Archived: Dr Renu Hans Also known as The Dartmouth Park Practice

Updated 3 March 2016

Dr Renu Hans (“the GP”) operates from 18 Dartmouth Park Hill, London NW5 1HL. Her surgery is also known as The Dartmouth Park Practice. The practice provides NHS primary medical services through a General Medical Services (GMS) contract to approximately 2,900 patients. The practice’s patient list increased by around 30% in November 2014, following the closure of two nearby GP surgeries. It is part of the NHS Islington Clinical Commissioning Group (CCG) which is made up of 38 general practices.

The practice’s clinical staff is made up of the GP, two part-time practice nurses and a male part-time healthcare assistant. Occasional use is made of locums to cover the GP’s absence. At the time of the inspection there was an administrative team of three.

The practice is open between 9.00am and 6.30pm on Monday, Tuesday, Wednesday and Friday. On Thursday it closes at 1.30pm. Telephones are answered from 8.30am. Bookable appointments are available from 9.00am to 11.00am, Monday to Friday. After 11.00am, the GP saw triaged emergency patients. The evening surgery for bookable appointments runs from 4.30pm to 6.00pm on Monday, Tuesday, Wednesday and Friday. Between 6.00pm and 6.30pm, only emergency patients are seen. A Saturday morning clinic, run by the GP or nurse, operates between 9.00am and 12noon.

The practice has opted out of providing an out of hours service. Patients calling the practice when it is closed are connected with the local out of hours service provider. There is also information provided to patients regarding a local walk in centre, a service which is available to all patients and open seven days a week, together with details of the NHS 111 service.

The practice is registered with the CQC to provide the following regulated activities - Diagnostic and screening procedures, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

The patient profile for the Islington CCG indicates a population of more working age people than the national average, with a particularly high proportion of younger adults in the 25 to 40 age range. There are a lower proportion of children and older people in the area compared with the national average.

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We carried out an announced comprehensive inspection on the 15 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.

• 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 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.

• Patients said they generally found it easy to make an appointment, 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.

• Risks to patients were assessed and well managed.

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

The practice should -

• Proceed with plans to obtain a defibrillator – a device used to restart a person’s heart in an emergency.

• Continue with efforts to increase the patient participation group to make it more representative of the practice population.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 March 2016

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

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

• The practice maintained a register of 138 patients with diabetes, of whom 101 (78%) had had an annual foot and eye (retinal) check.

• The practice had a register of 739 patients with long term health conditions. Records showed that health promotion lifestyle advice had been given to 691 (94%) of the patients.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice used its electronic records system to identify patients at high risk of developing long term conditions and to manage their health care.

Updated 3 March 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.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice cervical screening rate was comparable with the national average.

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

• Immunisation rates for the standard childhood immunisations were high, compared with the local average.

Updated 3 March 2016

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 maintained a register of 26 patients considered to be at high risk of admission to hospital, all of whom had had their care plans reviewed and shared with relevant parties.

• Ninety-five per cent of the 132 patients discharged from hospital had received a follow up consultation.

• Ninety per cent of the 426 patients prescribed more than four medicines had had their medicines reviewed

• Flu vaccination rates for older people were above the national average.

• Seventeen patients had been identified as at risk of developing dementia, of which 13 had been offered cognition tests.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• All patients aged over 75 had a named GP.

• The practice provided a service to a nearby care home, which the GP attended weekly.

Updated 3 March 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 and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• 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.

• The practice had carried out NHS health checks for 810 patients (56% of those eligible) and blood pressure tests on 1,048 patients (93% of those eligible) in the last five years

Updated 3 March 2016

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

• Seventeen (77%) of the 22 patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. Sixty-seven percent of patients had evidence of advance care planning in the records.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice maintained a register of patients experiencing poor mental health of whom 36 (71%) had received an annual physical health check.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• It 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 people with mental health needs and dementia.

Updated 3 March 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 homeless people, travellers and those with a learning disability.

• All 13 patients on the learning disabilities register had received an annual follow up and had their care plans reviewed.

• It offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told vulnerable patients about how to access various support groups and voluntary organisations and direct access appointments for the service could be made by practice staff.

• A drug and alcohol adviser attended the practice to support patients once a week.

• 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.