Archived: The Practice @188

Updated 1 October 2015

The Practice@188 is a practice located in the London Borough of Barnet. The practice is part of the NHS Barnet Clinical Commissioning Group (CCG) which is made up of 69 practices. It currently holds a Personal Medical Service (PMS) contract and provides NHS services to 7481 patients.

The practice serves a diverse population with many patients attending where English is not their first language. The practice has a large older population (28.6%) and 16% of the population is under the age of 14. The practice serves the general population but provides specific services to four nursing homes and two residential care homes. The practice covers the largest density of the Jewish population within the UK (30-40%), however there is an increasing transient migrant population where English is not the first language. The practice is situated within a two storey residential property with consulting rooms on two levels. There is no step-free access to the first floor; therefore patients who cannot manage stairs are seen in the ground floor consulting rooms. There are currently two full time GP partners (one male and one female), three part time salaried GPs (two female and one male), administrative staff and a practice manager.

The practice is open between 8am and 8.30pm on Monday, 8am to 6.30pm on Tuesday and Thursday, 8am to 4.30pm on Wednesday and 8am to 7pm on Friday. Appointments are from 8.30am to 1pm and 2pm to 6.30pm except on Wednesday where patients were directed towards out of hour’s provision. Extended hours surgeries are offered on Monday between 6.30pm and 8.30pm and Friday between 6.30pm and 7pm. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments are also available for people that need them. Patients are able to book appointments on-line.

The practice opted out of providing an out of hours service and refers patients to the local out of hours service or the ‘111’ service.

The service is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and the treatment of disease, disorder or injury.

At time of inspection the location was inspected as a partnership. We were informed at the time of inspection that one of the partners was in process of retirement and the provider would make the necessary application to the CQC to ensure the registration of the provider was appropriate to carry out the regulated activities within the law.

The practice provides a range of services including child health and immunisation, minor illness clinic, smoking cessation clinics and clinics for patients with long term conditions. The practice also provides health advice and blood pressure monitoring.

Updated 1 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Practice@188 on 1 July 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

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

The provider should:

• Ensure all equipment was regularly maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 October 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 1 October 2015

The practice is rated as good for the care of families, children and young people. 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. For example, the vaccinations given to under two year olds ranged from 81.5% to 88.9%. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 1 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, 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 end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice undertook ward rounds of four nursing homes and two care homes. Joint working was undertaken to promote end of life care plans. The practice worked with a local care of the elderly consultant and palliative care team to help manage the older people in the homes and within their own homes. The GPs provided an out of hour’s service to the nursing and residential homes in the event of the death of a resident in order to facilitate cultural needs.

Updated 1 October 2015

The practice is 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. Evening extended hours appointments were available and a special GP and nurse led commuter clinic was run in the evening. The practice was proactive in offering online services, including registering online, booking appointments, ordering prescriptions and accessing medical summaries. The practice had a full range of health promotion and screening that reflected the needs for this age group.

Updated 1 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 1 October 2015

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. It had carried out annual health checks for 70% of patients with a learning disability. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.