31 August 2016
The Bloomsbury Surgery operates from 1 Handel Street, London WC1N 1PD, premises owned and managed by the local NHS trust and shared with other healthcare services. The practice is near Russell Square underground station and Kings Cross is short distance away, with good transport links.
The practice provides NHS services through a General Medical Services (GMS) contract to approximately 4,300 patients. It is part of the NHS Camden Clinical Commissioning Group (CCG) which is made up of 40 general practices. The practice is registered with the Care Quality Commission to carry out the following regulated activities - Maternity and midwifery services; Family planning; Treatment of disease, disorder or injury; Diagnostic and screening procedures; and Surgical procedures. The patient profile has a higher than average young adult and working age population, with a lower than average number of children, teenagers and patients aged over-50. The practice has a higher than average overall deprivation score, being in the third “more deprived decile”. The patient list has an average 13% turnover rate and approximately 20% of the registered patients are of Bengali background.
The practice has a clinical team of two partner GPs (one female, working four clinical sessions per week and one male, working five), two salaried GPs (one female, who works two clinical sessions and one male, who works four), a female nurse practitioner (working eight sessions per week) and a female trainee practice nurse. There are 12 patient appointment slots per clinical session. One of the partner GPs is at the practice each day. It is a teaching practice, with three registrars (qualified doctors gaining general practice experience) currently placed there. The practice employs a part-time counsellor. The administrative team is made up of an assistant practice manager, a secretary and three receptionists.
The practice’s opening hours are 8.30 am to 8.00 pm on Monday, and 8.30 am to 6.30 pm on Tuesday to Friday. Appointments are available between 8.30 am and 7.30 pm on Monday; from 8.00 am to 6.00 pm on Tuesday and Wednesday; and from 8.30 am to 6.00 pm on Thursday and Friday. Appointments are normally available within two working days, although patients wishing to see a preferred GP may have to wait longer. The GPs conduct telephone consultations with patients and make home visits. Appointments with the nurse practitioner are normally available within one working day. Patients may book appointments up to eight weeks in advance. There is a 24-hour automated system allowing patients to book appointments by phone. If they have previously registered for the system, patients can also book appointments and request repeat prescriptions online.
The practice is closed at weekends, but a number of weekend appointments are available under a local scheme operating at three locations across the borough. The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. There is information given about the out-of-hours provider and the NHS 111 service on the practice website.
31 August 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection on 27 July 2016. 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.
- 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.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Information about how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
- 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.
- Data showed the practice was performing above local and national averages in several aspects of care.
However, there were some areas where the practice should make improvements:
- It should continue with efforts to improve patients’ satisfaction over staff members’ engagement, approach and communication.
- It should continue with efforts to increase the size of the patient participation group.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
31 August 2016
The practice is rated as good for the care of people with long-term conditions.
- The practice held monthly meetings to discuss patients at higher risk of unplanned admission to hospital.
- Longer appointments and home visits were available when needed.
- The practice’s performance relating to diabetes care was above local and national averages.
- The practice maintained a register of 235 patients with diabetes, of whom 198 (85%) had undergone a foot examination and 204 (87%) had undergone retinal screening.
- The flu vaccination rate for patients with diabetes was 98.95%, being 4% above the national average.
- The practice maintained of register of 23 patients with heart failure, all of whom had had an annual medicines review in the preceding 12 months.
- The practice’s performance relating to asthma care and chronic obstructive pulmonary disease was comparable with local and national averages.
31 August 2016
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 and maintained a register of vulnerable children.
- Take up rates for all standard childhood immunisations were above the local average.
- Data showed the take up rate for flu immunisations for children aged two-to-four years was above the local average.
- 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 positive examples of joint working with midwives and health visitors, including monthly MDT meetings.
- The practice had identified 368 mothers prescribed four or more medications, all of whom had had a structured annual review.
31 August 2016
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 enhanced needs.
- The practice maintained a case management register of patients at high risk of admission to hospital. Sixty-nine patients were currently on the register, all of whom had up to date care plans.
- Records showed that 369 patients were prescribed four or more medications, all of whom had had a structured annual review.
- The uptake for bowel cancer screening was above the local average.
- Sixty patients identified as being at risk of developing dementia had been offered cognition testing.
- The practice had 176 patients aged over-75, all of whom had been visited or contacted in the last 12 months.
- The flu immunisation rates for patients aged over-65 was 80%, being above local and national averages.
31 August 2016
The practice is rated as good for the care of working-age people (including those recently retired and students).
- 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.
- Evening appointments were available for those patients who could not attend during normal working hours.
- Telephone consultations were available.
- The practice’s uptake for the cervical screening programme was comparable with the local. It was seeking to increase this, particularly among the local Bengali community.
- Data showed that 1,198 patients (being 92% of those eligible) had undergone blood pressure checks in the last five years.
31 August 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
The practice maintained a dementia register of 15 patients, all of whom had had their care reviewed in a face-to-face review in the preceding 12 months.
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 advance care planning for patients with dementia.
Continuity of care for patients experiencing poor mental health was prioritised.
The practice had a register of 46 patients with severe mental health problems, 96% of whom had received an annual health check.
Ten of the thirteen eligible patients on the severe mental health register had cervical cancer screening in the last five years.
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.
31 August 2016
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 six homeless people and eight patients with a learning disability.
The register of homeless patients was used for health promotion, with the practice sending invites for sexual health and blood-borne virus screening and to recall for vaccinations such as Hepatitis B, flu and pneumonia.
The practice offered longer appointments for patients with a learning disability. All patients on the learning disability register had had an annual follow up and their care plans reviewed.
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.