Archived: Vale Drive Medical Practice

Updated 8 November 2016

Vale Drive Medical Practice is based in Barnet, North London. It is situated in a purpose built health centre and shares the building with a number of other community NHS services as well as another GP Practice. Disabled facilities include an access ramp, wide doors and corridors, ground floor facilities, disabled toilet and a reception desk which can be easily accessed by wheelchair users. A wheelchair is available for patients to use within the building if needed. The practice has a shared waiting area and uses an electronic display to call patients. The practice is close to High Barnet tube station and is served by a number of local bus routes. There is a disabled parking space.

Vale Drive Medical Practice has two GP partners, one male and one female (providing nine sessions per week) and also employs several long term locum GPs, two male and one female (providing six sessions per week). There are two female practice nurses providing four clinical sessions (0.4 WTE). Vale Drive Medical Practice is a teaching practice and teaches three final year medical students per year. The practice employs an administrator to provide 12 hours of practice management per week.

The practice is open from 8.00am Monday to Friday with afternoon/evening closing times varying through the week. Appointments are from 9.00am to 11.30am every morning and in the afternoon 5.00pm to 7.00pm Monday and Wednesdays, 5.00pm to 6.30pm on Tuesdays and 4.30pm to 6.00pm on Fridays. The practice is closed to patients from 1.00pm on Thursdays. Extended hours appointments are available on Monday and Wednesday evenings from 6.30pm to 7.00pm. Appointments can be booked up to four weeks in advance with a male or female GP, urgent appointments, telephone appointments and home visits are available. There is good access to appointments with an approximate waiting time of two days for an appointment with the first available doctor or up to a week with a named doctor.

When the practice is closed arrangements are in place for patients to access medical care via a local out of hours provider. The practice also organises patient appointments at the local health service hub where a GP is available from 8am to 8pm on Monday, Friday, Saturday and Sunday.

The practice is registered to provide diagnostic and screening procedures, surgical procedures, treatment of disease, disorder or injury, family planning and maternity and midwifery services.

The practice has a list size of approximately 4200. Its population has a slightly higher than average number of working age patients and children when compared to local CCG averages. The practice cares for 55 older patients at a local residential home. Deprivation scores for the practice population are comparable to the local CCG and national averages

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Vale Drive Medical Practice on 9th June 2016. Overall the practice is rated as requires improvement.

• Our key findings across all the areas we inspected were as follows: The partners had a vision and a strategy but not all staff were aware of this and their responsibilities in relation to it. However there was a clear leadership structure and staff felt supported by management.

• The practice had a number of policies and procedures to govern activity, but several needed to be reviewed and updated. For example, the complaints policy, recruitment policy and the health and safety policy.
• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, the system used to record and report safety concerns, incidents and near misses was inconsistent.

• The processes in place for managing risk were not always robust. The calibration of some clinical equipment had taken place but not all the necessary items had been tested or had had a risk assessment carried out.

• The learning needs of staff were not fully understood. The practice provided only limited mandatory training for staff, e-learning was not available.Individual training records we saw were incomplete and did not reflect the information we were told by staff.

• The Patient Group Directives had been signed by the nurse but not signed by the authorised person..

• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice was well equipped to treat patients and meet their needs.

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

The areas where the provider must make improvements are:

• Review and update policies and procedures, to include recruitment, complaints, and health and safety.
• Review its incident and significant event policies to ensure that reporting and recording systems are being used to identify risks and continuously improve patient safety.
• Ensure that all appropriate medical equipment is annually calibrated.
• Implement a system for assessing, monitoring and recording the training needs of staff and ensure that all staff have completed professional and mandatory training.Ensure that appropriately signed Patient Group Directives are on file to enable practice nurses to legally administer medicines in line with legislation.

In addition the provider should:

• Provide patient information regarding the services available, for example the interpreting service and local bereavement service.Facilitate regular patient participation group meetings

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 November 2016

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

The practice is rated as requires improvement for people with long term conditions

• Nursing staff had lead roles in chronic disease management for example COPD, asthma, diabetes and cardiovascular disease. Patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All patients with a long term condition had a named GP and 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.

• Involvement of the multidisciplinary team was encouraged. The practice liaised with a number of community health services such as the district nurses, local COPD team, the local rapid response team, community pharmacists, safeguarding team and social workers.

Updated 8 November 2016

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

The practice is rated as requires improvement 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.

• 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.

• Eighty percent of women aged 25-64 received cervical screening within the target period which is comparable to the CCG and national average.

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

• We saw positive examples of joint working with the family planning / sexual health clinic based in the same building. The local Child and Adolescent Mental Health Services and speech and language therapy services were also based in the same building.

Updated 8 November 2016

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

The practice is rated as requires improvement 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, telephone appointments and same day urgent appointments for those with enhanced needs.

• The practice provided a service to a local residential home for older people. A lead partner visited a 55 bed home on a weekly basis to carry out a full ward round. The practice had organised off site access to patient records to improve continuity of care for patients with multiple and complex health needs. This was achieved via a secure system allowing the partner to dial in to the practice patient records system.

• The practice worked closely with the palliative care team and followed the Gold Standard framework for end of life care.

• Winter flu jabs for housebound elderly patients were carried out by the partners so that they could visit patients in their home environment and could ensure their care plan was up to date. Care plans were kept in the patient’s home so that the information could be accessed by other community healthcare workers, carers and family.

• The local rapid response team carried out joint visits with the GP to promote joint working and continuity of care.

• The practice carried out health checks for patients aged over 75 years.

Updated 8 November 2016

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

The practice is rated as requires improvement 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. Telephone consultations were available to improve access for working age people.

• The practice was proactive in offering online services as well as a range of health promotion services and cervical screening that reflected the needs for this age group.

• Every patient at the practice had a named GP to improve continuity of care.

• Health promotion advice was offered but there was limited accessible health promotion material available in the waiting area.

• SMS text messaging was used to remind patients of their appointment and to promote andencourage the uptake of services such as cervical cytology.

• NHS health checks were offered to patients between 40 and 74 years of age.

• The practice referred patients to the Fit to Work scheme to help support people into employment.

Updated 8 November 2016

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

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

• 91% 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 of 84%.

• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their records in the last 12 months, which is comparable to the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out an enhanced annual health check for patients with dementia and those patients with poor mental health. The enhanced health check template included smoking, alcohol, psychological and emotional needs, sleeping patterns, dental needs, additional blood tests and carers input.

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

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice participated in a dementia related book prescription scheme with local library services.

• The practice 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. After each A&E episode a doctor followed up the patient either by phone or face to face consultation

Updated 8 November 2016

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

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and those requiring palliative care.

• The practice worked closely with the palliative care team and followed the Gold Standard framework for end of life care.

• The practice offered longer appointments for patients with a learning disability.

• The practice nurses provided an individual phlebotomy service for frail elderly or vulnerable patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. They were aware of their responsibilities regarding information sharing.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations for example the citizen’s advice bureau and the local food bank.

• The practice carried out an annual health check and used enhanced care plans for patients with a learning disability. The health check template included information such as eating and drinking needs, taking medication and gave the option of additional blood tests. Carers where encouraged to attend the review, the patient and their family or carer held the enhanced care plan so that it was accessible to the wider multidisciplinary team. The practice worked closely with the local learning disabilities nurses.

• 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. One of the partners was the adult safeguarding lead for the CCG and also worked closely with the child protection team.

• There were arrangements to allow people with no fixed address to register at the practice.