25 August 2016
St Peter's Street Medical Practice operates from 16 and a Half St Peter's Street, London, N1 8JG, converted domestic premises, owned by the practice. It is close to Islington Angel and has good transport links nearby.
The practice provides NHS services through a General Medical Services (GMS) contract to approximately 10,700 patients. It is part of the NHS Islington Clinical Commissioning Group (CCG) which is made up of 38 general practices. The practice is registered with the CQC to carry out the regulated activities Treatment of disease, disorder or injury, Family planning. The patient profile for the practice has a higher than average working age population, with a lower than average number of teenagers and patients aged over-50.
The practice has a clinical team of six partner GPs (four female and two male) and a salaried female GP. Two of the partners work part time; the other GPs work full time. The GPs worked between five and seven clinical sessions per week. It is a training practice, with one female registrar (a qualified doctor gaining general practice experience) currently placed there. There is a practice nurse manager, who was on maternity leave at the time of our inspection, and a female health care assistant, who works part time. Locum nurses are being used to cover. There is a practice manager and deputy and an administrative and reception team of eleven staff.
The practice’s opening hours are 8.30 am to 6.30 pm, Monday, Tuesday and Friday; 8.30 am to 2.45 pm on Wednesday; and 8.30 am to 8.45 pm on Thursday. Appointments can be booked for consultations between 8.30 am to 10.00 am each morning; from 3.00 pm until 6.30 pm on Monday, Tuesday and Friday; from 1.30 pm to 2.45 pm on Wednesday; and from 3.00 pm until 8.45 pm on Thursday. Morning and afternoon appointments may be booked up to four weeks in advance. Appointments for Thursday evening can be booked up to one week in advance. In addition, the practice operates a walk-in service each morning from 10.00 am. Patients wishing to use the walk-in clinic are required to attend the practice between 8.30 am and 10.00 am, to add their name to the clinic list and they are be given an estimated time slot. Patients aged over-75 can register for the walk-in clinic by phone. GPs cover the walk-in service by pre-arranged rota. The GPs conduct telephone consultations with patients and make home visits.
The practice is closed at weekends, but a number of weekend appointments are available under a local scheme operating from three locations in 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.
Routine appointments with preferred GPs can be booked up to four weeks in advance. Pre-booked appointments are 10 minutes long, but patients may book double appointments if there are a number of healthcare issues to discuss, or if interpreting services are required. Walk-in consultations are not limited to 10 minutes. Appointments with nurses are 15 minutes long. Patients can book appointments online if they have previously registered to use the system. Patients who have provided the practice with their mobile telephone numbers are sent text reminders of their appointments.
25 August 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection on 14 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.
- Patients said they sometimes encountered delays when making appointments. However, the practice operated a walk-in clinic each weekday morning for which no appointment was needed.
There were some areas where the practice should make improvements:
- The practice should consider making more information available to patients clarifying how the walk-in clinics operate and the availability of telephone consultations.
- It should continue to review its staffing levels particularly relating to the nursing team.
- It should consider arranging for clinical staff to regularly attend meetings with the patient participation group.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
25 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.
- All 1,527 patients with recorded long-term health conditions 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 maintained a register of 309 patients with diabetes, of whom 278 were eligible for a foot examination and risk assessment. Data showed that 263 patients (95%) had undergone a foot examination.
- The practice’s performance relating to diabetes care was above local and national averages.
- The practice maintained of register of 43 patients with heart failure, of whom 30 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.
25 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.
- 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 and a monthly clinic with the health visitor.
- The practice had introduced chlamydia self-testing to improve detection and treatment following an in-house audit.
25 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. Eighty-six patients aged over 75 years were recorded on the register, all of whom had up to date care plans.
- Records showed that 13 patients aged over 65 years were prescribed four or more medications; 10 (77%) of whom had had a medication review in the last 12 months.
- Patients aged over-75 could book slots in the daily walk-in clinics by telephone.
- The uptake for bowel cancer screening was above the local average.
25 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, but some patients were not aware of this.
- The practice’s uptake for the cervical screening programme was 84%, being above the local and national averages.
- Data showed that 5,312 patients (62% of those eligible) had undergone blood pressure checks in the last five years.
25 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 31 patients. Data showed that 27 patients (90%) had had their care reviewed in a face-to-face review in the preceding 12 months, being above both local and national averages.
- 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 90 patients with severe mental health problems, 95% of whom had an agreed care plan documented in their records, being above both local and national averages.
- 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.
25 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 travellers (two patients) homeless people (11), and those with a learning disability (21).
- The practice offered longer appointments for patients with a learning disability. Patients on the learning disability register had been sent three invitations for an annual health check in the last 12 months; 14 of whom had attended for the check. All patients on the register had a named GP.
- 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.