St David's Family Practice

Updated 5 July 2016

St David’s Family Practice is located in purpose built premises in Stanwell, a busy residential area. Stanwell is located near Heathrow airport and many local people work at the airport. There is a lot of social housing in the area and a large migrant community.

The practice is based on the first and second floor of the premises and there is a lift to access these floors. The ground floor has community healthcare facilities, a pharmacy and library.

The practice operates from:

St David’s Family Practice

Hadrian Wall

Stanwell

Staines

Middlesex

TW19 7HE

There are approximately 11,300 patients registered at the practice. Statistics show quite a high degree of income deprivation among the registered population. The registered population is lower than average for 55-79 year olds, and higher than average for those aged 0-9 and 25-44. The population is made up of many different ethnic groups with an ethnic estimate based on Public Health England data of 14.5% Asian, 3.1% black, 2.8% mixed and 1.3% other non-white. There is a high turnover of patients, around 10% of the practice population move on each year. Practice figures from 2015 showed that 1196 patients joined the practice and 815 left the practice. This creates a large administrative and clinical workload, as well as making it more difficult to develop a long term relationship with patients.

The practice has four partners, two salaried GPs and two regular locum GPs (four male and four female). The partners all work full time and the other doctors work part time. There are two practice nurses.

The practice is a training practice and there are regularly GP trainees working in the practice. At the time of the inspection there were six trainees, three doing a rotation in general practice whilst based in a hospital and three in their final year of GP training.

The practice is open from 8.00am to 6.30pm from Monday to Friday. Appointments are from 8am to 10.30am, followed by an emergency clinic. Afternoon appointments are from 4pm to 6.20pm with an emergency clinic at 3pm. In addition the practice offers extended hours opening with appointments until 8pm on Monday and Wednesday, and from 9am to 11.30am on Saturdays. Patients can book appointments in person, by phone or on line.

Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hours service on telephone number 111. The GP out of hours service is provided by Care UK.

The practice has a Personal Medical Services (PMS) contract. PMS contracts are nationally agreed between the General Medical Council and NHS England.

Updated 5 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St David’s Family Practice on 11 May 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• The practice provided safe and effective clinical care.
• There was an open and transparent approach to safety and an effective system in place 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.
• The practice had recently employed a pharmacist who led a diabetes clinic providing holistic patient centred care; this clinic had very positive patient feedback.
• 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 was available and easy to understand, although there was only limited information available on how to complain. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review the arrangements for ensuring that patients with long term conditions receive high quality care in light of the high level of exception reporting in the Quality and Outcomes Framework. Implement the action plan produced following the inspection.
• Ensure that action plans are written and followed up after infection control audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 July 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.
• 79% of patients on the diabetes register had a record of a foot examination and classification which was below the clinical commissioning group (CCG) average of 89% and national average of 88%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and 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 had recently employed a pharmacist who carried out medicines management reviews and led a diabetes clinic.
• The CCG prescribing advisor worked with the practice to carry out medicine reviews for patients.

Updated 5 July 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. Immunisation rates were relatively high for all standard childhood immunisations. The practice nurse rang parents to encourage them to bring children in for their immunisations, and followed up those who did not attend.
• 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.
• 81% of eligible female patients had a cervical screening test which was in line with the clinical commissioning group average of 80% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, they were based on site and there was good communication between midwives and doctors.
• A consultant gynaecologist visited monthly to run a gynaecology clinic on site, which was convenient for patients to attend.

Updated 5 July 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided support for patients in two local care homes and feedback from the homes was positive.

Updated 5 July 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 offered electronic prescribing allowing patients to collect prescriptions from a pharmacy closer to their place of work.
• The practice offered evening appointments until 8pm twice a week and Saturday morning appointments.

Updated 5 July 2016

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

• 74% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84% and clinical commissioning group (CCG) average of 83%. The practice told us that there was a high turnover of patients in the local care homes, which both specialised in providing care for people with dementia. This meant that GPs did not have time to set up face to face meetings for all patients in the care home before these patients moved on.
• 93% of patients experiencing poor mental health had an agreed care plan, which is the same as the CCG average of 91% and better than the national average of 88%.
• 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 had told patients experiencing poor mental health about 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 may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 5 July 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.
• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.
• Doctors telephoned patients who did not attend for appointments and carried out a telephone consultation where appropriate.
• 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.
• The practice worked closely with a local carers support group to ensure carers were able to access the support they needed.