Dr Iqbal and Partners Also known as Abernethy House Surgery

Updated 28 April 2017

Abernethy House is located in the centre of Enfield close to the main shopping area and the district council offices. There was no parking available for patients at the surgery but public car parks were located close by. The practice’s list size is approximately 12,806 patients. The list size has grown by 900 patients since 2014. The practice was part of Enfield Clinical Commissioning Group (CCG)

There are eight GPs in total (four male and four female), three partners and five assistant GPs some of whom worked part time. Female GPs worked 25 sessions per week. The partners worked 26 sessions a week. The salaried GPs worked 33 sessions per week.  There are five practice nurses who work a total of 147 hours per week. There are 15 support staff at the practice including the practice manager, reception staff and prescription clerks.

The building was owned by the three partners. There were nine consultation rooms and two nurse treatment rooms. The practice planned to add an additional consultation room and a lift. There are plans to refurbish two consultation rooms.

The practice supports practice nurse and GP training. The practice was an approved teaching practice for GPs. There was one GP registrar and one FY2 when we inspected. There was also one trainee nurse

The practice is open from 8.00 am until 6.45 on Monday, 8.00 until 6.30 on Tuesday, Wednesday and Friday. On Thursdays, the practice was open from 8.00 am until 8pm. Evening opening on Thursdays provided bookable appointments for patients who worked or found it difficult to access the service at other time.  

Patients who required the services of a GP out of hours contacted the NHS out of hours 111 service.

The number of children and babies under four years was greater than the national average. The number of female patients in the age 30 to 40 age group and over 70 was higher than the national average. The number of young people aged 10 to 20 was slightly less than the national average. Life expectancy was 81 for men and 85 for women compared with 80 and 84 in the CCG and 79 and 83 nationally. 56% of patients at the practice had a long standing health condition compared with the CCG average of 51% and 54% nationally

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Iqbal and Partners on 12 January 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 an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.

• When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

• The practice carried out clinical audits demonstrated quality monitoring and improvement

• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

• Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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.

• Partners had defined responsibilities for example for safeguarding, the quality and outcomes framework and information governance.

• The practice involved their patient and public involvement group (PPG) in discussions about practice development.

• 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvements:

• Replace the flooring in clinical rooms where the current carpeted areas are unsuitable.

• Identify patients who are carers.The practice had identified 100 patients who were carers which was less than 1% of the practice’s patient list

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Nurses specialised in the care of patients with diabetes and asthma.

• There were effective call and recall systems which included letters to patients, bulk mail, text messages and telephone calls. Three staff were engaged in contacting patients about their appointments.

• The practice proactively carried out tests and investigations.

• The practice performed well for all the quality and outcomes framework indicators (QOF). For example, for diabetes the practice performed better than the average of other practices within the CCG and national averages for a range of indicators.

Updated 28 April 2017

The practice is rated as good for the care of families, children and young people.

• Six postnatal checks for mothers, eight week baby check clinics and baby immunisations were offered on the same day.

• Well woman clinics were held five times a week with a range of early morning, afternoon and early evening appointments for cervical screening and contraception. Contraceptive services included coil fitting and implants. Nurses were trained to initiate contraception as well as to insert contraceptive coils.

• The practice used templates for fast referral to antenatal clinics. The practice held joint GP and midwifery antenatal clinics monthly.

• The surgery also offered a triage system for emergencies in the morning run by  nurses where a patient who needed an appointment for an emergency can discuss their problems and be given advice over the phone or seen by the nurse or their GP on the same day.

• Parents used the telephone nurse triage system for advice about children’s’ minor illnesses

• The practice met monthly with a health visitor to discuss any problems regarding  vulnerable children.

• There were systems in place 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 relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 77% of women aged 25-64, attending cervical screening compared with 73% for other practices in the CCG, the national average was 74%.

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

• We saw positive examples of joint working with midwives and health visitors

Updated 28 April 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with complex needs.

• Frail and older patients accessed phlebotomy at the surgery for example for anti-coagulation therapy.

• A dressing service was provided for patients with leg ulcers.

• The practice supported 109 patients living in nursing and residential homes in the area.

• All patients have a named GP which they are aware of.  Patients were encouraged to see their GP for continuity of care.

• Housebound patients were able to phone for home visits which were screened by the visiting GP before the visit.

• The surgery implemented admission avoidance plans for the most vulnerable of the older people and was actively involved in multidisciplinary (MDT) meetings as well as regular discussion of accident and emergency admissions for older people.

• The surgery has a good working relationship with the local pharmacies especially for organising dispensing boxes (Dosset Boxes) for patients

Updated 28 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students)

• The surgery opened at 8.00am and there was an extended surgery open until 8pm on Thursdays. Patients could book appointments and order prescriptions on line.

• The practice sent patients text reminders about their appointments.

• 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 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 28 April 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 75% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is slightly worse than the national average.

• The results for all other areas of mental health care were comparable to other practices in the CCG and the national average.

• The practice liaised with the local mental health team regarding mental health issues.

• The practice invited patients with a mental health condition for a health check at least once a year.

• The practice was flexible about arranging appointments for mental health patients recognising that their conditions might deteriorate unexpectedly.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 April 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• GPs used an alert box to alerts staff dealing patients who needed to see a GP urgently when they rang for an appointment.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• GPs carried out annual health checks and 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 informed vulnerable patients about how to access various support groups and voluntary organisations. 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.