22 March 2017
The Morris House Group Practice is based in the Lordship Lane Primary Health Care Centre located at 239 Lordship Lane London N17 6AA in a predominantly residential area of Tottenham in the London Borough of Haringey.
The part of the Health Care Centre leased by the provider includes 10 consulting rooms and three treatment rooms and a large reception and waiting area which is shared with the provider of NHS community services in the centre. All rooms used for patient care are based on the ground floor and administration offices are based on the first floor of the building.
Haringey Clinical Commissioning Group (CCG) is responsible for commissioning health services for the locality.
Services are delivered under a General Medical Services (GMS) contract. (A GMS contract is a nationally negotiated contract for the provision of services in general practice).
The practice is registered with the CQC as a Partnership of five partners (four GPs and one Practice Manager). The partnership is registered to provide the regulated activities of family planning; maternity and midwifery services; treatment of disease, disorder and injury, surgical procedures and diagnostic and screening procedures.
The practice has 12500 registered patients. The practice age distribution is similar to the national average with a slightly higher than average number of patients in the 40 to 55 year age group. The surgery is based in an area with a deprivation score of 1 out of 10 (with 1 being the most deprived and 10 being the least deprived).
GP services are provided by four GP partners, three male and one female (3.4 wte); four female part-time salaried GPs (3 wte) and two GP trainees. At the time of the inspection two of the salaried GPs employed by the practice were on maternity leave (1.3 wte) and locum GPs were used to cover their sessions when required.
Clinical services are also provided by a Nurse Practitioner (1 wte); a Practice Nurse (0.8 wte) and two Health Care Assistants (1.8 wte).
Administrative services are provided by the Practice Manager (1.0 wte) Assistant Practice Manager (1.0 wte), Senior Receptionist (1.0 wte) and 13 administration/reception staff (9.65 wte).
The surgery is a teaching and training practice providing placements for up to three GP trainees each year and placements for medical students from Kings College London and registered nurses undertaking practice nurse training with the South Bank University. All partners and the Nurse Practitioner were involved in the practice training programme.
The practice reception is open from 7.30am to 7pm on Monday and Wednesday; from 8am to 7pm on Tuesday; from 7.30am to midday on Thursday and from 7.30am to 6.30pm on Friday.
The practice telephone lines are open between 8am and 6.30pm Monday to Friday except Thursday when the telephone lines close at 1pm. On Thursday afternoons, between 1pm and 6.30pm, Barndoc is the out-of-hours service provider. The contact number for this service is provided on the practice answerphone message and website.
The surgery is closed at weekends.
Pre-booked and urgent appointments are available with a GP from 7.30am to 7.15pm on Monday and Wednesday; from 9am to 7.15pm on Tuesday; from 7.30am to midday on Thursday and from 7.30am to 6.30pm on Friday.
Appointments are available with the Nurse Practitioner from 7.30am to 4.30pm on Monday; from 8am to midday and 2pm to 5.30pm on Tuesday; from 8.30am to 5pm on Wednesday and from 8am to midday on Friday.
Appointments are available with the Practice Nurse from 8.30am to 5.30pm on Monday and Tuesday and from 8.30am to 1pm on Wednesday.
Appointments are available with a Health Care Assistant from 9.30am to 3.30pm on Monday; from 9am to 3pm on Tuesday; from 9am to midday on Thursday and from 9.30am to 3pm on Friday.
When the surgery is closed urgent GP services are available via NHS 111 (apart from Thursdays between 1pm and 6.30pm when GP services are available via an alternative number).
22 March 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at The Morris House Group Practice on 19 January 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 an effective system 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.
- Data from the Quality and Outcomes Framework showed that patient outcomes for most indicators were comparable to the local and national averages. However, the Clinical Exception Reporting rate was above the local and national average.
- Patients said they were treated with compassion, dignity and respect and felt involved in decisions about their care and 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.
- The GP patient survey results showed that patient’s satisfaction with regards to booking appointments was below the local and national average. Patients said they often found it difficult to make an appointment with a GP and had difficulty getting through to the surgery by telephone.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- The practice had identified only 51patients as carers (0.4% of the practice list).
- There was a clear leadership structure and staff felt supported by management.
- The practice sought feedback from staff and patients, which it acted on. However, there was no active patient participation group.
- The provider was aware of and complied with the requirements of the duty of candour.
The areas where the provider should make improvements are:
- The provider should continue to monitor patient satisfaction rates regarding booking routine and urgent appointments and implement improvements as appropriate.
- The provider should continue to develop and implement a clinical quality improvement programme aimed at reducing the exception reporting rate for the Quality and Outcomes Framework (QOF).
- The provider should record batch numbers of blank electronic prescriptions placed in individual printers and maintain records when prescription pads are assigned to individual GPs.
- The provider should consider proactive strategies to encourage patients to join a patient participation group (PPG) and establish regular communication with group members.
- The provider should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure that information, advice and support is made available to all carers registered with the practice.
Professor Steve Field CBE FRCP FFPH FRCG
Chief Inspector of General Practice
22 March 2017
The practice is rated as good for the care of people with long-term conditions.
- Nursing staff worked closely with GPs and community specialist nurses in the management of patients with long-term conditions.
- Patients at risk of hospital admission were identified as a priority.
- The practice performance rate for the Quality and Outcomes Framework (QOF) diabetes related indicators was comparable to the local and national average.
- Longer appointments and home visits were available when needed.
- Patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
- For those patients with the most complex needs the GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The management of patients with complex needs were discussed at weekly teleconference multi-disciplinary team meetings held with local hospital clinicians.
22 March 2017
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 who were at risk, for example, children and young people who had a high number of A&E attendances.
- Immunisation rates for all standard childhood immunisations were comparable to national targets.
- Children and young people were treated in an age-appropriate way.
- The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages. Sample taking for cervical smears was carried out by both GP and nursing staff to improve access for patients.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- We saw evidence of joint working with health visitors who attended six-weekly safeguarding meetings at the practice to discuss children of concern.
22 March 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.
- Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to local
and national averages
- The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
22 March 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, flexible and offered continuity of care.
Extended hours appointments were available at the surgery from 7.30am four mornings a week and up to 7.15pm three evenings a week.
The practice was proactive in offering online services. An application form for access to on-line access was included in new patient registration packs to encourage uptake of the service.
A telephone consultation call-back service was available for patients who required telephone advice only.
A full range of health promotion and screening services were provided that reflected the needs of this age group.
22 March 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local average of 83% and national average of 84%.
100% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was comparable to the local average of 83% and national average of 89%.
- 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 informed 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 had been experiencing poor mental health.
- A dedicated mental health review clinic was in place with a nurse and GP both in attendance to ensure both a physical and mental health screening and management review could be undertaken sequentially.
- Staff had a good understanding of how to support patients with mental health needs and dementia.
22 March 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 and those with a learning disability.
The practice offered longer appointments and annual reviews for patients with a learning disability. 70% of patients on the learning disability register had received an annual review.
The practice regularly worked with other health care professionals in the case management of vulnerable patients.
The practice informed vulnerable patients 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.
The practice had a higher than average number of patients who were refugees or victims of torture. These patients were referred to appropriate local support services and an alert was placed on the patient’s records.