Archived: The Enterprise Practice

Updated 16 November 2017

The Enterprise Practice is situated in Harrow in North West London within purpose built premises, with car parking for patients and staff. These premises are shared with three other GP services including a GP walk-in clinic which offers appointments from 8am to 8pm. All patient services are offered on the ground floor. The practice comprises two consulting rooms, a shared treatment room, a shared patient waiting area, a reception area, and administrative and management offices.

The practice has core opening hours from 8am to 6.30pm Monday to Friday. The practice telephone line is closed from 1pm to 2pm Monday to Friday but the reception desk is open during this time. When the practice telephone line is closed from 1pm to 2pm, telephone calls are directed to the out-of-hours service. The out-of-hours service is able to contact one of the practice oncall GPs. The practice offers extended hours appointments every Monday evening until 7.15pm and Thursday evening until 7pm. The reception desk has opened from 9am to 1pm every Saturday. The practice has published information about this at the practice website and on the practice leaflet.

The practice offers a range of scheduled appointments to patients every weekday from 8am to 6pm including open access appointments with a duty GP throughout the day. 

The practice has a patient population of approximately 3,800 registered patients. The practice population of patients aged between 25 to 44 years old is higher than the national average and there is lower number of patients aged between 10 to 24 and 45 to 59 years old compared to national average.

Ethnicity based on demographics collected in the 2011 census shows the patient population is ethnically diverse and 59% of the population is composed of patients with an Asian, Black, mixed or other non-white background.

There is one principal GP, a salaried GP and two locum GPs. Three GPs are female and one male, who work a total of 14 sessions. The practice employs a shared practice nurse and three locum practice nurses. The practice manager is supported by a team of administrative and reception staff. Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS).

Services are provided from the following location which we visited during this inspection:

Belmont Health Centre

516 Kenton Lane

Harrow

Middlesex

HA3 7LT

The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the practice is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided by Care UK or after 6:30pm, weekends and bank holidays by calling NHS 111.

The practice service is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; family planning services; surgical procedures; and maternity and midwifery services.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Enterprise Practice on 10 October 2017. Overall the practice is rated as requires improvement.

The Enterprise Practice was previously inspected in February 2015. Overall the practice was rated as good, however the practice was rated as requires improvement for providing safe services. The full comprehensive report on the February 2015 inspection can be found by selecting the ‘all reports’ link for The Enterprise Practice on our website at www.cqc.org.uk.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, lessons learned were not always communicated widely enough to support improvement.
• There were inconsistent arrangements in how risks were assessed and managed.
• The practice was unable to demonstrate that all appropriate recruitment checks had been undertaken prior to employment.
• The practice had a number of policies and procedures to govern activity and most were updated and reviewed regularly.
• Data showed patient outcomes were lower than average for childhood immunisation rates and the cervical, breast and bowel cancer national screening programme uptakes.
• Most staff had received up to date training relevant to their role. Staff appraisals had been completed in a timely manner.
• We found one completed clinical audit cycle which was driving positive outcomes for patients.
• Feedback from patients reported that access to pre-bookable GP appointments was limited.
• Patients we spoke with on the day informed us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice was renting a space in a shared premises but the practice was unable to demonstrate that they had an effective monitoring system to ensure that regular health and safety checks had been undertaken and action plans had been followed up by the contractor who was responsible for managing the premises.
• There was a clear leadership structure and staff felt supported by management. However, the practice was unable to demonstrate that the nursing staff had attended the team meeting or received the team meeting minutes.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

In addition the provider should:

• Review the system in place to promote the benefits of childhood immunisation, cervical, breast and bowel cancer national screening in order to increase patient uptake.
• Review patient feedback and address the concerns raised regarding the availability of pre-bookable appointments.
• Provide patient information in languages and formats suitable to the patient population.
• Share the learning and team meeting minutes widely if staff are unable to attend the team meetings.
• Review the appropriate staff training necessary to enable them to carry out their duties.
• Review that all appropriate emergency medicines are in stock and remind all staff about their location.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for providing safe and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There were clinical leads for long-term disease management and patients at risk of hospital admission were identified as a priority.
• Data from 2015/2016 QOF showed performance for diabetes related indicators was above the CCG and national averages.
• 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.

Updated 16 November 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for providing safe and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 the national averages for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 73%, which was below the CCG average of 77% and the national average of 81%.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• 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.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 16 November 2017

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for providing safe and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice had a virtual ward system in operation, where high risk patients could be referred and monitored by the community health team to avoid hospital admission.
• Pathology results had been reviewed seven days a week and the patient was contacted immediately if urgent action was required.
• 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.
• The premises were accessible to those with limited mobility. However, the practice did not provide a low level desk at the front reception.
• There were good working relationships with external services such as community nurses.
• Where older patients had complex needs, the practice shared summary care records with local care services.

Updated 16 November 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The provider was rated as requires improvement for providing safe and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 appointments.
• The practice was proactive in offering online services as well as a full range of health promotion that reflects the needs for this age group. The practice informed us that 33% patients were registered for the online access.
• Health promotion advice was offered but there was limited accessible health promotion material available through the practice.
• There was a low uptake for national cancer screening programmes.

Updated 16 November 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as requires improvement for providing safe and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Data from 2015-16 showed, performance for dementia face to face reviews was above the CCG and national averages. The practice had achieved 88% of the total number of points available, compared to 87% locally and 84% nationally.
• The practice carried out advance care planning for patients living with dementia.
• Patients experiencing poor mental health were involved in developing their care plan and health checks.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 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 16 November 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for providing safe and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• Annual health checks and care plans were completed for patients on the learning disability register.
• 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.