Archived: The Sheldon Practice

Updated 7 June 2016

The Sheldon Practice provides NHS primary medical services to around 2400 patients in the Cricklewood area of Brent through a General Medical Services contract. The partners own another four practices in London. This inspection focused on the service provided at The Sheldon Practice.

The practice staff team comprises the GP partner (female), two ‘long term locum’ GPs (male and female), a part-time practice nurse and a health care assistant. The practice has a practice manager (who is also a partner in the business), and employs a team of receptionists.

The practice is open from 8am until 6.30pm during the week except for Wednesday afternoon when the practice closes from 1pm. Appointments can be made between:

• 8.30am-11.30am Monday to Friday
• 4pm-6pm Monday, Tuesday, Thursday and Friday
• 6.30pm-8pm, Tuesday evening

The practice offers an electronic prescription service. 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, the website and on a recorded telephone message.

The practice differs from the average practice in England in having a larger proportion of young adults and a smaller proportion of patients aged over 65. The practice population is ethnically diverse and highly mobile with a relatively high number of patients joining and leaving the service each year. The prevalence of some chronic diseases, notably diabetes, is high locally.

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

We previously inspected the practice in December 2013 and June 2014. The practice was judged to be compliant with the regulations at its most recent visit in June 2014.

Updated 7 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Sheldon Practice on 22 December 2015. 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 the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect.
• Patients said they were involved in their care and decisions about their treatment but the practice scored below average on this aspect of the service in the latest national GP patient survey.
• Some patients told us they had to wait too long after their appointment time before being seen.
• 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 a named GP and there was continuity of care, with urgent appointments available the same day.
• 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:

• All staff should have annual basic life support refresher training and the practice should be able to evidence this.
• The practice should develop a register of patients who are carers and a strategy for identifying and supporting carers.
• The practice should develop its own internal programme of clinical audit to drive quality improvement in line with practice priorities.
• The practice should provide regular opportunities for non-clinical staff to meet as a team and keep minutes for future reference.
• The practice should review ways to increase patient uptake of bowel cancer screening.
• The practice should reduce delays and overrunning of appointments where possible.
• The practice should improve its patient feedback scores in relation to involving patients in decisions.
• The practice should introduce the facility to book appointments online.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 June 2016

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

• The practice maintained registers of patients with particular long-term conditions. Individual clinicians had lead roles for specific conditions and the practice ran clinics for common long-term conditions such as diabetes.
• Practice performance for diabetes related indicators tended to be similar or better than the national average. For example, the percentage of diabetic patients whose blood sugar levels were well controlled (that is, their most recent HbA1c measurement was 64 mmol/mol or below) was 72% compared to the national average of 78%. The percentage of diabetic patients whose last blood pressure reading was in the normal range was 86% compared to the national average of 78%. Ninety-seven per cent of the practice’s diabetic patients had a recorded foot examination within the last year which was higher than the national average of 88%.
• Patients with a long-term condition had a named GP and a structured annual review to check their health and medicines needs were being met. Longer appointments and home visits were available when needed.
• 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 participated in the Brent Integrated Care initiative and coordinated care with other community and social services teams and professionals as appropriate.

Updated 7 June 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. 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with health visitors, for example to follow up children who had not attended for immunisation. Staff had contact details for the local midwives and school nurses.

Updated 7 June 2016

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

• Around 4% of practice patients were aged 75 years or over. The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice participated in the Integrated Care Pilot in Brent with the intention of improving care for people over the age of 75 years with complex needs and preventing avoidable hospital admissions.
• The practice was able to demonstrate regular communication and coordination with other providers of care for older patients with complex needs, for example, the district nurses and the Brent ‘Starrs’ rapid response service.
• The practice was responsive to the needs of older people and offered home visits to older patients unable to travel to the surgery.
• The practice served an ethnically diverse population. The reception team were able to speak Gujarati, Hindi and Urdu which older patients in particular valued.
• The practice did not formally meet with the local palliative care team to review patients coming to the end of life but instead carried out joint visits to patients at home.

Updated 7 June 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.
• The practice offered evening opening hours one day a week and an electronic prescription service. The practice did not yet offer an online appointment booking facility but were planning to introduce this in the New Year.
• The practice offered a range of health promotion and screening services reflecting the needs for this age group.
• The practice encouraged patients who were sexually active or at risk to be tested for chlamydia and HIV.
• The practice’s coverage for the cervical screening programme was 80%, which was comparable to the national average of 82%.
• The practice provided family planning services. The practice displayed information about where to obtain emergency contraception out of hours on the practice door so this was visible when the practice was closed.

Updated 7 June 2016

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

• The practice had seven patients with a diagnosis of dementia. All but one had attended a face to face review of their care in the last year. We were told that the practice screened patients at risk of dementia and referred patients to a local memory clinic for further investigation and diagnostic tests.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice advised patients experiencing poor mental health 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.

Updated 7 June 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 people with a learning disability and patients recently arriving in the UK without family.
• However the practice did not maintain a register of patients who were also carers.
• 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.
• 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 shared with us several examples of how they had responded flexibly to patients in difficult circumstances, for example in one case, carrying out multiple home visits out of the practice catchment area.