Archived: The Muswell Hill Practice

Updated 4 August 2017

The Muswell Hill Practice is located in Muswell Hill, North London and is part of the NHS Haringey Clinical Commissioning Group (CCG) which is made up of 51 practices. It currently holds a General Medical Service (PMS) contract (an agreement between NHS England and primary care practices for delivering primary medical services). The practice provides a range of enhanced services including adult and child immunisations, proactive support for people living with dementia, and identifying patients who are at high risk of avoidable unplanned admissions.

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

The practice had a patient list of approximately 13,645 at the time of our inspection.

The staff team at the practice includes four GP partners (three male and one female) which accounts for 2.9 working time equivalent (WTE) hours. In addition, four salaried GP’s (three female and one male) which accounts for 2.3 WTE hours. There are three practice nurses (female) and one healthcare assistant (female) working 3.2 WTE hours in total. To support the practice and patients there are a team of administrators; including a practice manager, working in total 9.6 WTE hours. All staff work a mix of part time hours. The practice has a keen focus on education and is a training practice. It provides placements for GP registrars, GP returners and those training as practice nurses. The practice currently has three GP registrars and one practice nursing trainee. The practice was also the first in Haringey CCG to recruit it’s own Pharmacist to support safe and effective prescribing at the practice.

The practice opening hours are:

Monday        8:00am to 6:30pm

Tuesday       8:00am to 6:30pm

Wednesday  8:00am to 6:30pm

Thursday      8:00am to 6.30pm

Friday           8:00am to 6.30pm

Saturday      Closed

Sunday        Closed

In addition, pre-booked doctor’s appointments are available during extended hours from 7.30am to 8.00am on weekdays, and 6.30pm until 8.00pm on Thursday evenings. Late nursing appointments are also available until 8.00pm on Thursday evenings.

Urgent appointments are available each day and GPs also complete telephone consultations for patients. In addition, the practice is a member of the Pan Haringey federated GP’s network a federation of local Haringey GP practice’s which was set up locally to provide appointments for patients at local hub practice’s between 8am and 8pm; providing additional access out of hours. There is also an-out of hour’s service provided to cover the practice when it is closed. If patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on their circumstances. Information on the out-of-hours service is provided to patients via the practice website and practice leaflet as well as through posters at the practice.

The practice has a lower percentage than the national average of people with a long standing health conditions (48% compared to a national average of 53%). Seventy four percent of patients are in paid work or full time education compared with 63% nationally. The practice compares to the national average in terms of the proportion of patients aged under 18 (21% compared to 21% nationally). There are a lower percentage of patients who are aged 65 or more (12%) compared to the national average (17%).

Updated 4 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Muswell Hill Practice on 28 June 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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. However, patient survey results were mixed in relation to access to the practice.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Consider reviewing arrangements for medicines carried in GP doctor’s bags on home visits to ensure risks continue to be minimised in regard to medicines management.

• Review the appointment management system to consider the best way to provide access to patient’s preferred GP.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 4 August 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was above the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood sugar level is 64 mmol/mol or less in the preceding 12 months was 82% compared to a local CCG average of 73% and a national average of 78%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

• There is a weekly anti-coagulation clinic which manages 160 patients. This has received positive comments from the practice’s annual survey.

• Patients are encouraged to self-monitor their blood pressure using the practice’s blood pressure equipment. Telephone reviews are available.

• Patients have access to the Haringey Alcohol support service at the practice.

Updated 4 August 2017

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

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, every six weeks practice leads meet with the health visitor for under 5’s and review over 5’s and the most vulnerable children, including those on the child protection register.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for premature babies and their families following discharge from hospital.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The practice offers a wide range of on-site contraceptive services, including free condoms and long active reversible contraception.

• One evening a week there are extended hours with two nurses until 8pm as well as during week day mornings from 07.30am to 8.00am.

Updated 4 August 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• The practice has a dedicated GP who conducted a weekly ward round for local nursing homes providing continuity of care topatients.

• The health care assistant has been trained in administeringscreening for dementia.

• Where older patients had complex needs, the practice shared summary care records with local care services and referred the most vulnerable patients to the local integrated Locality team where both health and social care professionals work in an integrated way. Support focused on the most frail and avoiding hospital admission.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 4 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments and week day evenings were available through the local hub.

• 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.

Updated 4 August 2017

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

• The practice carried out advance care planning for patients living with dementia.

• Performance for dementia related indicators were similar to the national average. Seventy seven percent of patients diagnosed with dementia had had their care reviewed in the preceding 12 months compared with a local CCG average of 83% and a national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

• The practice hosts the local IAPT (Improving Access to Psychological Therapies) weekly as is able to refer patients for counselling support.

Updated 4 August 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 homeless people, travellers and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.