Archived: Acton Lane Surgery

Updated 17 March 2017

Acton Lane Surgery is located in Harlesden, London and holds an Alternative Provider Medical Services contract. The practice is commissioned by NHS England, London and is under Brent Clinical Commissioning Group. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice is staffed by two male GP partners and a female salaried GP who provide a combination of nine sessions a week. The practice also employs a part-time practice manager who works 15 hours a week, three practice nurses who work a combination of 11 hours a week, two healthcare assistants/administrators and two reception staff.

The lead GP is actively involved in the community and is one of the founding members of the Neasden Temple. He was awarded the Member of the Order of the British Empire, given in honour in view of his community service.

The practice is part of the Harness locality which consists of 21 GP practices led by a clinical director, where the GPs work together to improve health services for the patients in their area. Being part of the Harness locality ensures the practice is provided with easy access to members of the multidisciplinary team including integrated care community services and local outpatient clinics. Being a part of this locality also allows them to refer their patients for evening and weekend appointments at the Harness locality hub which consists of three provider practices.

The practice is open between 8.45am and 6.30pm on Monday, Tuesday, Wednesday and Friday and between 8.45am and 4.00pm on Thursday. The practice provides a walk-in clinic every morning until 11.00am. Extended hours surgeries are offered on Monday, Tuesday and Friday evenings between 6.30pm and 7.15pm. Outside of these hours, their answerphone redirects patients to an out-of-hours provider.

The practice has a list size of 3,907 patients and provides a wide range of services including health promotion, child health screening, chronic disease management, minor surgery, smoking cessation and insulin initiation. The practice also provides care to patients who are housed in a local residential home.

The practice is located in a purpose built building situated over two floors, the ground floor and basement. The ground floor contained the waiting area and treatment rooms and the basement contained the practice office and nurses’ room.

The practice is located in an area where the largest population are working people aged between 20-44 years of age and has a large black and minority ethnic population of 71%. The practice is also located in the most deprived area of the borough with large amount of patients with difficult social circumstances and chronic, physical or mental health conditions.

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acton Lane Surgery on 9 June 2016. Overall the practice is rated as good.

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

• Some risks to patients were assessed and well managed, with the exception of those relating to Legionella infection, gaps in fire safety awareness training and fire evacuation drills. The provider addressed these issues shortly after our inspection.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Patients said they were treated with compassion, dignity and respect and the majority of patients felt the nurses involved them in their care and decisions about their treatment.
• The practice proactively sought feedback from staff and patients. However, action taken to improve on some areas of the service that had been rated as below local or national averages by patients were not clearly outlined.
• 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.
• There was a walk-in clinic every morning and urgent appointments were 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 had not documented actions taken in response to patient feedback, and a risk assessment and infection control audit had not been dated to indicate when they were undertaken.
• The provider was aware of and complied with the requirements of the duty of candour.

There are areas where the provider should make improvements:

• Document clearly actions and processes pertaining to the running of the service are clearly documented, such as for risk assessments and infection control audits conducted, and actions taken in response to feedback from patients about the service.

• Implement effective systems to monitor and improve the quality of the services where improvements are identified as required. Specifically, improve patient engagement and monitoring in relation to areas of high exception reporting.

• Raise non-clinical staff awareness of the relevant consent and decision-making requirements of the Mental Capacity Act.

• Maintain on-going training in order to protect patients from any associated risks to their health and welfare caused by insufficient training.

• Consider displaying the mission statement so it is visible within the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 17 March 2017

The provider  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.

• Nationally reported data showed the practice's targets for the management of patients with diabetes were mostly comparable to local and national averages. For example, the percentage of patients with diabetes on the register, who had a foot examination in the last 12 months was 95%, compared to the Clinical Commissioning Group average of 90% and national average of 88%. Where the practice had failed to achieve national average targets, steps had been taken to improve outcomes for this patient group.

• The practice was proactive in taking steps to improve outcomes in some areas where clinical performance was below average.

• Longer appointments and home visits were available when needed.

Updated 17 March 2017

The provider  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 those who were at risk, for example, children and young people who had a high number of attendances to Accident & Emergency.

• Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• Cervical screening rates were comparable to local and national averages. For example, the percentage of women aged 25-64 who had received a cervical screening test in the last 5 years was 80%, compared to the Clinical Commissioning Group average of 78% and national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children were given priority at reception.

• We saw positive examples of joint working with midwives.

Updated 17 March 2017

The provider 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 including those patients cared for in the residential home.

• Older patients received an annual face-to-face review where their clinical medical records were updated and. Patients were offered influenza immunisations at these reviews.

• Nationally reported data showed that the practice achieved high targets for conditions commonly found in older people. For example, data published in 2014/2015 showed the percentage of patients with atrial fibrillation who were being treated with anticoagulation therapy was 100%, above the national average of 98%.

Updated 17 March 2017

The provider  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.

• Well adult NHS health checks were offered for people aged between 40-74 years of age who had no medical conditions. All new patients received health checks on the same day they registered with the practice.

Updated 17 March 2017

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

• 98% of patients diagnosed with mental health conditions had their alcohol consumption recorded in the last 12 months, compared to the national average of 90%.

• Patients were screened for dementia as well as for alcohol and drug abuse when they registered with the practice.

• 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 and those with memory problems were referred to the memory clinic.

• 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 & 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. Patients with mental health problems unable to attend the surgery were offered home visits to ensure ease of access to healthcare.

Updated 17 March 2017

The provider 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.

• 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.

• The practice offered the silent sounds service for those hard of hearing or requiring interpreters.

• 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.