Archived: R Isaacson - The Surgery Also known as Dr R Isaacson & Partners

Updated 7 November 2016

R Isaacson - The Surgery is located in Muswell Hill, north London. It is one of the member GP practices in the Barnet Clinical Commissioning Group (CCG).

The practice is located in the fifth less deprived decile of areas in England. Census data shows some 10% to 20% of the local population does not speak English as their main language. At 81 years, male life expectancy is higher than the England average of 79 years; and at 86 years, female life expectancy is higher than the England average of 83 years.

The practice has approximately 5,800 registered patients. The practice population distribution is mostly similar to the England average although there is a greater proportion of patients in the 25 to 44 years age group and fewer patients in the 60 to 85+ age groups. Services are provided under a General Medical Services (GMS) contract with NHS England.

The practice is in a converted residential property which the GP principal part-owns. On street parking is available nearby. There are three GP consulting rooms and one practice nurse treatment room. The premises and facilities are wheelchair accessible and there is a hearing loop.

The GP principal and a salaried GP together provide the equivalent of two whole time GPs. Both GPs are male. There is a regular GP locum who provides cover when needed and additional capacity in the winter months when demand on the service is higher. There are two part time practice nurses and a part time healthcare assistant. There is a team of reception, administrative and secretarial staff and a practice manager. One of the receptionists is also the healthcare assistant for the practice.

The practice’s opening times are:

• 8.00am to 1.00pm and 2.00pm to 6.30pm Monday to Friday.

Patients are directed to an out of hours GP service outside these times.

Appointments are available at the following times:

• 9.00am to 11.30pm and 4.00pm to 6.30pm on Monday to Friday

• 6.30pm to 8.00pm on Monday (extended hours face to face appointments)

• 6.30pm to 8.00pm on Tuesday (telephone appointments)

R Isaacson - The Surgery is registered with the Care Quality Commission to carry on the following regulated activities at 192 Colney Hatch Lane, Muswell Hill, London N10 1ET: Diagnostic and screening procedures, Maternity and midwifery services, and Treatment of disease, disorder or injury. One of the partners left the practice in March 2016 and the provider is in the process of amending their registration with CQC accordingly. Part of this is changing the registered name of the practice to Colney Hatch Lane Surgery.

We had previously conducted an announced comprehensive inspection of the practice on 18 August 2015. As a result of our findings during that visit, the practice was rated as good for being caring, responsive, and well led, and requires improvement for being safe and effective. This resulted in a rating of requires improvement overall. We found that the provider had breached one regulation of the Health and Social Care Act 2008: Regulation 9(3)(b) Person-centred care. You can read the report from our last comprehensive inspection at www.cqc.org.uk/location/1-540467299. The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements.

At this inspection on 27 September 2016 we found the provider had remedied the shortfalls found during the previous inspection.

Updated 7 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at R Isaacson - The Surgery on 27 September 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.
• There were systems and processes to assess and manage risks to patients, however arrangements for the repeat prescribing of high risk medicines were not embedded.
• 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 were able 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 areas where the provider must make improvement are:

• Ensure high risk medicines are prescribed in line with the repeat prescribing protocol to maximise medication safety.

The areas where the provider should make improvement are:

• While the provider demonstrated a commitment to being open and transparent there was no written procedure in place for identifying and handling notifiable safety incidents under the duty of candour.

• The provider did not keep a record of the action it had taken in response to patient safety alerts relevant to the practice.

• Consider further ways of meeting the needs of patients with Depression given the comparatively high exception reporting rate in this clinical domain.
• Staff demonstrated understanding of the consent and decision-making requirements of the Mental Capacity Act 2005, however they had not received formal training.
• All the GPs who worked regularly at the practice were male and there was no protocol in place for a patient to see a female GP if they requested this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 November 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.

• The practice had significantly improved its Quality and Outcomes Framework (QOF) performance in 2015-16, achieving 85% of the point available, up from 57% in 2014-15. The improved performance was being sustained in 2016-17.

• Longer appointments and home visits were available when needed.

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

Updated 7 November 2016

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

• There were systems in place to identify children living in disadvantaged circumstances and who were at risk. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme in the first six months 2016-17 was 76%. This was an improvement on its performance of 72% for the whole of 2014-15. The CCG average in 2014-15 was 79% and the national average was 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 health visitors.

Updated 7 November 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.

• It worked with other services to meet complex needs where required, for example local pharmacists, district nurses and social services.

• Medicines were prescribed in dossett boxes where this helped the patient with taking their medicines.

Updated 7 November 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.

Updated 7 November 2016

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

• 71% of patients diagnosed with dementia had their care reviewed in a face to face meeting between 01 April 2016 and 26 September 2016. This was a significant improvement on the practice’s performance in 2014-15 when the percentage was 49%. The CCG average for the whole of 2014-15 was 85% and the national average was 84%.

• The practice’s patient outcomes for mental health indicators were similarly improved. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses:

  • Who have a comprehensive agreed care plan documented in the record between 01 April 2016 and 26 September 2016 was 67%.

  • Whose alcohol consumption has been recorded between 01 April 2016 and 26 September 2016 was 90%. The CCG average for the whole of 2014-15 was 92% and the national average was 90%.

• The practice worked with other health and care professionals in the case management of patients experiencing poor mental health, including those with dementia.

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

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 7 November 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability, and worked with a specialist service to ensure they received their annual health check.

• The practice worked with other health and 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.