Nightingale House Surgery

Updated 13 February 2017

Nightingale House Surgery is located in a residential area of Enfield, North London. The practice is located in a two-storey converted building. There is parking on the streets nearest to the practice, and a bay for parking for disabled patients at the front of the surgery. The nearest bus stop is approximately five minutes’ walk from the practice.

The practice operates from:

1-3 Nightingale Road

Enfield

Middlesex

N9 8AJ

There are approximately 6000 patients registered at the practice. Statistics shows high income deprivation among the registered population. The registered population is slightly higher than the national average for those aged between 5 to19 and between 50 to 59. Patients registered at the practice come from a variety of backgrounds including Asian, Western European, Eastern European and African Caribbean.

Care and treatment is delivered by four GPs (three male and one female) including three partners and one salaried GPs who conduct 27 clinical sessions weekly. There are three practice nurses (female) who conduct 18 sessions weekly. Nine administrative staff work at the practice and are led by a practice manager.

The practice is open from the following times:-

• 7:30am - 7:00pm (Monday, Wednesday, Friday)

• 8:00am - 6.30pm (Tuesday,Thursday)

Clinical sessions are run during the following times:-

• 7:30am - 11:50am; 2:00pm - 7:00pm (Monday)

• 7:30am - 8:00am; 8:30am – 11:50am; 3:30pm - 6:30pm (Tuesday)

• 7:30am - 8:00am; 8:30am – 11:50am; 3:30pm - 6:40pm (Wednesday)

• 8:30am - 11:50am; 3:30pm - 6:30pm (Thursday)

• 7:30am - 8:00am; 8:30am – 11:50am; 3:30pm - 6:40pm (Friday)

Extended hours surgery is conducted on a Monday, Tuesday, Wednesday and Friday mornings between 7:30am-8:00am. In addition, the surgery is open until 7:00pm on a Monday evening. Patients can book appointments in person, by telephone and online via the practice website.

Patients requiring a GP outside of practice opening hours are advised to contact the NHS GP out of hours service on telephone number 111.

The practice has a Personal Medical Services (PMS) contract. PMS contracts are nationally agreed between the General Medical Council and NHS England. The practice conducts the following regulated activities:-

- Diagnostic and screening procedures

- Treatment of disease, disorder or injury

- Maternity and midwifery services

- Surgical procedures

- Family planning

Enfield Clinical Commissioning Group (CCG) is the practice’s commissioning body.

Nightingale House Surgery was inspected in 2014 by the CQC. At this time the practice was found to be compliant with CQC requirements.

Updated 13 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nightingale House Surgery on 13 July 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.
• Risks to patients were assessed and well managed.
• 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.
• 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.

The areas where the provider should make improvement are:

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 February 2017

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.
• The Quality Outcomes Framework (QOF) recorded the practice as scoring higher than the national average on all five of the diabetes indicators.
• 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.

Updated 13 February 2017

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. 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.
• 84% of women aged 25-64 notes record that a cervical screening test has been performed in the preceding 5 years which was above the CCG average of 81% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 13 February 2017

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.
• Longer appointments for this population group were available when needed.

Updated 13 February 2017

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.
• Telephone consultations with clinicians were available to meet the needs of this population group.
• The practice offered extended hours surgery once a week to meet the needs of this population group.

Updated 13 February 2017

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

• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the CCG average of 83% and the national average of 84%.
• 93% of patients with schizophrenia, bipolar effective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months, which is comparable to the national average of 89%.
• 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.
• 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 13 February 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 including homeless people and 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.
• 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.