Archived: Dr Rebecca Hatjiosif Also known as Rutland House Surgery

Updated 18 April 2017

Dr Rebecca Hatjiosif (also known as Rutland House Surgery) is located on Colney Hatch lane, London N10 1DU in a three storey converted house with consulting rooms on the ground and first floor. The premises are owned and maintained by the practice. The practice provides services to approximately 6000 patients. The practice is commissioned to provide services by NHS Haringey Clinical Commissioning Group, through a Personal Medical Services contract (a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract).

The premises have step free access with an accessible toilet and baby changing facilities.

The practice staff includes one principal GP (female) providing six sessions per week, three salaried GP’s (two male, one female) providing a total of 15 sessions respectively and a sessional GP (female) providing four sessions. The practice nurse (female) provides four sessions and a Healthcare Assistant (HCA male) providing three sessions per week. The practice manager works full time and there are six administration, reception and secretarial staff working a variety of full and part time hours.

The practice is open from:

• Monday 8am - 8pm
• Tuesday 8am - 8pm
• Wednesday 8am - 6:30pm
• Thursday 8am - 6:30pm
• Friday 8am - 6:30pm

Appointments are from:

• Monday 8:30am - 11:30pm and 4pm - 8pm
• Tuesday 9am - 12pm and 3:30pm - 8pm
• Wednesday 8:30am - 11:30pm and 4:30pm - 6:30pm
• Thursday 9am - 12pm and 3pm - 6:30pm
• Friday 9am - 11:30pm and 2:30 - 6:30pm

Extended hours appointments are offered on Mondays and Tuesdays from 6:30pm to 8pm. Out of hour’s services covered by the Haringey GP Collaborative who cover from 6:30pm to 8pm weekdays and 8am to 6pm on Saturdays. Outside of these hours cover is provided by the 111 service.

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

Sixty seven percent of the practice population have England as their country of birth, with the next largest group being other European. At 81 years for males and 85 years for females, the average life expectancy is higher than the England averages of 79 and 83 years, respectively. Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

This practice was not inspected under the previous CQC inspection regime.

Updated 18 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rebecca Hatjiosif on 20 December 2016. 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. All opportunities for learning from internal and external incidents were maximised.

• 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 and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 April 2017

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

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

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 82% which is comparable to the CCG and national averages of 78%.

• 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.

• The practice nurse watched health promotion videos with patients to help them manage their conditions.

Updated 18 April 2017

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

• From the sample of documented examples we reviewed we found 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 below average 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.

• The practice provided support for premature babies and their families following discharge from hospital.

• 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, post-natal and child health surveillance clinics.

Updated 18 April 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.

• 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, and participated regular teleconferencing with the local hospital to discuss these and high risk patients.

Updated 18 April 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 and Saturday appointments.

• 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.

• All students were offered the AWCY meningitis vaccination by the practice nurse.

Updated 18 April 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.

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  The practice specifically considered the physical health needs of patients with poor mental health and dementia and the lead GP specialised in this area.

• 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 18 April 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.