Lanfranc Medical Centre

Updated 11 April 2017

Lanfranc Medical Centre provides NHS primary medical services to around 6300 patients in Sudbury, South Harrow from a single surgery. The practice falls within the Brent NHS clinical commissioning group area and is provided through a personal medical services contract. The practice is located within a converted property on the ground floor of a residential apartment block.

The current practice clinical team comprises two GP partners (male and female), five salaried and regular locum GPs (male and female). The GPs typically provide 25 clinical sessions at the practice per week. The practice also employs a part-time practice nurse and a part time locum practice nurse. The staff team includes a practice manager, administrators and receptionists.

The practice opening hours are from 8.30am to 7pm on Monday, Tuesday, Wednesday and Friday and from 8.30am to 1pm on Thursday. Morning consultation times run from 8.40am to 12 noon and afternoon consultations run from 3.55pm until 7pm. Telephone consultations are also provided daily. The GPs make home visits to see patients who are housebound or are too ill to visit the practice. Same day appointments are available for patients with complex or more urgent needs. The practice offers online appointment booking and an electronic prescription service.

When the practice is closed, patients are advised to use the local out-of-hours primary care service or attend the local 'hub' primary care service. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on its website and on a recorded telephone message.

The practice population is characterised by somewhat below average levels of income deprivation and unemployment and above average levels of life expectancy. The practice age-sex profile is similar to the English average although it has a smaller proportion of patients aged over 65. The population is ethnically diverse.

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

Updated 11 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lanfranc Medical Centre on 13 January 2017. Overall the practice is rated as good.

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

• Staff were open and transparent and committed to reporting incidents and near misses.
• Learning was based on analysis and investigation of any errors and incidents. The practice acted on its findings to improve the service.
• The practice had effective systems in place to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had the skills and knowledge to deliver effective care and treatment.
• Patient feedback indicated that patients were treated with compassion and respect and were involved in their care and decisions about their treatment.
• 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 service was accessible. Patient feedback was positive about the ease of getting an appointment. Urgent appointments were available the same day.
• The practice had adequate facilities and was 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 practice should make improvement are:

• The practice should consider holding more regular practice meetings. This would enable a fuller discussion among the full team, for example about learning from significant events.
• The practice should consider making more use of interpreting services to communicate with patients who do not speak English well, for example to ensure that patients are able to give informed consent to treatment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 11 April 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice maintained registers of patients with long-term conditions. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The GPs and practice nurse had lead roles in long-term disease management.
• The practice had performed well on the Quality and Outcomes Framework (QOF) for managing long-term conditions. It had recently run an awareness raising campaign about atrial fibrillation with older patients attending for flu vaccination.
• The local diabetic specialist nurse visited the practice monthly to review patients with poorly controlled diabetes. The practice performed well on key diabetes related indicators in 2015/16.
• 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.

Updated 11 April 2017

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

• The practice provided antenatal and postnatal services with mother and baby clinics at six weeks after birth.
• Immunisation rates were above target (90%) for all standard childhood immunisations.
• The practice trained staff on treating children and young people in an age-appropriate way and as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies, for example with baby changing facilities.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• 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.

Updated 11 April 2017

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments as appropriate. Patients participating in the inspection commented positively about this aspect of the service.
• The practice maintained a register of patients receiving palliative care and met regularly with the local palliative care nurse. One of the GP partners provided a direct telephone number for patients receiving palliative care and their families. This GP also carried out home visits to certify deaths promptly including over weekends, holiday periods and out of hours.
• Patients over 75 made up the majority of the group of patients identified by the practice as requiring personalised care plans. The practice planned these patients' care and made use of local community services such as STARRS (the local short term assessment, reablement service) to avoid unnecessary hospital admissions.
• The practice followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with advice and preventive care to help them to maintain their health and independence. For example, the practice ran campaigns (including letters and telephone reminders) to encourage eligible patients to have the flu, shingles and pneumococcal vaccinations.
• Staff were able to recognise the signs of abuse in vulnerable older patients and knew how to escalate any concerns.

Updated 11 April 2017

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

• The needs of working age patients had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible. For example, the practice was open until 7pm four days a week. GP and nurse consultations were available after 5pm.
• The practice offered a range of ways to access services, for example, daily telephone consultations with a GP, online appointment booking and an electronic prescription service.
• The practice offered health promotion and screening services reflecting the needs for this age group, for example NHS health checks for patients aged 44-75 years.
• In 2015/16, 81% of eligible women registered with the practice had a cervical smear test within the last five years, in line with the national average.
• The practice ensured that patients seeking emergency contraception were able to book a same day appointment.

Updated 11 April 2017

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

• Patients at risk of dementia were offered screening and referral to the local memory services.
• In 2015/16, 28 of 29 (97%) of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the local and national averages.
• In 2015/16, 55 of 58 (95%) of patients with a diagnosed psychosis had a comprehensive care plan in their records. This was comparable to the local and national averages.
•  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.
• The practice had information available for patients experiencing poor mental health and stress about how they could access local counselling services, support groups and voluntary organisations. This included information signposting families to children’s mental health and counselling services. The practice also offered regular counselling sessions at the practice.

Updated 11 April 2017

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 for example patients with a learning disability. Alerts were included on the electronic patient record system to ensure that staff were aware of patients who required additional assistance.
• The practice offered longer appointments for patients with a learning disability and annual health checks.
• The practice 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 services, support groups and voluntary organisations for example drug and alcohol services.
• Staff interviewed knew how to recognise signs of abuse in children, young people and vulnerable adults. 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.
• The practice identified carers and provided them with information about available support.