St Davids Practice

Updated 25 October 2017

St Davids Practice, provides primary medical services in the London Borough of Hounslow to approximately 7400 patients. The practice operates under a General Medical Services (GMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

The practice operates from one site. The surgery is a purpose built health centre, which they share with four other practices. The ground floor is occupied by retail shops; the health centre is located on the first floor with lift access. There is ramp access to the waiting area and reception desk. The practice has six consulting rooms.

The practice clinical team is made up of three GP partners (male and female), one practice nurse, two healthcare assistants (HCA), one phlebotomist and non-clinical staff.

The practice offers 26 GP sessions per week.

The practice opens between 8.30am and 6.30pm Monday to Friday. Appointments are available between 8:30am to 6:30pm. Extended hours are available from 6:30am to 8:30am on Tuesdays.

When the practice is closed patients can call NHS 111 in an emergency or a local out of hours service.

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

Updated 25 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of St Davids Practice on 24 October 2016. The overall rating for the practice was good with requires improvement in Safe. Breaches of legal requirements were found relating to the Safe domain. The registered person did not have a clear process in place for analysing significant events, incidents and near misses. The provider did not ensure that there was a defibrillator available at the practice or conduct a risk assessment to indicate the risks of not having one had been assessed.

After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report can be found by selecting the ‘all reports’ link for St Davids Practice on our website at www.cqc.org.uk.

This inspection was a document-based review carried out on 12 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 24 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as Good for providing Safe services, and overall the practice remains rated as Good.

Our key findings were as follows:

• The practice had reviewed its policy on safeguarding and its process for recording and reporting safeguarding concerns. We saw a revised policy, we saw comprehensive safeguarding minutes, detailing all safeguarding cases, including a description, action plan and learning points.

• The practice had reviewed its policy on significant events we saw a revised policy detailing the process for recording and reporting all significant events. We saw comprehensive minutes of significant events and analysis meeting minutes detailing five significant events that had occurred between May and July 2017, including case discussions, reflection, actions taken and lessons learnt.

• The practice had carried out a risk assessment on 14 April 2017 to demonstrate that they had considered and mitigated against the risk of not having access to their own defibrillator.

• The practice also submitted a written agreement to confirm arrangements were in place to borrow a defibrillator from the practice they shared premises with. However, whilst it was signed by both parties there was no date.

• The practice had reviewed its policy on carers. We saw a revised policy detailing the process for identifying and registering new carers. The practice had now identified (47 patients) as carers 0.6% this had increased by 0.1% since the last inspection.

The area where the provider should make improvements are:

• Continue to review arrangements in place to ensure that patients with caring responsibilities are identified and their needs met.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 30 March 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.

• 74% of patients diagnosed with asthma had an asthma review in the last 12 months; this was comparable to the local average of 76% and national average of 75%.

• Performance for diabetes related indicators was comparable to the local and national average, for instance:

• 69% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 69%, national average 77%).
• 73% of patients with diabetes on the register had their cholesterol measured as well controlled (local average 74%, national average 81%).
• 92% of patients with diabetes on the register had a recorded foot examination and risk classification (local average 85%, national average 88%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered an 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 30 March 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.

• 73% of women aged 25-64 had it recorded on their notes that a cervical screening test has been performed in the preceding five years; this was comparable to the local average of 77% and national average of 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 midwives and health visitors.

Updated 30 March 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.

• These patients had a named GP and were offered an 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 30 March 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.

• The practice offered extended opening hours on Tuesday evenings which suited working age people.

Updated 30 March 2017

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

• Performance for mental health related indicators was comparable to the local and national average:

  • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 91%, national average 90%).

• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months (local average 88%, national average 88%).

• 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 30 March 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, travellers 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.