Archived: Boundary Surgery

Updated 31 October 2017

Boundary Court Surgery is located in Upper Edmonton in the London Borough of Enfield, North London. The practice serves a deprived population. It is located in the most deprived ward in Enfield and falls within the most deprived ten per cent of all areas in England. It serves a highly mobile and ethnically diverse population, and a significant number of patients speak English as an additional language. The population in Enfield overall is younger than the England average, yet there is a comparatively high prevalence of long term conditions such as diabetes, hypertension and severe enduring mental illness. Childhood immunisation rates and participation in national cancer screening programmes in Edmonton are lower than the Enfield and London averages. Life expectancy in Edmonton is nine years less than life expectancy in the more prosperous areas in the borough.

The services provided by the practice include child health care, ante and post natal care, immunisations, sexual health and contraception advice and management of long term conditions.

The practice holds an Alternative Provider Medical Services (APMS) contract. This is a locally negotiated contract open to NHS practices, voluntary sector or private providers. The patient list size is approximately 3,900.

The staff team comprises one male salaried lead GP and one female long term locum GP (providing a combined 20 sessions per week) in addition to one female practice nurse (providing 8 sessions per week), a practice manager and administrative/reception staff. The provider’s Medical and Clinical Directors also provide strategic clinical and management support to Boundary Court Surgery and three other practices in the borough.

The practice’s opening hours are:

• Monday to Friday: 8:00am -6:30pm

The practice offers extended hours opening at the following time:

• Saturday: 9am-1pm

Appointments are available at the following times:

• Monday - Friday: 9am-12:30pm and 2:30pm -6:30pm

• Saturday: 9:30am-12:30pm

Outside of these times, cover is provided by out of hours provider: Barndoc Healthcare Limited.

The practice is registered to provide the following regulated activities which we inspected:

Treatment of disease, disorder or injury; Diagnostic and screening procedures and Family planning.

Updated 31 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boundary Court Surgery on 23 August 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; although satisfaction with how patients were involved in decisions about their care and treatment was below local and national averages.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The provider had taken recent action in order to improve appointments access and on the day of our inspection urgent same day appointments were available, in addition to routine appointments being available within 24 hours.
• 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 the lead GP. The practice proactively sought feedback from staff which it acted on.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure that appropriate arrangements are in place to control the risk from Legionella (a term for a particular bacterium which can contaminate water systems in buildings).

• Develop systems for providing support to carers.

• Continue to monitor and seek improvements in national GP patient satisfaction on the extent to which patients are involved in decisions about their care.

• Consider new ways of increasing the membership of its patient participation group.

From 1 October 2014 to 31 July 2016, this service was provided on a caretaking basis by a CQC registered organisation: Evergreen Surgery Limited. This was following a July 2014 CQC inspection which highlighted concerns and which resulted in enforcement action against the then GP provider partnership. The two GPs constituting this partnership retired in October 2014.

We conducted an inspection of the caretaker organisation in July 2015 and overall the practice was rated as good. In August 2016, NHS England awarded the contract to deliver this service to Enfield Healthcare Alliance; a consortium of local GPs and of which Evergreen Surgery Limited was a founding member. In November 2016, Enfield Healthcare Alliance registered Boundary Court Surgery with the CQC as one of its locations.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 31 October 2017

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

• The practice had introduced software which enabled the generation and despatch of bespoke patient recall letters and blood forms for patients with long term conditions. Staff spoke positively about how the service had helped improve the practice’s QOF performance.

• For example, 88% of patients with diabetes had a blood sugar level which was within the required range compared with the respective 89% and 91% CCG and national averages.

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

• 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.

Updated 31 October 2017

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

• There were systems 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.

• Immunisation rates were either at or near the national 90% target.

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

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

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

Updated 31 October 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.

Updated 31 October 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.

• 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 31 October 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.

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.

• 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.

Updated 31 October 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 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.