The Grove Medical Practice

Updated 15 August 2016

The Grove Medical Practice is a well-established GP practice situated within the London Borough of Ealing. The practice lies within the administrative boundaries of Ealing Clinical Commissioning Group (CCG) and is a member of the North North Ealing GP network and Ealing GP Federation. The practice is an approved training practice for both GP specialist trainees (GP Registrars) and foundation year two doctors.

The practice provides primary medical services to approximately 6,600 patients living in Northolt and South Harrow and holds a core General Medical Services Contract and Directed Enhanced Services Contracts. The practice is located in Danemead Grove off Petts Hill at the South Harrow end of Northolt with good transport links by bus and rail services.

The practice operates from a converted detached house that has been extended and refurbished. There are four consultation rooms on the ground floor of the premises and two on the first floor with stair access. The reception and waiting area are on the ground floor with wheelchair access to the entrance of the building. There are accessible toilets for people with disabilities and off site car parking in surrounding residential areas.

The practice population is ethnically diverse and has a higher than the national average number of patients between 20 and 44 years of age and lower than the national average number of older patients 65 years plus. The practice area is rated in the fifth more deprived decile of the national 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 to provide the regulated activities of diagnostic & screening procedures, family planning, maternity & midwifery services, surgical procedures and treatment of disease disorder & Injury.

The practice team comprises of one female and two male GP partners, a male sessional GP, a female GP retainee, a female GP trainee and a male foundation year two doctor who all collectively work a total of 46 clinical sessions per week. They are supported by two part time practice nurses, a practice manager partner, assistant practice manager and six administration staff.

The opening hours are 8.30am to 1.00pm and 2.30pm to 6.00pm Monday, Tuesday, Wednesday and Friday and from 8.30am to 1.00pm Thursday. GP appointments in the morning are available from 9.00am to 11.30am on Monday and from 8.40am to 11.30am Tuesday to Friday. GP appointments in the afternoon are available from 2.30pm to 5.40pm Monday, Tuesday, Wednesday and Friday. Extended hours appointments are offered from 6.00pm to 8.00pm every Wednesday with a total of six hours covered by two GPs and a practice nurse. Open access GP telephone consultations with a GP are available between 12.00 -12.40 Monday to Friday. The out of hours services are provided by an alternative provider. The details of the out-of-hours service are communicated in a recorded message accessed by calling the practice when it is closed and on the practice website.

The practice provides a wide range of services including chronic disease management, antenatal and postnatal care and over 75’s health checks. The practice also provides health promotion services including, cervical screening, childhood immunisations, contraception and family planning.

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grove Medical Practice on 15 March 2016. Overall the practice is rated as good.

• 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 the staff were helpful, caring, friendly, professional and treated them with dignity and respect.
• 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.

We saw an area of outstanding practice:s

• The practice regularly updated and adapted standard templates used on the electronic record system to reflect new NICE guidelines. The practice maintained a comprehensive practice handbook that contained a complete reference to staff of services provided by the practice, including all operational procedures, prescribing and clinical guidelines, policies, community and secondary care services, and external organisations contact details. The handbook also provided electronic links to a variety of national and local guidance for staff to expediently access.

The areas where the provider should make improvement are:

• Review prescriptions tracking log incorporating allocated distribution.

• Display a warning notice where the oxygen cylinder is stored.

• Ensure all staff are appropriately trained in basic life support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 August 2016

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

• The practice offered GP and nurse led chronic disease management for conditions including diabetes, hypertension, asthma and COPD. Patients were invited for six monthly health checks for management of their disease and medication review. Reminders were placed on patients repeat prescriptions when their review was due.

• Quality and Outcome Framework data for long-term conditions were at or above average compared to national figures.

• The practice engaged in local enhanced services to identify patients with long-term conditions at high risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk. The care plans included a section called ‘rescue plan’ that advised the patient when to consult with their GP or other services if required. The practice’s avoidable admissions rate was lower compared to the CCG average.

• The practice held regular multi-disciplinary team meetings with community nurses, palliative care team and community matron to discuss older patients with complex medical needs and review and update their care plans.

• Home visits were available for patients unable to attend the practice due to illness or immobility and alerts were placed on electronic records for patients who had difficulty using the stairs.

Updated 15 August 2016

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

• There was a named GP lead for safeguarding vulnerable children and staff had received role appropriate child protection training and were aware of their responsibilities to raise any concerns. The practice maintained a register of vulnerable children and their families and monthly meetings with health visitors took place to discuss cases on the register.

• The practice engaged with local services to support vulnerable children and young adults. For example, they proactively referred patients to a local multi-agency team of counsellors, psychologist and family support workers who provided support for vulnerable children, their families and for young parents.

• The practice maintained a register of young carers and offered support and signposting to local services when appropriate.

• Uptake rates for childhood immunisations 2014/15 were at or above CCG averages.

• The practice provided shared ante-natal care with local hospitals and GP-led post-natal checks for mothers and babies at six weeks.

• The practice nurses were trained to offer family planning and contraceptive advice as required.

Updated 15 August 2016

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

• Patients over the age of 75 years had a named GP to promote continuity of care.

• The practice offered daily telephone consultations and home visits for patients unable to attend the surgery due to illness or immobility.

• Information on support groups was provided to patients who may benefit from this support.

• The practice participated in a local transport pilot scheme that provided assisted travel to the surgery.

• The practice aimed to provide services in house to avoid travel to distant sites. For example, the practice initiated an in-house anticoagulation monitoring service in response to feedback from patients who were having difficulties travelling to the local hospital.

• Patients were pro-actively referred to local community services including falls prevention, occupational therapy and social services as required.

• The practice engaged in local enhanced services and identified older patients at high risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk. The care plans were agreed with the patient and they kept a copy of their care plan at home. The practice’s avoidable admissions rate was lower compared to the CCG average.

• The practice held regular multi-disciplinary team meetings with community nurses, palliative care team and community matron to discuss older patients with complex medical needs and review and update their care plans. The practice also took part in quarterly network multi-disciplinary meetings attended by local GP practices and consultants in care of the elderly and mental health to discuss difficult cases and share knowledge and expertise to improve management and avoid admissions.

Updated 15 August 2016

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

• The practice offered extended hour appointments with two doctors and one practice nurse one evening a week for patients unable to attend the surgery during working hours. Both booked and open access telephone consultations were also available.

• There was the facility to book appointments and request repeat prescriptions online.

• The practice nurses had received smoking cessation training to offer support and advice for patients who wished to stop smoking with onward referral to local smoking cessation services if required.

• Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.

Updated 15 August 2016

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

• Screening for dementia was offered to patients at risk or those with concerns about their memory with onward referral to local memory clinic services if indicated.

• The practice provided primary medical services to three local supported living homes for patients with learning disabilities and people experiencing poor mental health.

• One of the GPs was the mental health lead for the practice and had been involved in reviewing the criteria for discharge from secondary care services back to the community teams. Discussion with the patients GP was sought before discharge from secondary care mental health services and the practice was currently auditing the impact of this service.

• The practice proactively referred patients with depression or anxiety to local Improving Access to Psychological Therapies (IPAT) services when required.

• QOF data for 2014/2015 showed the practice was comparable to local and national averages for mental health indicators.

Updated 15 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There was a named GP lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns. Alerts on electronic patient records were used to highlight vulnerable patients and these cases were regularly discussed at multi-disciplinary team meetings.

• The practice maintained a register of patients with learning disabilities and they were invited for annual health checks to update care plans and review medication. Alerts placed on electronic records ensured these patients were offered first and double time slots when booking appointments.

• Patients who did not have English as their first language could also book longer appointments to allow time for use of translation services.

• The practice list was open for people who were homeless to register and they were encouraged to use the practice address for correspondence to reduce the rate of missed hospital appointments.