Archived: The Good Practice

Updated 27 July 2016

The Good Practice provides GP primary care services to people living in the south of the London Borough of Kensington and Chelsea. It had just over 3000 people registered. It is located is an urban area, one of the most densely populated in the United Kingdom. There is a far higher proportion of 20-39 year old people living in Kensington and Chelsea than in most areas, and a lower proportion of younger people (under 19 year olds) and people over the age of 50.

The practice is staffed by two GP partners – one male and one female who do a total of 16 sessions a week. Other staff include, a healthcare assistant, practice manager and two receptionists. They have one surgery in Kings Road, Chelsea. The practice holds a General Medical Services (GMS) contract and was commissioned by NHSE London. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury and maternity and midwifery services.

The practice was open from 8.30am to 6.00pm Mondays to Friday, except Wednesdays when they closed at 12 noon. Patients had access to GPs at other local surgeries on Saturdays and Sundays between 9am to 4pm. The telephones were staffed throughout working hours, except between 12.00pm and 2.00pm when the phones were switched over to the ‘out of hours’ provider. Appointment slots were however, only available between 9am - 11am and 2.30pm and 4.30pm. The ‘out of hours’ services are provided by an alternative provider. The details of the ‘out of hours’ service were communicated in a recorded message accessed by calling the practice when closed. Longer appointments were available for patients who needed them and those with long-term conditions. This included appointments with a named GP or health care assistant. Pre-bookable appointments could be booked up to one weeks in advance; urgent appointments were available for people that needed them.

The practice provided a wide range of services for patients with diabetes, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provided health promotion services including a flu vaccination programme.

Updated 27 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Good Practice on 18 May 2016. Overall the practice is rated as requires improvement.

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 not adequately assessed for example the practice did not have oxygen or a defibrillator available for use in an emergency and had not assessed the risks of this.

• 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 difficult to make an appointment and there were limited 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 leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure patient specific prescription or direction from a prescriber are in place in accordance with legislation to support the Health Care Assistant with the safe administration of vaccines and medicines.

• The practice should ensure an automated external defibrillator (used to attempt to restart a person’s heart in an emergency) and oxygen are available or should carry out a risk assessment to identify what action would be taken in an emergency.

• Implement processes to continually assess risks to patients and staff, such as carry out an infection control audit and fire drills. 

The areas where the provider should make improvement are:

• Review the telephone and booking system to ensure that patients are able to book appointments when needed.
• Review the practice’s opening hours in light of patient feedback in the GP patient survey
• Review their exception reporting in relation to the Quality and Outcomes Framework (QOF) with the aim of reducing it. Implement processes to improve the uptake for the cervical screening programme.
• Document the practice vision and ensure the practice strategy and supporting business plans reflect it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 July 2016

The provider was rated as requires improvement for people with long term conditions.

The provider was rated as requires improvement for safe and well led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The HCA carried out reviews of patients with diabetes and respiratory conditions

• Performance for diabetes related indicators was 58%, which was 22% below the CCG and 31% below national averages. For example, the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months was 56% compared to the CCG average of 72%. Longer appointments and home visits were available when needed.
• All these patients had a named GP however review to check their health and medicines needs were being met was carried out opportunistically.
• The practice has signed up to provide Spirometry and ABPM (ambulatory blood pressure monitoring) as part of the ‘out of hospital’ services.

Updated 27 July 2016

The provider was rated as requires improvement for the care of families, children and young people.

The provider was rated as requires improvement for safe and well led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 comparable to the CCG 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.
• The practice’s uptake for the cervical screening programme was 42%, which was below the CCG average of 75% and below the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 27 July 2016

The provider was rated as requires improvement for people with long term conditions.

The provider was rated as requires improvement for safe and well led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Patients over 75 years had a named GP to co-ordinate their care
• 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. They carried out home visits when needed.
• One GP provided twice weekly ward rounds at a local older persons home.

Updated 27 July 2016

The provider was rated as requires improvement for the care of working age people.

The provider was rated as requires improvement for safe and well led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Practice patients had access to extended hours appointments at another local practice at weekends.

Updated 27 July 2016

The provider was rated as requires improvement for the care of people experiencing poor mental health.

The provider was rated as requires improvement for safe and well led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 94%
• Patients experiencing poor mental health were invited to attend annual physical health checks and 83 out of 108 had been reviewed in the last 12 months.
• 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 27 July 2016

The provider was rated as requires improvement for the care of people whose circumstances may make them vulnerable.

The provider was rated as requires improvement for safe and well led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 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.