The Tudor House Medical Centre

Updated 30 March 2017

The Tudor House Medical Centre provides NHS primary medical services to around 3300 patients in the Wembley area of Brent from a single surgery. The service is provided through a personal medical services contract. The practice is located within a converted property in a residential area.

The current practice clinical team comprises two GP partners (male and female), two part-time practice nurses and a phlebotomist. The GPs typically provide 15 clinical sessions at the practice per week. The staff team also includes two practice managers and receptionists.

The practice opening hours are from 8.30am to 6.30pm on Monday, Tuesday, Thursday and Friday and from 8.30am to 1.30pm on Wednesday.  Morning consultation times run from 9am to 11.30am and afternoon consultations run from 4pm to 6.30pm. The practice also runs an 'extended hours' surgery on Monday evening from 6.30pm to 8pm. Telephone consultations are also provided daily.

The GPs make home visits to see patients who are housebound or are too ill to visit the practice. Same day appointments are available for patients with complex or more urgent needs. The practice offers online appointment booking and an electronic prescription service.

When the practice is closed, patients are advised to use the local out-of-hours primary care service or attend the local 'hub' primary care service. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on its website and on a recorded telephone message.

The practice population is characterised by average levels of income deprivation, employment rates and life expectancy. The practice age-sex profile is also similar to the English average. The population is ethnically diverse.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; maternity and midwifery services and treatment of disease, disorder and injury.

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Tudor House Medical Centre on 19 January 2017. Overall the practice is rated as good.

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

• Staff were open and transparent and committed to reporting incidents and near misses. The level and quality of incident reporting ensured a reliable picture of safety.
• Learning was based on analysis and investigation of any errors and incidents. The practice acted on its findings to improve the service.
• The practice had effective systems in place to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had the skills and knowledge to deliver effective care and treatment.
• Patient feedback indicated that patients were treated with compassion and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The service was accessible. Patient feedback was positive about the ease of getting an appointment. Urgent appointments were available the same day.
• The practice had adequate facilities and was 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 area where the practice should make improvement is:

• The practice should consider ways to further improve the control of diabetes in the practice population.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 30 March 2017

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

• The practice maintained registers of patients with long-term conditions. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The GPs and practice nurse had lead roles in long-term disease management.
• The practice had performed well on the Quality and Outcomes Framework (QOF) for managing most long-term conditions. The practice held monthly clinics for patients with poorly controlled diabetes which were run jointly by GP and the specialist diabetes nurse consultant for Brent. However practice performance on key diabetes related indicators were below average in 2015/16.
• The practice participated in a Brent-wide scheme to reduce unplanned admissions which targeted patients with complex or multiple long-term conditions. Patients at risk of hospital admission or sudden deterioration were identified as a priority.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• The practice posted information for patients about a range of long term conditions on its website with links to further resources. The website included a translation facility.

Updated 30 March 2017

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

• The practice provided antenatal and postnatal services. One of the GPs and the practice nurse ran a joint mother and baby clinic at six weeks after birth.
• Immunisation rates were high for standard childhood immunisations. The practice encouraged pregnant women to have the flu and pertussis vaccinations (whooping cough).
• The practice trained staff on treating children and young people in an age-appropriate way and as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies, for example with baby changing facilities and a space where mothers could breastfeed in privacy.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• 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.
• The practice liaised with midwives, health visitors and school nurses to support families and children, for example in following up potential safeguarding concerns.

Updated 30 March 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 patients in its population. Reception staff were trained on individualising care for older people, for example on the use of the hearing loop; reminders for dementia patients; arranging blister packs of medicines and arranging transport to health appointments.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments as appropriate. All patients over 75 had a named GP.
• The practice maintained a register of patients receiving palliative care and liaised with the local palliative care team. Patients receiving palliative care were involved in planning their care, including their end of life care.
• Patients over 75 made up the majority of the group of complex patients identified by the practice as requiring personalised care plans. One of the practice partners attended (and chaired) the monthly Brent multidisciplinary complex care group meetings. In doing so, the practice had  developed links with local specialist elderly care consultants, old age psychiatrists, social services professionals and the local primary care dementia nurse and was aware of local services and resources such as STARRS (the Brent short term assessment, reablement and rehabilitation service).
• The practice followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with advice and preventive care to help them to maintain their health and independence. For example, the practice ran campaigns to encourage eligible patients to have the flu, shingles and pneumococcal vaccinations.
• Staff were able to recognise the signs of abuse in vulnerable older patients and knew how to escalate any concerns.

• The practice provided a bypass telephone line to care homes, the ambulance service and other healthcare professionals to facilitate urgent queries.

Updated 30 March 2017

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

• The needs of working age patients had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible. For example, the practice was open on Monday evening. GP and nurse consultations were available after 5pm. Patients also had access to the local primary care 'hub' service in the evening and at weekends. 
• The practice offered a range of ways to access services, for example, daily telephone consultations with a GP, online appointment booking and an electronic prescription service.
• The practice used text messaging with patient consent to communicate test results and vaccination reminders.
• The practice offered health promotion and screening services reflecting the needs for this age group, for example NHS health checks for patients aged 44-75 years.
• The practice provided a contraceptive service (including oral, injectable and barrier methods) and signposted patients to local family planning services if they were interested in using long acting reversible contraceptive methods.
• In 2015/16, 75% of eligible women registered with the practice had a cervical smear test within the last five years, in line with the clinical commissioning group (CCG) average of 77%.
• The practice used its website to promote useful health information including on smoking cessation, sexual health and healthy living. The practice also promoted Brent CCG's health 'app' for mobile phones.

Updated 30 March 2017

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

• Patients at risk of dementia were offered screening and referral to the local memory services.
• The practice team worked with primary care dementia nurses, social services and old age psychiatry to manage dementia patients in the community and ensure up to date dementia care plans in place.
• In 2015/16, 10 of 14 (71%) of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the local and national average.
• In 2015/16, 31 of 31 (100%) of patients with a diagnosed psychosis had a comprehensive care plan in their records. This was above the national average.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. The practice also used coded alerts on the electronic patient record system to identify patients at risk of self-harm.
• The practice offered shared care for eligible patients with mental health conditions and was able to obtain specialist advice, referral and support though a local single point of access to the mental health teams. 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.

• The practice had information available for patients experiencing poor mental health about how they could access local counselling services, support groups and voluntary organisations. This included information signposting families to children’s centres, health visiting services and children’s mental health services. The practice had posted relevant information and resources on its website which included a translation facility.

Updated 30 March 2017

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 for example patients with a learning disability. Alerts were included on the electronic patient record system to ensure that staff were aware of patients who required additional assistance.
• The practice offered longer appointments for patients with a learning disability and annual health checks. We were given two examples where serious health conditions had been diagnosed at an early stage in the last year as a result of these health checks.
• 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 services, support groups and voluntary organisations for example drug and alcohol services. The practice had access to a local 'care navigator' who could visit patients at home.
• Staff interviewed knew how to recognise signs of abuse in children, young people and vulnerable adults. 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.
• The practice identified carers and provided them with information about available support.