Archived: North Road Surgery - Crowley

Updated 2 August 2016

North Road Surgery provides primary medical services in Kew to approximately 7000 patients and is one of 29 practices in Richmond Clinical Commissioning Group (CCG). In 2012 the practice had registered around 1000 patients at very short notice following the closure of a nearby practice.

The practice population is in the least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 7%, which is lower than the CCG average of 9%, and for older people the practice value is 10%, which is lower than the CCG average of 11%. The practice has a smaller proportion of patients aged 15 to 29 than the CCG average, and a slightly larger proportion of patients aged 35 to 40 years and over 85 years. Of patients registered with the practice, the largest group by ethnicity are white (86%), followed by asian (8%), mixed (4%), black (1%) and other non-white ethnic groups (2%).

The practice operates from a 2-storey converted residential premises. Car parking is available on in the surrounding streets. The reception desk, waiting area, and consultation rooms are situated on the ground floor. An administrative area is on the first floor, which is accessible by a flight of stairs. The practice has access to three doctors’ consultation rooms, one nurse consultation room and one healthcare assistant’s consultation room. During the inspection the practice explained that lack of space was a challenge and that they did not have a sufficient number of consulting rooms available for the list size (which had risen dramatically at very short notice due to them agreeing to accept a share of patients from a local practice which closed suddenly). They told us that they had been raising this with NHS England for some time, and that they had recently identified a suitable site to move to, but were in the process of arranging funding.

The practice team at the surgery is made up of three part time female GPs and two full time male GP who are partners; in total 31 GP sessions are available per week. In addition, the practice also has one part time female nurse, one part time male nurse, one part time male healthcare assistant and a part time practice pharmacist. The practice team also consists of a practice manager, seven reception/administrative staff, two secretaries, and a notes summariser.

The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice building and phone lines are open between 8:30am and 6pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning, and 2:30pm to 6pm every afternoon. Extended hours surgeries are offered between 7am and 8am and between 6:30pm and 7:30pm on Wednesdays. Patients can also access appointments via the CCG seven-day opening Hub, which offers appointments from 8am until 8pm every day.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; family planning services; maternity and midwifery services; treatment of disease, disorder or injury and surgical procedures.

Updated 2 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Road Surgery on 19 May 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 with the exception of those relating to Legionella.

• 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.
• We saw evidence of clinical audit; however, there was little evidence of this being used to drive improvements, and there was no audit schedule in place.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice had processes in place to identify carers, and they had identified approximately 1% of the practice’s list. They offered pro-active support to these patients.
• 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.
• Overall, 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 made good use of the facilities they had available and were in the process of securing larger premises to move into.
• 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.
• Policies and procedures were available to all staff, and there were processes in place for communicating to staff about changes to these.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw three areas of outstanding practice:

• The practice had a policy of continuing to provide a service to patients who were vulnerable or who had ongoing care needs once they had moved out of the area, until the patient was satisfied with the package of care had been established in their new area. This policy was applied, for example, to patients who were receiving cancer treatment, or who were substance misusers.
• The practice had employed an expert in their patient record computer system to interrogate the system in order to identify patients who were suffering from, or likely to develop, a long-term condition. As a result of this work, the practice’s prevalence of patients with Chronic Heart Disease increased from 1.81% in 2014/15 to 2.14% in 2015/16. The practice also reviewed their systems for calling patients with long-term conditions for reviews, and began to liaise more closely with specialist teams to co-ordinate these reviews. As a result, the percentage of the practice’s patients with chronic obstructive pulmonary disease (COPD) who had received an assessment of breathlessness in the preceding 12 months rose from 76% in 2014/15 to 91% in 2015/16.

The areas where the provider should make improvement are:

• They should ensure that they are using clinical audit in order to drive improvement.
• They should ensure that they are taking all necessary action to manage the risk of Legionella.
• They should put in place a system to track and monitor prescription pads.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 2 August 2016

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.
• Performance for diabetes related indicators were mixed. Overall the practice achieved 82% of the total Quality and Outcomes Framework (QOF) points available, compared with an average of 90% locally and 89% nationally. The proportion of diabetic patients who had a record of well controlled blood pressure in the preceding 12 months was 81%, which was above the Clinical Commissioning Group (CCG) average of 80% and national average of 78%. The proportion of these patients with a record of a foot examination and risk classification in the preceding 12 months was 91% (CCG average 91%, national average 88%), and the percentage of diabetic patients who had received influenza immunisation was 90% (CCG average was 90% and national average was 94%). The proportion of newly diagnosed diabetic patients who were referred to a structured educational programme within nine months of diagnosis was 50% (with an exception rate of 43%), which was below the CCG average of 94% and national average of 90%; however, we saw evidence that for the 2015/16 reporting year the practice had achieved 100% for this indicator.
• The practice had employed an expert on their patient records system to review the system in order to identify as many patients as possible who potentially had, or were likely to develop, a long term condition, in order to ensure that these patients received the required treatment and monitoring.
• 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.

Updated 2 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 Accident and Emergency (A&E) attendances. In addition to a child protection register, the practice also held an “in need” register which identified children who could potentially be vulnerable.
• 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.
• Cervical screening had been carried-out for 80% of women registered at the practice aged 25-64, which was comparable to the Clinical Commissioning Group (CCG) average of 84% and national average of 82%.
• 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.
• The practice provided new baby checks following home births.

Updated 2 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 provided a service to two nursing homes, one of which housed elderly mentally ill patients.
• The practice kept a register of patients who were housebound, so that arrangements could be made for these patients to receive preventative care (such as flu vaccinations) and appointments when they were needed.

Updated 2 August 2016

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 reflected the needs for this age group.
• The practice sent appointment reminders and health promotion information by text message.

Updated 2 August 2016

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

• The practice had 68 patients diagnosed with dementia and 86% had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the Clinical Commissioning Group (CCG) average of 86% and national average of 84%.
• The practice had 56 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 93% of these patients, compared to a CCG average of 94% and national average of 88%.
• 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, and provided care to patients in two nursing homes, one of which housed elderly mentally ill patients.

Updated 2 August 2016

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

• The practice had processes in place to register patients of no fixed abode or who were temporarily residing in the area, such as travellers.
• The practice registered patients from a nearby facility for people who had recently been released from prison, and worked with the staff there and the wider multidisciplinary team to ensure that these patients were being provided with appropriate treatment and that any risks relating to their previous offending were managed.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and offered longer appointments to these patients.
• 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.
• The practice had a policy of continuing to provide a service to patients who were vulnerable or who had ongoing care needs once they had moved out of the area, until a package of care had been established in their new area.