The Surgery

Updated 5 May 2016

• The practice is in The London Borough of Eailing, it is located on the ground and first floor of a two storey building with a small parking facility. There are three consulting rooms and a room a for baby consultations. There two toilets, one for patients with disabled access and other for staff. Access to the surgery is via the side entrance of the building on level flooring for wheelchair access.
• The practices provides the following services to the whole population:

• Diagnostics and screening services

• Treatment of disease, disorder or injury

• Maternity and midwifery services

• Surgical procedures

• Family Planning Services

• The practice is run by two male GP partners who are supported by two female GP locums. There is also one female nurse, three members of reception staff, one administrator and one practice manager.

• The practice is open between Monday 08:00am and 6:30pm Monday to Fridays.
• When the practice is closed patients can call 111 in an emergency or Care UK, a local out of hours service.

• The practice has a patient list of approximately 4,060 patients. The practice is situated in an area which is classified as fourth less deprived decile. The majority of the patients within the practice are either young or of working age. A small percentage of patients are aged between 65 and 85.

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery, 35 Allendale Road, Greenford, Middlesex, UB6 0RA on 16 February 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.
• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Clinical audits demonstrated quality improvement.
• Staff had most of the skills, knowledge and experience required to deliver effective care and treatment.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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:

• Ensure that provisions of the Mental Capacity Act 2005 are fully understood and implemented.

• The practice should take action to proactively identify patients with caring responsibilities.

• Implement a programme of clinical audit to improve outcomes for patients.

• Improve sharing of care plans of patients with mental health disorders.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 May 2016

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.

• 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.

• The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) is 81.61% at the practice compared to 77.54% nationally, this is higher than the national average.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less (01/04/2014 to 31/03/2015) is 57.72% at the practice compared to 78.03% nationally, this is significantly lower than the national average.

• The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) is 83.52% at the practice compared to 94.45% nationally, this is lower than the national average.

Updated 5 May 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 relatively high for all standard childhood immunisations.

• 67.74% of patients with asthma, on the register, had an asthma review in the preceding 12 months, including an assessment of asthma control using the 3 RCP questions. This is comparable to 75.35% nationally.

• 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.

• 78.12% of women aged 25-64 notes record that a cervical screening test has been performed in the preceding 5 years.This is comparable to 81.3% nationally.

• 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, health visitors and school nurses.

Updated 5 May 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.

Updated 5 May 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 5 May 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) is 66.67% at the practice compared to 88.47% nationally, this is comparable to the national average.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) is 100% at the practice compared to 89.55% nationally; this is higher than the national average.

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) is 77.78% at the practice compared to 84.01% nationally; this is comparable to the national average.

• The percentage of patients with physical and/or mental health conditions whose notes record smoking status in the preceding 12 months (01/04/2014 to 31/03/2015) is 96.22% at the practice compared to 94.1% nationally, this is higher than the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 5 May 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 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 multi-disciplinary teams in the case management of vulnerable people.

• 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.