Archived: Elm Trees Surgery

Updated 30 June 2016

Elm Trees Surgery is situated at 2A Horsenden Lane North, Greenford, Middlesex, UB6 0PA. The practice provides NHS primary care services through a General Medical Services (GMS) contract to approximately 5000 patients living in the London borough of Ealing. The practice is part of the NHS Ealing Clinical Commissioning Group (CCG).

The practice has a higher than national average patient population between 25 and 39 years of age and young children. The predominant ethnicity is Asian, however in recent years the Polish population has increased and other eastern Europeans such as Romanians and Bulgarians. The practice area is rated in the third least deprived decile of the Index of Multiple Deprivation (IMD). People living in more deprived areas tend to have greater need for health services.

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

The practice team consists of two full time GP partners (one male and one female), one full time nurse, two part time nurses, a practice manager and a small team of non-clinical staff.

The practice opening hours are 08:00hrs to 18:00hrs Monday to Friday with the exception of Wednesday where the practice closes at 13:00hrs. Appointments are from 08:00hrs to 13:00hrs every morning and 14:00hrs to 18:00hrs daily with the exception of Wednesday where there is only a morning clinic. Extended hours appointments are offered from 18:30hrs to 19:30hrs on Monday and Thursday. For out-of-hours (OOH) care including weekends and Wednesday afternoons patients are instructed to contact the NHS 111 service where they are directed to local OOH services.

In addition to core primary medical services the practice provides childhood immunisations / developmental checks, travel vaccinations, cervical screening and NHS health checks for new patients and those over 40 years of age. The practice also provides out of hospital services including high risk diabetes management, wound care, care plans and spirometry.

Updated 30 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elm Trees Surgery on 10 May 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.
• Although national GP patient survey results were below average, patients told us on the day of our inspection, and through completed comment cards, that 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 could get an appointment in a reasonable time with a named GP and there was continuity of care, with urgent appointments 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 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:

• Continue to implement measures to improve patient satisfaction with the service provided.
• Consider providing access to a hearing loop to aid communication with patients who are hard of hearing.
• Proactively identify and support more patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 June 2016

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

• Nursing staff supported the GPs in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Data provided by the practice showed they had achieved 99% of the total number of QOF points available in 2015/16 for diabetes indicators which was an improvement on the previous years score of 96%.
• 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 30 June 2016

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 comparable to local averages 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.
• 77% of patients with asthma, on the register, had an asthma review in the preceding 12 months which was comparable to the CCG average of 77% and the national average of 75% (2014/15).
• The practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 78% and the national average of 82% (2014/15).
• Appointments were available outside of school hours and the premises were suitable for children and babies. 

Updated 30 June 2016

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.
• The practice provided services for a local residential care home.

Updated 30 June 2016

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.

Updated 30 June 2016

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

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 88% and the national average of 84% (2014/15).
• 74% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive , agreed care plan documented in the record, in the preceding 12 months, which was comparable to the CCG average of 91% and the national average of 88% (2014/15).
• 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 June 2016

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 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.