom work part time. The health care assistant is also trained as a phlebotomist (Phlebotomists are specialist healthcare assistants who take blood samples from patients for testing in laboratories). There are also a practice manager, two senior administrators and four administrative and reception staff.

The practice registered with the Care Quality Commission in January 2017 and was formed from the merger of two previously separate practices; Dr Renu Hans (also known as Dartmouth Park Practice) and Dr Heskel Kateb (also known as The Tufnell Surgery). The practice is registered to provide the regulated activities of maternity and midwifery services, diagnostic and screening procedures, family planning, treatment of disease, disorder or injury and surgical procedures.

The practice provides services from two locations, a main surgery and a branch surgery, which are located approximately 300 metres apart. The main surgery is located in a two storey building and patients are given the option of being seen on the ground floor. The branch surgery is sited entirely on the ground floor.

The opening hours for the main surgery are:

Monday 8am to 6:30pm

Tuesday 8am to 6:30pm

Wednesday 8am to 6:30pm

Thursday 8am to 1:30pm

Friday 8am to 6:30pm

Saturday Closed

Sunday Closed

The opening hours for the branch surgery are

Monday 8am to 6:30pm

Tuesday 8am to 6:30pm

Wednesday 8am to 1:30pm

Thursday 8am to 6:30pm

Friday 8am to 6:30pm

Saturday Closed

Sunday Closed

Appointments are from 8:30am to 12:30pm every morning and 3:30pm to 6:30pm daily. On Wednesday afternoons when the main surgery is closed, patients can visit the branch surgery and on Thursday afternoons when the branch surgery is closed, patients can visit the main surgery. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for patients that need them.

The practice also has access to pre-bookable appointments with GPs and nurses at a local hub. These are available between 6:30pm and 8pm from Monday to Friday and between 8am and 8pm on Saturdays and Sundays.

The practice has opted not to provide out of hours services (OOH) to patients and these were provided on the practice’s behalf by London Central & West Unscheduled Care Collaborative (LCW). The details of the how to access the OOH service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website.

Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to six weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

The practice provides a wide range of services including clinics for diabetes, asthma, contraception and child health care and also provides a travel vaccination clinic. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

Updated 19 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Junction Medical Practice on 30 May 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 provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and 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 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The area where the provider should make improvement are:

• Review procedures for managing repeat prescriptions, including steps to undertake earlier reviews of uncollected prescriptions.
• Consider carrying out regular fire drills to ensure that staff who may be required to work at both practice locations are familiar with evacuation procedures in each location.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 19 July 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.
• 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 19 July 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice had a significant population of younger adults and the practice website was used to provide useful information around sexual health screening and contraception

Updated 19 July 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 instance the local integrated care management team.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice had made arrangements with an organisation that supported older people to have a volunteer attend the practice to provide a befriending service for patients experiencing or at risk of experiencing, social isolation.

Updated 19 July 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 19 July 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.
• We saw unvalidated data that showed 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the most recently published national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• 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 19 July 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.
• The practice population included a significant number of patients who were refugees from other countries and the practice had put arrangements in place to support these patients.