Lancaster Gate Medical Centre

Updated 18 February 2016

Lancaster Gate Medical Centre provides primary medical services through a Personal Medical Services (PMS) contract in the W2 and W11 postcode areas of London within the London Borough of Westminster. The practice is part of NHS West London Clinical Commissioning Group. The services are provided from a single location to around 4,600 patients The list size has increased significantly from 2,500 over the past two years, due in part to local practice closures. The practice has a relatively young patient demographic with 85% of patients being of working age, and only 5% above the age of 65; Eighteen percent of registered patients are under the age of 16. This is reflected in the practice’s low chronic disease prevalence. The practice has a predominantly white patient population.

The practice is registered to carry on the following regulated activities: Diagnostic and screening procedures; Family planning; Maternity and midwifery services; and Treatment of disease, disorder or injury. The practice is also a training practice, teaching final year medical students.

At the time of our inspection, there were 2.5 whole time equivalent (WTE) GPs comprising the two partner GPs and a salaried GP, and practice manager (0.8 WTE) at Lancaster Gate Medical Centre. The practice also employed a part-time advanced nurse practitioner (0.7 WTE) and practice nurse (0.5 WTE), an assistant practice manager (1 WTE) and five administrative staff (3.5 WTE).

The practice is open between 8:00am to 6:00pm Monday and Thursday; 9:00am to 7:30pm Tuesday and Wednesday; and 9:00am to 6:00pm Friday. Appointments are from 8:00am to 11:30am and 3:30pm to 6:00pm Monday Thursday; 9:00am to 12:30pm and 4:30pm to 7:30pm Tuesday and Wednesday; and 9:00am to 12:30pm and 3:00pm to 6:00pm Friday. Extended surgery hours are offered for pre-booked appointments on Monday and Thursday mornings from 8:00am to 9:00am, and Tuesday and Wednesday evenings from 6:00pm 7:30pm. As part of a local ‘weekend collaborative’ patients can also access appointments on Saturday and Sunday between 9:00am to 5:00pm.

In addition to pre-bookable appointments that can be booked up to 6 weeks in advance, urgent appointments are also available for people that needed them. A walk-in surgery is held daily between 9:00am and 10:30am, to patients arriving before 10:00am on a first come, first serve basis.

There are also arrangements to ensure patients received urgent medical assistance when the practice was closed. Out of hours services are provided by a local provider. Patients are provided with details of the number to call.

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lancaster Gate Medical Centre on 16 December 2015. 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, with the exception of some areas relating to medicines management which should be improved.
• 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.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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:

• As recommended in national guidance, consider: placing an additional thermometer in all vaccine fridges or carrying out monthly calibration checks of single thermometers; and arranging for all fridges to be wired into switchless sockets or put in place cautionary notices that the fridge plug switches should not be turned off.

• Document the risk assessment of the practice’s decision not to stock bradycardia medicine in the emergency medicines kit.

• Ensure all monthly checks of emergency medicines are recorded in the log available and that medicine which has passed its expiry date is removed from the kit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 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.
• The practice performance for the majority of QOF indicators for long-term conditions was above average, although performance for diabetes related indicators was below the CCG and national average
• 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 practice had begun a number of out of hospital services to ease pressure on admissions, including anti-coagulation monitoring, spirometry, diabetes management and electro cardiograms (ECGs).

Updated 18 February 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 CCG averages for standard childhood immunisations.
• Clinical staff worked closely with health visitors to ensure good professional links and regular discussion of at risk children and troubled families.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors and school nurses. The practice held regular baby clinics, regularly, monitored childhood vaccination uptake and recalled late responders as necessary.
• The practice also offered family planning, preconception advice, antenatal care, postnatal care, a dedicated women’s health clinic, and screening for sexually transmitted infections (STIs).

Updated 18 February 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 participated in the ‘Whole Systems pilot’, a new community service which has been developed by the CCG to ensure comprehensive care planning for older at risk patients in a multi-disciplinary setting.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. . Vulnerable patients and all patients over the age of 75 had a nominated GP.

• There was a primary care navigator on site to support vulnerable older patients and facilitate access to a range of services.

• The practice had monthly multidisciplinary meetings with district nurses, social workers, a patient navigator, community matron, and the community pharmacist to discuss at risk patients and plan care and treatment.

• The community pharmacist was attached to the practice and could offer medication reviews, in the home where necessary, for patients on multiple medications in order to optimise safety and compliance.

Updated 18 February 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 reflected the needs for this age group. At the time of the inspection the practice had suspended NHS health checks for people aged 40-74 because of a low rate of uptake and instead targeted health checks were offered on an opportunistic basis.

• Services included advice on smoking cessation, sexual health, weight loss and alcohol advice. The practice also offered women’s and men’s health clinics.
• Booked appointments were provided during extended hours to allow working people early morning and late evening access. The practice was part of a local Weekend Collaborative offering its patients appointments for Saturday and Sunday.

Updated 18 February 2016

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

• 71% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average the national average. QOF performance for mental health related indicators was above the CCG and 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 participated in the local Out of Hospital (OOH) service for these patients, providing share care prescribing and frequent reviews, with long appointments where necessary. The practice also provided blood tests and ECG monitoring for patients on antipsychotic medication.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, including referral of those diagnosed with dementia to the local memory service.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 18 February 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 and those with a learning disability.
• The practice worked with the local Homelessness Intervention Team and participated in the local Out Of Hospital Service for the Homeless
• The practice encouraged patients from vulnerable groups to access care services, through flexible appointment systems including walk in surgeries, and longer appointment times for people with multiple needs. Vulnerable patients and all patients over the age of 75 had a nominated GP.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice facilitated vulnerable patients’ access to support groups and voluntary organisations through the support of a primary care navigator.
• 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.