Background to this inspection
Updated
21 February 2020
Bush Hill Park Trinity Surgery provides primary medical services from 22-24 Trinity Avenue, Bush Hill Park, Enfield EN1 1HS to 2,630 patients and is one of 54 practices in Enfield Clinical Commissioning Group (CCG). The practice website can be accessed by the following link .
The practice has a General Medical Services (GMS) contract. GMS contracts are nationally agreed between the General Medical Council and NHS England.
The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury.
The practice had recently applied and been accepted to become a member of the Medicus Super Partnership. Following the inspection in December 2019 the practice was given consent by NHS England to become a full member of Medicus. This gives the practice access to a wider range of services and staff in order to support the practice and provide a greater level of service to patients.
Statistics show moderate income deprivation among the registered population. Information published by Public Health England rates the level of deprivation within the practice population group as six on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The registered population is slightly higher than the national average for persons aged between 40 and 59. Patients registered at the practice come from a variety of backgrounds including Asian, Western European, Eastern European and African Caribbean. Fifty-seven percent of patients have a long-standing health condition compared to the CCG average of 50%.
The clinical team at the surgery is made up of two GPs (both male) who provide nine clinical sessions weekly. There is one practice nurse (female) who provides two sessions weekly.
Five administrative and reception staff work at the practice and are led by a practice manager.
The practice reception opening times are:
• 8am - 7pm (Monday, Tuesday, Wednesday, Friday)
• 8am - noon (Thursday)
Clinical sessions are as follows:
• 8:30am - noon (Monday - Friday)
• 5pm – 6:30pm (Monday, Tuesday, Wednesday, Friday)
The practice offers extended hours surgeries on Monday, Tuesday and Wednesday evenings, between the hours of 6:30pm and 7pm. In addition, the practice holds telephone and Skype consultations between noon and 12:30pm daily. Patients can book appointments in person, by telephone and online via the practice website.
Patients requiring a GP outside of practice opening hours, including Thursday afternoon are advised to contact the NHS GP out of hours service on telephone number 111.
Updated
21 February 2020
We carried out an announced focussed inspection at Bush Hill Park Trinity Surgery on 12 December 2019.
We previously inspected the practice in February 2016, when we rated the practice as Requires Improvement for providing safe, effective and well-led services. Included amongst the issues we identified, the practice could not provide sufficient evidence regular clinical audits were being conducted, a programme of regular in-house infection prevention and control audits had not been established and the practice did not have oxygen at its premises.
We subsequently carried out a focused inspection on 8 May 2017 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we had previously identified. At the inspection on 8 May 2017, we rated the practice good for providing safe and well led services and requires improvement for providing an effective service. We asked the practice to ensure the correct clinical pathways were being followed as current clinical pathways were not being adhered to. We rated the practice Good overall.
We carried out a further comprehensive inspection in June 2018, at which time we rated the practice good for providing a safe, caring, responsive and well led service and requires improvement for providing an effective service. The practice was rated as good overall. At the inspection we asked the practice to ensure all medical alerts were followed up, clinical pathways were being followed, to review the cold chain policy in respect of ensuring there was a backup thermometer for the fridge and to look at their rate of antibiotic prescribing as it was higher than the local average.
A further comprehensive inspection was undertaken in May 2019. We rated the practice good for providing a caring and responsive service and requires improvement for providing a safe, effective and well led service. The practice was rated requires improvement overall. We issued a requirement notice for Regulation 12 HSCA (RA) Regulations 2014 safe care and treatment because we found that infection prevention and control policies had not been reviewed, areas of the practice were dirty and omitted from cleaning schedules, there was no record of the cleaning of hand-held medical equipment, actions from the recent infection prevention and control audit had not been followed up, there was no register of staff vaccines and emergency medicines were monitored inconsistently.
At the latest inspection in December 2019 we found that action had been taken to address all of these areas.
At this inspection, on 12 December 2019, we based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as good overall.
We found that:
- Published child immunisation figures were below the minimum World Health Organisation target of 90%.
- The practice provided care in a way that kept patients safe and protected them from avoidable harm.
- Patients received effective care and treatment that met their needs.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
- The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
Whilst we found no breaches of regulations, the provider should:
- Review and update health and safety and premises risk assessments;
- Clarify who the infection and prevention control lead is when the nurse is absent;
- Review current nursing provision to ensure patient needs are met;
- Include the identification of members of staff who undertake the checking of medical devices and general cleaning schedules;
- Continue to look at ways to improve the prescribing rate;
- Continue to look at ways to improve outcomes for the childhood immunisation programme.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care