Archived: Drs E Greenbury & J Rosenthal Also known as Park Road Surgery

Updated 26 May 2016

Drs E Greenbury & J Rosenthal (“the provider”) operate at the Park Road Surgery, 153 Park Road, London N8 8JJ. The premises, which are owned by the provider, were converted from original domestic use.

The practice provides NHS services through a General Medical Services (GMS) contract to 2,546 patients. It is part of the NHS Haringey Clinical Commissioning Group (CCG) which is made up of 45 general practices. The practice is registered with the CQC to carry out the following regulated activities - diagnostic and screening procedures and treatment of disease, disorder or injury, surgical procedures. The patient profile for the practice has a fewer than average children and younger adults than the national average, with a higher number of older patients.

The practice has a clinical staff of three GP partners (two female and one male), two salaried GPs (one female and one male), a practice nurse and a healthcare assistant. A fourth GP partner left the practice in January 2016. It is a teaching practice, with medical students occasionally attending on training placements. The three partners each work four clinical sessions per week and the salaried GPs three sessions. The practice nurse works 23 hours per week over four days and the healthcare assistant 32 hours a week. The administrative team is made up of an assistant practice manager, senior receptionist and receptionist. The provider is also responsible for another practice in a neighbouring CCG. Two of the partners and one of the salaried GPs, together with the administrative staff, share their time between the two practices.

The practice’s opening hours are 8.30 am to 6.30 pm, Monday, Tuesday, Thursday and Friday. It is closed on Wednesday afternoon and at weekends and the lunch break is between 1.00 pm and 2.00 pm. Appointments with GPs are available each morning between 9.00 am and 11.50 am and during afternoons between 4.00 pm and 6.00 pm, except Wednesdays. Nurse appointments are available until 6.30 pm. All appointments can be booked up to one month in advance, including being booked online by patients who have previously registered to use the facility. Telephone consultations are available and the GPs also make home visits.

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 a link to the NHS 111 service on the practice website. The website and practice leaflet also includes details of local urgent care centres and other NHS services.

We had inspected the practice using our previous methods in November 2013, when we set actions regarding cleanliness and infection control and complaints handling. We carried out a follow up inspection in May 2014 and found that the provider had taken appropriate action to comply with the regulations in force at the time.

Updated 26 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 16 March 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 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• 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. However, results from the GP patient survey suggested that fewer patients compared with local and national averages were happy with the opening 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 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 generally assessed and well managed. The practice had not carried out Disclosure and Barring Service checks in relation to non-clinical staff who performed chaperoning duties and had no portable oxygen supply for use in medical emergencies. However, the practice provided evidence shortly after the inspection that both these issues had been addressed.

The areas where the provider should make improvement are:

• Continue to monitor the service provision, particularly with regard to patient access and opening hours.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 26 May 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.
• Flu immunisation rates for patients identified as being at risk due to existing health conditions was higher than the national average.
• 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.
• Data showed that the practice was performing better than local and national averages in relation to diabetes care. It maintained a register of 155 patients with diabetes and had carried out annual foot checks on 142 of the patients.
• The practice maintained of register of 48 patients with heart failure, of whom 45 had had an annual medicines review.
• The percentage of patients on the practice’s asthma register, who have had a review in the preceding 12 months was comparable with the national average.

Updated 26 May 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 and maintained a register of vulnerable children.
• Immunisation rates for all standard childhood immunisations were comparable with the local average.
• 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.
• 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, health visitors and school nurses.

Updated 26 May 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 maintained a register of 51 patients identified as needing complex case management and of those receiving palliative care (9 patients).
• Records showed that the practice monitored the patients discharged from hospital and had carried out a follow up consultation for eight patients of the nine patients.
• The flu immunization rate for older patients was comparable with the national average.
• Records showed that the practice had offered cognition tests to 44 patients who had been identified as being likely to benefit from the test.

Updated 26 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• 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’s uptake for the cervical screening programme was 88%, being above the national average of 81%.
• Data showed that 1,348 patients (96% of those eligible) had undergone blood pressure checks.
• The practice was reviewing the service provision generally, including patient access issues, which particularly related to this population group.

Updated 26 May 2016

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

• The practice maintained a register of 22 patients diagnosed with dementia. Nineteen of the patients had their care reviewed in a face to face meeting in the last 12 months, above the national average.
• 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.
• Data showed that 34 patients, being 90% of those with severe mental health problems, 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.
• 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 26 May 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. It maintained a register of eight patients and had carried out annual follow ups and care plan reviews in relation to their care.
• 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.
• 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.