Archived: The Pinner Road Surgery

Updated 10 August 2017

The Pinner Road Surgery provides primary medical services to approximately 4250 patients in the West Harrow area. The practice operates under a personal medical services contract and provides a number of local and national enhanced services. (Enhanced services typically offer additional provision above that required under the core GP contract).

The practice is located in a relatively affluent area with higher than average levels of life expectancy, high employment rates and low levels of income deprivation. The practice population profile is similar to the national age/sex profile and is ethnically diverse.

The practice operates from one site and is located in purpose built premises which have recently been renovated. The practice is accessible to people with disabilities. The reception area and consultation rooms are located on the ground floor.

The clinical team has changed since our previous inspection. The partnership currently comprises three GP partners, two of whom no longer provide regular clinical sessions at the practice. The practice has three regular ‘locum’ GPs one of whom is in the process of becoming a partner. The practice typically offers 18-20 GP sessions per week and patients have the choice of a male or female GP.

The practice also employs a practice nurse, a healthcare assistant and administrative and reception staff. Since our previous inspection it has also recruited a part-time pharmacist to the clinical team. At the time of the inspection, the practice had engaged a management consultancy to provide interim practice management services. The practice also offers practice nurse training placements. One trainee nurse was attached to the practice at the time of inspection.

The practice has increased its opening times since our previous inspection. The practice opens from 8am to 6.30pm, Monday to Friday. Face to face appointments are available from 8am to 11:30am and from 4pm to 6:30pm on weekdays. Extended hours appointments are available on Saturday morning from 9am to 11:30am.

When the practice is closed, patients are advised to use the local out of hours primary care service or call NHS 111. 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 by recorded telephone message.

The practice is registered to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder or injury; and, maternity and midwifery services.

Updated 10 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Pinner Road Surgery on 7 June 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Pinner Road Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 6 June 2017. We found that improvements had been made since the previous inspection and the practice was meeting the regulations which it had previously breached. Overall the practice is now rated as good.

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

• There was a more positive, transparent approach to safety and an effective system in place for reporting, recording and learning from significant events and other incidents.
• 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 and had the skills, knowledge and experience to deliver effective care and treatment.
• The practice had implemented a programme of clinical audit to identify areas for improvement and acted on the findings.
• The practice had implemented mechanisms for multidisciplinary working for example to support care planning and palliative care.
• The feedback we received from patients was positive. The practice scored in line with the local and national averages on the national GP patient survey.
• Information about services and how to complain was now available and easy to understand. Improvements were made to the quality of care as a result of complaints.
• Patients said they found it easy to make an appointment with a named GP. Urgent appointments were available the same day.
• The practice had recently renovated the premises and had secured funding for further expansion.
• The practice was developing its leadership structure and staff said they were supported by management through this process. The practice proactively sought feedback from staff and patients, which it acted on.
• On being placed in special measures the practice had sought and engaged with external advice and support to improve its service.

The area where the provider must make improvement is:

• The practice must establish effective systems and processes to ensure good governance is embedded and sustained in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• The practice should focus on improving its cervical screening uptake rate which remains below the local average.
• The practice should implement an effective induction programme to support newly recruited staff members.
• The practice should include information about the NHS independent advocacy service in its complaints procedure and leaflet.
• The practice was in the process of recruiting a permanent practice manager. The partners should provide the post holder with appropriate and ongoing support and training so that current improvements are sustained.
• The practice should publicise changes and improvements to patients, for example changes in staffing, premises development, the range of services offered and changes in opening hours.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 10 August 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 roles in long term disease management.
• The practice team included GPs with a special interest and training in diabetes and cardiology.

• The practice ran monthly specialist diabetes clinics and offered monthly dietician clinics for patients with type 2 diabetes or serious weight problems.
• The practice provided an extended range of diagnostic services including spirometry and an in-house phlebotomy service so patients did not need to be referred elsewhere.
• The practice provided information for patients on managing long term conditions. The practice could provide patients with a range of patient information leaflets (in multiple languages) covering conditions including diabetes and cardiovascular conditions.
• The practice referred patients who could benefit to the local whole system integrated care programme. One of the GPs attended the integrated care programme meetings to review and plan patients’ care with specialist and multidisciplinary input.
• The practice followed up patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

Updated 10 August 2017

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

• The practice provided postnatal and six week baby checks.
• At our previous inspection we noted that the practice was performing poorly in relation to carrying out asthma reviews. Since then, the practice had carried out an audit of all patients who were prescribed medicines for asthma related symptoms. The practice had carried out reviews with patients to confirm the diagnosis and review their medicines. The electronic records system had been updated with the appropriate diagnostic coding so patients would be routinely recalled for further review.
• Immunisation rates were high for standard childhood immunisations. The practice encouraged pregnant women to have the flu and pertussis vaccinations (whooping cough).
• Appointments were available outside of school hours and the premises were suitable for children and babies, for example with baby changing facilities.
• 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.
• Alerts were added to the electronic records of vulnerable children and parents and those with complex needs to ensure that staff members were aware of any issues.
• The practice liaised health visitors and school nurses to support families and children, for example in following up potential safeguarding concerns.

• One of the GPs had a special interest and training in paediatrics.
• The practice provided family planning and sexual health services (for example chlamydia screening) including to young people with capacity to consent.

Updated 10 August 2017

The provider was rated as good for the care of older people.

• The practice offered personalised care to meet the needs of the older people in its population.

• The practice maintained a register of patients who were housebound and offered home visits for those too unwell to attend the surgery.

• For those older patients identified with the most complex needs and at risk of sudden deterioration, the practice carried out care planning.

• The practice had recruited a pharmacist who provided support to GPs on reducing polypharmacy in older patients (that is where patients are taking multiple medicines with potential adverse interactions) and medicines reviews.

• The practice worked with a local enhanced nurse practitioner who was able to visit patients at home.

• Since our previous inspection, the practice had improved arrangements for multidisciplinary working and coordination between different agencies. The practice now held regular multidisciplinary meetings at the practice involving the district nurses and the enhanced nurse practitioner.

• The practice had introduced palliative care meetings since our previous inspection. These were attended by the palliative care nurse and district nurse.

• The practice offered eligible older patients the seasonal influenza, pneumococcal and shingles vaccinations.

Updated 10 August 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 available outside of working hours.

• The practice offered online services, telephone consultations and text messaging. The practice was equipped to offer online consultations and was waiting for approval from the clinical commissioning group to start providing this facility.

• The practice provided a full range of health promotion and screening reflecting the needs for this age group.

• The practice was open every Saturday morning. GP, nurse and health care assistant appointments were available before 9am and after 5.30pm during the week.

• Patient uptake for the cervical screening programme in 2015/16 was below average at 67% compared to the local average of 77%. Exception rate reporting was 4% compared to the CCG average of 11%. Unverified data for 2016/17 did not show any significant improvement.

Updated 10 August 2017

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

• The practice held monthly clinics with a primary care mental health nurse for patients with mental health problems.
• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
• The practice carried out advance care planning for patients with dementia including consideration of ‘do not resuscitate’ decisions. The practice involved patients and carers in care planning and considered carers’ needs, for example for respite care.
• The practice was able to signpost patients experiencing poor mental health to various support groups and voluntary organisations.
• The practice referred or signposted patients experiencing stress and mental distress to local counselling services.
• The practice had a system in place to follow up patients who had attended accident and emergency for example for self-harm or who were known to have mental health problems.

Updated 10 August 2017

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

• The practice held registers of patients living in vulnerable circumstances including a register of patients with a learning disability. The practice completed annual health action plans for patients with a learning disability which included a face to face health review.

• Vulnerable patients were supported to register at the practice.

• The practice offered longer appointments for patients with a learning disability, patients with an interpreter or other complex needs.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access support groups and voluntary organisations, for example the local carers associations.

• 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.