The Shaftesbury Medical Centre

Updated 15 March 2017

The practice is based within 39 Shaftesbury Parade, Harrow, Harrow, HA2 0AH. The practice is situated in a residential area and car parking was available to the front of the premises. The practice was well served by local buses and train links.

The practice staff includes one male and one female GP partners, one male salaried GP, one female enhanced nurse practitioner and a female practice nurse, two female healthcare assistants, a practice manager and a team of reception/administrative staff.

The practice was open from 8am to 1pm and then from 1.30pm to 6.30pm Monday, Tuesday, Thursday and Friday and to 5pm on Wednesday. The practice was also open every Saturdays 9am to 12pm. Appointments were from 9am to 12pm every morning and 3.30pm to 6pm daily. Outside of these hours, cover was provided by the out of hours GP service which operated from 6.30pm to 8pm, seven days a week and the NHS 111 service.

The practice looked after two care homes, one of which was a residential care home with 30 patients and a learning disabilities care home with 10 patients. The practice was a training practice and trained one GP registrar.

Shaftesbury Medical Centre is one of a number of GPs covered by Harrow Commissioning Group (CCG). It has a practice list of around 4500. The practice’s patient population has an above average number of young children (five to year years) and adults aged from 25 to 44 years. In terms of deprivation, Harrow is in the seventh less deprived decile.

The practice provides the following regulated activities:

• Treatment of disease, disorder or injury;

• Maternity and midwifery services;

• Family planning;

Diagnostic and screening procedures.

Updated 15 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shaftesbury Medical Centre on 20 December 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 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.
• 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 are:

• To continue monitoring phone and appointment provision to improve patient satisfaction with the provision.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 March 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.

• There were alerts for long term conditions on patient records.

• At 83%, the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was comparable to the CCG and national averages of 77%.

• Longer appointments and home visits were available when needed.

• All these patients 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.

• The practice had online appointment booking and prescription requests.

• The practice had a palliative care register with monthly reviews taking place.

Updated 15 March 2017

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.

• 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.

• At 81%, the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was comparable to the CCG and national averages of 77% and 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Children and babies were prioritised for same day appointments.

• We saw positive examples of joint working with health visitors.

• A range of family planning services were provided including hormone implants.

Updated 15 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 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 placed an alert on patient records highlighted elderly patients who were particularly vulnerable.

Updated 15 March 2017

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.

• 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.

• Same day appointments were available.

• The practice was open from 8am to 1pm and then from 1.30pm to 6.30m Monday to Friday and every Saturdays from 9am to 12pm to accommodate working people.

• Telephone consultations were available.

• Online appointment booking and prescription requests was available.

Updated 15 March 2017

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

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  95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015). This was comparable to the CCG average of 91% and the national average of 88%.

• Patients with severe mental health conditions were offered weekly appointments with a named GP.

• 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.

• 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 15 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 including those with a learning disability. There was also an alert on the patient records where a patient was identified as vulnerable.

• The practice also maintained a homeless register, with four patients on the register and had completed healthcare checks for all four patients as well as signposting them to external support groups.

• The 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.

• The practice provided a fortnightly substance misuse clinics for patients with drug and alcohol dependency.

• 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.