Archived: Colney Hatch Lane Surgery

Updated 19 April 2018

Colney Hatch Lane Surgery is located in Muswell Hill, North London. It is one of the member GP practices in Barnet Clinical Commissioning Group (CCG). The practice is located in the fifth less deprived decile areas in England. Census data shows 10% to 20% of the local population does not speak English as their main language. At 81 years, male life expectancy is higher than the England average of 79 years; and at 86 years, female life expectancy is higher than the England average of 83 years.

The practice has approximately 5,500 registered patients.

The practice population distribution is mostly similar to the England average although there is a greater proportion of patients in the 25 to 44 years age group and fewer patients in the 60 to 85 plus age groups. Services are provided under a General Medical Services (GMS) contract (a contract providing general primary medical services) with NHS England.

There are three GP consulting rooms and one treatment room. The GP principal and the salaried GP together provide the equivalent cover of two whole time GPs (both male). There is a regular locum GP who provides cover when needed and additional capacity in winter months when demand on the service is higher. There are two part time female practice nurses and a health care assistant. The practice also has a practice manager and a number of reception and administration staff members.

The practice’s opening times are Monday to Friday 8am to 1pm and 2pm to 6:30pm and appointment times are as follows:

• Monday: 9am to 11:30am and 4pm to 8pm

• Tuesday: 9am to 11:30am and 4pm to 8pm

• Wednesday: 9am to 11:30am and 4pm to 6:30pm

• Thursday: 9am to 11:30am and 4pm to 6:30pm

• Friday: 9am to 11:30am and 4pm to 6:30pm

Urgent appointments are available each day and GPs also complete telephone consultations for patients. In addition, the practice is a member of the Pan Barnet federated GP’s network; a federation of local Barnet GP practices which was set up locally to provide appointments for patients at local hub practices on weekday evenings and weekends when the practice is closed. There is also an out of hour’s service that provides cover for the practice including telephone calls when the practice is closed.

Colney Hatch Lane Surgery is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury from one location.

Updated 19 April 2018

We carried out an announced comprehensive inspection at Colney Hatch Lane Surgery on 2 August 2017. The overall rating for the practice was requires improvement. The full comprehensive report on 2 August 2017 inspection can be found by selecting the ‘all reports’ link for Colney Hatch Lane Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused follow up inspection carried out on 20 February 2018 to confirm that the practice had carried out their plan to correct the issues that we identified in relation to identifying, monitoring and mitigating risks, knowledge of national guidelines incident reporting, quality improvement, involvement in multidisciplinary meetings, inadequate cytology rates and governance structure in our previous inspection on 2 August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Although the practice now documented internal clinical meetings, there was no participation in multidisciplinary meetings.

• The practice had a good system of dealing with complaints, but did not discuss the learning and outcomes of complaints at relevant practice meetings.

• There was no system to identify vulnerable patients and there was no child safeguarding register.

• The practice vision and strategy with associated business plans were not formally documented and discussed.

• There was an open and transparent approach to safety and effective systems in place for recording and reporting significant events.

• The practice carried out risk assessments, including health and safety and fire safety.

• There was a process to review Quality Outcomes Framework (QOF) exception reporting rates where the practice was now achieving below the CCG and national averages.

• The practice had a system in place to monitor, review and improve inadequate cytology rates.

• There was evidence of quality improvement and the practice made good use of clinical audits.

• Clinical guidelines and patient safety alerts were discussed in clinical meetings where learning was shared.

• Blank prescriptions were secured and there use was effectively monitored.

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However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Continue to work to improve inadequate cytology rates.

• Consider a system for multidisciplinary meeting involvement.

• Continue to monitor and review the child protection register.

• Review how vulnerable patients are highlighted on the clinical system.

• Ensure the system to discuss learning from complaints is implemented.

• Formalise the practice vision and strategy.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 2 October 2017

The provider was rated as requires improvement for being safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 69% of patients with diabetes, on the register, now had their last blood sugar level is 64 mmol/mol or less in the preceding 12 months; an 8% improvement on 2015/16 bringing performance more in line with local and national outcomes. 74% of patients with diabetes, on the register, now had their last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less; an increase of 6% on 2015/16 bringing performance more in line with local and national outcomes.

• 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 and this was arranged on a case by case basis.

Updated 2 October 2017

The provider was rated as requires improvement for being safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• Immunisation rates were comparable 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.

• 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 and post-natal clinics.

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

Updated 2 October 2017

The provider was rated as requires improvement for being safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 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. However, some older people did not have care plans where necessary.

• 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.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• 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 2 October 2017

The provider was rated as requires improvement for being safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 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 access to weekend appointment via a 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 2 October 2017

The provider was rated as requires improvement for being safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

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

• Performance for dementia related indicators was below the national average. Seventy five percent of patients diagnosed with dementia had had their care reviewed in the preceding 12 months compared with a local CCG average of 85% and a national average of 84%.

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

• 84% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months; an 8% increase on 2015/16 bringing performance more in line with local and national outcomes.

• 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 2 October 2017

The provider was rated as requires improvement for being safe, effective and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 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 on a case by case basis. However, the practice was not meeting regularly with local professionals to coordinate patient care and information sharing in order to better meet the needs of its most 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.