Parkview Surgery Edgware

Updated 19 March 2018

Parkview Surgery Edgware is located in a residential area in Burnt Oak, North London. The practice is located in shared rented premises on a residential street. There is on street parking in front of the surgery, a bay for parking for disabled patients in front of the surgery and a bus stop approximately ten minutes’ walk from the practice.

The practice also provides services from a branch location, which is approximately a mile away. The branch practice is located within shared premises, situated within the Grahame Park housing estate. There are approximately 6000 patients registered at the practice.

Statistics shows high income deprivation among the registered population. The registered population is slightly higher than the national average for those aged between 25-44. Patients registered at the practice come from a variety of ethnic backgrounds including Asian, Western European, Eastern European and Afro Caribbean. The practice is open from 8 am to 6:30 pm Monday to Friday. The practice offers extended hours appointments from 7:15 to 8 am on Thursday mornings, from 7:30 am to 8 am on Friday mornings and from 8 am to 11 am on one Saturday in four. 

The practice is registered with the Care Quality Commission to provide the following regulated activities:

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury

• Maternity and midwifery services

• Surgical procedures

Updated 19 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkview Surgery on 21 June and 5 July 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June and July 2017 inspection can be found by selecting the ‘all reports’ link for Dr T Ganesh and Dr S Shanmugaratnam on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 21 June and 5 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

• Staff were aware of their responsibilities in relation to information governance, and had undertaken information governance training.

• New systems and processes had been developed to improve record keeping within the practice to ensure that a complete and contemporaneous record is kept in respect of each service user in an accessible way. Staff had also received record keeping training.

• New processes had been put in place to improve areas where patient outcomes were below average, in particular in relation to the proportion of patients excepted from the Quality and Outcomes Framework and the uptake of cancer screening and childhood immunisation programmes.

• The minutes of internal and external meetings were being taken consistently.

• The significant events process had been reviewed to ensure significant events were promptly recorded.

• The process for checking uncollected prescriptions had been reviewed and a new prescribing policy had been developed.

• Care plans developed for those patients that required these were given to patients to take home for their information following their consultations.

• The practice had reviewed areas where patients rated the service below average as part of the NHS GP Patient Survey and had set up a new Patient Participation Group to optimise patient feedback.

• The interpreting service was advertised to patients at reception and via posters and leaflets.

• The allocation of tasks and responsibilities within the practice had been reviewed to ensure that all staff were clear about their roles

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 2017

The provider was rated as requires improvement for being effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The Quality Outcomes Framework showed that outcomes for patients with diabetes were mixed, as the practice had a significantly higher exception reporting rate for several indicators.
• 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 30 August 2017

The provider was rated as requires improvement for being effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• 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 below average for all standard childhood immunisations and the practice did not have a formal strategy in place to address this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 30 August 2017

The provider was rated as requires improvement for being effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs; however, copies of care plans were not routinely provided to patients.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 30 August 2017

The provider was rated as requires improvement for being effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 30 August 2017

The provider was rated as requires improvement for being effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice carried out advance care planning for patients living with dementia.
• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Data showed that the practice’s performance for the management of mental health conditions, including dementia, were above the local and national average.
• 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 30 August 2017

The provider was rated as requires improvement for being effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.