Skyways Medical Centre

Updated 6 February 2017

Skyways Medical Centre provides NHS primary medical services to around 4500 patients in Hounslow. The service is provided through a general medical services contract.

The current practice clinical team comprises two GP partners and three regular locum GPs. The GPs typically provide around 20 sessions in total each week. The practice employs two practice nurses (part time) and a phlebotomist. The practice also employs a practice manager and administrative and reception staff. Patients have the choice of seeing a male or female GP.

The practice is open from 8am-6.30pm Monday to Friday. The practice additionally runs extended hours surgeries from 6.30pm-8pm on Monday and Friday evenings. The practice offers online appointment booking and an electronic prescription service. Same day and longer appointments are available for patients with complex or more urgent needs. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. 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 on a recorded telephone message.

The practice is located in a converted property which has been further extended and modernised in 2016.

The practice population age profile is similar to the English national average with around 5% of patients aged under five and 15% of patients aged over 65. The population in the practice area is characterised by average life expectancy and employment rates. The practice population is ethnically and culturally diverse with a relatively high proportion of patients of Indian heritage.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; maternity and midwifery services and treatment of disease, disorder and injury. The practice has not previously been inspected by CQC.

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Skyways Medical Centre on 27 September 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.
• Most 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 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.
• Patients said they found it easy to make an appointment with urgent appointments available the same day and routine appointments usually available within one week.
• 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.

The areas where the provider should make improvement are:

• The practice should ensure that any follow-up or 'fail-safe' procedures for example in relation to urgent referrals are effectively designed, implemented and reviewed.
• The practice should risk assess its prescription security measures to ensure that its systems are sufficient to protect against the loss or misuse of prescription materials.
• The practice should improve the uptake of recommended child immunisations to meet the national 90% targets.
• The practice should ensure it includes the date of creation or review on all key documents and policies to reduce the risk of confusion.
• The practice should consider introducing some form of internal 'appraisal' process for the GP partners to ensure that their personal and practice-related development needs are identified.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 February 2017

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

• The practice had improved its performance on the Quality and Outcomes Framework (QOF) achieving 96.4% in 2015/16.
• The practice kept registers of patients with long term conditions. These patients had a structured annual review to check their health and medicines needs were being met.
• The practice ran clinics for diabetes and patients receiving anticoagulant therapy. The practice offered insulin initiation when appropriate.
• The practice operated call-recall systems to encourage patients with long-term conditions to attend for their review.
• Practice performance for diabetes had improved markedly and was now above average. The percentage of diabetic patients whose blood sugar levels were adequately controlled was 85% compared to the clinical commissioning group average of 75% and the national average of 78%.
• Patients identified as at risk were reviewed and had a personalised care plan. Cases were discussed at regular multidisciplinary meetings.

Updated 6 February 2017

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

• The practice offered pre-conception, maternity and postnatal services.
• 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.
• The practice had not met the 90% national targets for standard childhood immunisations. For example, in 2015/16, 80% of children had received the recommended vaccinations by the age of one.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. The premises were suitable for children and babies.
• Appointments were available outside of school hours. Young children and young people in vulnerable circumstances had priority access to same day appointments.

• We saw positive examples of timely communication and referral to health visitors, midwives and other health services.

Updated 6 February 2017

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, care planning and urgent appointments for those with enhanced needs. The practice nurse and GPs carried out home visits when appropriate.
• All patients over 65 were offered the annual flu vaccination. Housebound patients were able to have the flu vaccination at home.
• The practice also offered the shingles and pneumococcal vaccines to eligible older patients.
• The practice made use of relevant community health and other services, for example domiciliary phlebotomy, the falls clinic, carers centre. The practice had access to a local care coordinator who could assist for example if an older patient was socially isolated.

Updated 6 February 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 accessible and flexible.
• Appointments were available until 8pm two days a week. GP and nurse appointments were available in the evening.
• The practice offered a range of ways to access services, for example telephone consultations with a GP, online appointment booking and an electronic prescription service.
• The practice offered a full range of health promotion and screening services reflecting the needs for this age group, including NHS health checks for patients aged 40-74.
• 73% of eligible women registered with the practice had a recorded cervical smear result in the last five years compared to the CCG average of 78%.

Updated 6 February 2017

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

• 98% of patients with dementia had attended a face to face review of their care in the last year compared to the CCG average of 86%.
• All patients diagnosed with psychosis had a comprehensive care plan recorded in their notes compared to the CCG average of 89%.
• The practice was participating in a local audit to identify patients currently under the care of the local mental health services who could benefit from transfer to primary care.
• The practice liaised with specialist teams in the case management of patients experiencing poor mental health or who showed signs of becoming unwell.
• The practice was able to advise patients experiencing poor mental health and their carers how to access various support groups and voluntary organisations. The practice facilitated mental health advocacy when appropriate.
• 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.

Updated 6 February 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 people with a learning disability.
• The practice offered longer and same day appointments for patients with a learning disability or who were otherwise vulnerable due to their circumstances.
• The practice maintained a register of patients who were also carers. Carers were offered regular reviews and flu vaccination and referred to the local carers centre.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Patients with no fixed address were supported to register at the practice.
• 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.