Archived: Isleworth Centre Also known as Greenbrook Isleworth

Updated 31 March 2015

Isleworth Practice and Grove Practice are two co-located GP surgeries based in the Isleworth Centre for Health. The practices have separate Alternative Provider Medical Services (APMS) contracts with NHS England for delivering primary care services to the local community. Although performance data is submitted separately, service provision and delivery is done collectively and they are registered with the Care Quality Commission as the Isleworth Centre (‘the practice’). They are part of Greenbrook Healthcare, an NHS primary care provider, whose services include urgent care centres, walk-in centres, and GP practices.

The Isleworth Centre provides primary care services to around 9,600 patients living in the surrounding areas of Isleworth, in the London Borough of Hounslow. The Indices of Multiple Deprivation (2010) shows that Hounslow is the 92nd most deprived local authority (out of 326 local authorities, with the 1st being the most deprived). The practice has a higher proportion of patients between the ages of 25-45, when compared with the England average. The proportion of patients over the age of 60 is lower than the England average.

The practice has nine salaried GPs (two male, seven female) and a longstanding female GP locum. The number of sessions covered by the GPs equates to 5.6 whole time equivalent (WTE) staff. The number of sessions covered by the two nurses and two health care assistants equates to 1.6 WTE staff. The practice manager and business support manager are responsible for the day to day management of the service, and support the administrative team.

The practice shares the premises at Isleworth Centre for Health with other health care providers. It is open every weekday from 08:00 to 21:00, and weekends 09:00 to 13:00. Appointments must be booked in advance, and some emergency appointments are available daily. The practice also participates in a ‘hub’ service, which provides weekend access to a GP for patients in the locality. The practice has opted out of providing out-of-hours services to their own patients. Outside of normal opening hours patients are directed to the NHS 111 service.

The CQC intelligent monitoring placed the practice in band 5. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Updated 31 March 2015

Letter from the Chief Inspector of General Practice

This report presents the findings from our inspection of the Isleworth Centre. The practice is registered with the Care Quality Commission to provide primary care services. We carried out a comprehensive inspection on 20 November 2014. We spoke with patients, a member of the patient participation group (PPG), and staff including the management team.

The practice is rated as ‘good’ for providing a safe, effective, caring, responsive and well-led service. We gave the practice an overall rating of ‘good’.

Our key findings were as follows:

• The practice had systems in place to record, monitor, review and address risks to patients. Staff understood and fulfilled their responsibilities to raise safety concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised to support development.
• The practice’s focus was on improving patient outcomes, and the practice networked with other local providers to monitor performance and share best practice.
• Appraisals and personal development plans were undertaken for all staff, and staff received support to develop in their roles.
• Feedback from patients about their care and treatment was positive. There was a patient-centred culture where staff treated patients with kindness and respect.
• Areas identified by patients as requiring improvement, such as telephone access, were recognised by the practice and we found examples to demonstrate how patient feedback was valued and acted on. The practice actively reviewed complaints to identify any themes and learning.
• The practice understood the needs of the local population and services were planned to ensure these needs were met. There was flexibility for patients to book appointments at a time that suited them. The practice was open 08:00 – 21:00 every weekday, and 09:00 – 13:00 at the weekend.
• Urgent appointments were available the same day, and longer appointments were available for people who needed them. A child emergency policy was in place where children under the age of five would be seen the same day after a discussion with the GP, and children under six months old were automatically booked in by reception staff to be seen the same day.
• Policies and procedures to govern activity were in place, and there were systems in place to monitor and improve quality and identify risk. There was a strong focus on learning and training, and staff described a culture of openness and support.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site.

The provider should:

• Provide chaperone training for staff who undertake these duties.
• Risk assess whether non-clinical staff require health-care associated infection prevention and control training.
• Ensure that both patient participation groups are able to contribute to the continuous improvement of the service.
• Improve signage directing patients around the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 31 March 2015

The practice was rated as good for the care of people with long term conditions. The practice conducted clinical audits which looked at the management of patients with long-term conditions, and changed their practice as a result. Patients who had a care plan were reviewed every three months, and longer appointment slots were booked for these reviews. The practice worked with other healthcare providers to coordinate patient care. Clinical risk meetings were held monthly to discuss patients with complex needs, including long-term conditions. The practice had a palliative care register and monthly clinical meetings, as well as quarterly multidisciplinary meetings, were held to discuss the care and support needs of these patients and their families. New patients registering with the practice were screened to identify if they were at risk, or had chronic disease or conditions requiring medicines. These patients were then followed up by the GPs or nurses. There were GP leads in specialist areas such as palliative care and dementia.

Updated 31 March 2015

The practice was rated as good for the care of families, children and young people. Systems were in place for identifying and following-up children who were at risk, and child protection cases were reviewed with the health visitor every six weeks or sooner if required. There was a dedicated clinical lead for safeguarding children, and all staff had received relevant role-specific training in child protection. A new ‘child emergency policy’ was in place where children under the age of five were seen after a discussion with the GP, and children under six months old were automatically booked in by reception staff. A good skill mix was noted amongst the GPs with many having additional diplomas in areas relevant to the needs of the local population, such as sexual and reproductive health, obstetrics and gynaecology, children’s health, and family planning. Longer appointments were allocated for antenatal and postnatal checks, and childhood immunisations were carried out by the GPs and nurses. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 31 March 2015

The practice was rated as good for the care of older people. All patients over the age of 75 had a named GP and were informed of this in writing. The practice’s appointment system allowed for longer appointment slots, telephone consultations, and home visits for patients over the age of 70. The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and unplanned admissions. Clinical risk meetings were held monthly to discuss older patients with complex needs, and the practice worked with other healthcare providers including district nurses to coordinate patient care. The practice also offered the flu and shingles vaccinations to older patients in line with current national guidelines.

Updated 31 March 2015

The practice was 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 open 08:00 – 21:00 every weekday, and 09:00 – 13:00 at the weekend. Patients could book appointments online, over the phone, or in person, and emergency appointment slots were available daily. Text message reminders for appointments and practice updates were also utilised. Repeat prescriptions could be requested online, in person, via e-mail, post, or by pharmacy request. NHS health checks were offered to all patients between the ages of 40 and 74. This was an opportunity to discuss any concerns the patient had and identify early signs of medical conditions. GPs had additional diplomas in areas relevant to the needs of the local population, such as sexual and reproductive health, obstetrics and gynaecology, and family planning. Cervical smear tests were offered to patients in line with national guidelines. Travel vaccinations were administered at the practice, and health promotion material was also available to patients.

Updated 31 March 2015

The practice was rated as good for the care of people experiencing poor mental health (including people with dementia). There was a GP lead for mental health, and longer appointment slots were available for patients with mental health conditions. New patients with mental health conditions were booked for a health check with the GP and nurse, and were offered further support in line with their needs. The practice made urgent referrals to secondary care mental health teams, and also utilised a pathway for patients with mental health issues who were not in crisis to be seen in primary care.

Updated 31 March 2015

The practice was rated as good for the care of people whose circumstances may make them vulnerable. There was a system to highlight vulnerable patients. Care plans had been completed for 177 patients on an enhanced care list, and this list was reviewed regularly at practice meetings. The practice held a register of patients with learning disabilities, and longer appointments were offered to these patients. The practice had signed up to enhanced services for patients with learning disabilities, and had carried out annual health checks for these patients. There was a system in place for identifying carers, and these patients were offered health checks and immunisations. Referrals were also made so that carers could access further support, and a designated noticeboard in the practice provided carers with further information. There was a clinical lead for safeguarding vulnerable adults, and staff knew how to recognise signs of abuse in vulnerable adults. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours.