Preston Hill Surgery

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 10 March 2016 at Preston Hill Surgery. At that inspection the practice was rated good overall. However we rated the safety of the service as requires improvement. This was because the practice could not demonstrate it had carried out all necessary recruitment checks prior to new members of staff starting work at the practice. The practice was also unable to show us evidence of the fire safety checks it carried out. The full comprehensive report of the 10 March 2016 inspection can be found by selecting the ‘all reports’ link for Preston Hill Surgery our website at www.cqc.org.uk.

This inspection was a desk-based review undertaken on 2 May 2017 to check that the practice had addressed the requirements identified in our previous inspection. This report covers our findings in relation to those requirements and also outlines some additional improvements made since our previous inspection.

Overall the practice remains rated as good. Following this desk-based review, we have revised the practice’s rating for safe services. The practice is rated good for providing safe services.

Our key findings were as follows:

• The practice was demonstrated that all employed staff had undergone appropriate recruitment checks before starting work at the practice.
• The practice provided evidence of weekly fire safety monitoring checks and six monthly fire drills.

The practice had made some other improvements since our previous inspection:

• The practice had significantly increased the number of patients identified as carers. The practice had now identified 191 patients who were carers (that is, 3% of the patient list). It had done this through carrying out a systematic audit of patient contacts, a programme of staff training and developing links with the local carers centre.
• The practice had set up a patient reference group since our previous inspection. The practice told us of recent actions taken in response to patient feedback which included increasing the number of sessions offered by a male GP and installing an electronic check-in system and patient display board in the waiting room.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 6 October 2016

The provider was rated as good for the care of people with long term conditions.

• The practice had identified diabetes control as an area for improvement. For example, the percentage of diabetic patients whose blood sugar levels were adequately controlled in 2014/15 was 64% compared to the national average of 78%. The practice was aware of this and had introduced joint clinics with the community diabetic nurse specialist and insulin initiation for eligible patients. The practice had recently audited its management of diabetes and could demonstrate positive improvement. 
• The practice systematically identified patients at risk of hospital admission and developed care plans with those patients and their carers where appropriate.
• 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. 
• Longer appointments and home visits were available when needed. The practice appointment system was set up so that patients with long term conditions experienced continuity of care with the patient's named or preferred GP.
• Patients with long term conditions had a named GP and a structured annual review to check their health and medicines needs were being met. The practice offered in-house phlebotomy to reduce the need for patients to travel for routine blood tests.

Updated 6 October 2016

The provider was 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 in line with the CCG averages for standard childhood immunisations for all age cohorts. Non attendance was followed-up. 
• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children and babies were prioritised and seen the same day.

Updated 6 October 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 wrote to patients over 75 to inform them of their named GP and what this meant.
• The practice had become increasingly popular with patients in the local nursing home. One of the GPs made regular visits to the nursing home, including joint visits with the district nurse and was working in partnership with the local prescribing team. However, there was mixed feedback about the practice's capacity to be responsive to these patients' needs.
• The practice ran regular 'over 75s teas' to obtain feedback, provide relevant health advice and combat social isolation.

Updated 6 October 2016

The provider was rated as good for the care of working age people (including those recently retired and students)

• The practice was proactive in offering a full range of health promotion and screening services reflecting the needs for this age group. The practice had identified patients with previously undiagnosed diabetes through the NHS health checks programme for patients aged 40-74 years.
• Cervical screening coverage was in line with the national average at 83%.
• The practice offered a range of contraceptive services and advice.
• The practice offered evening surgeries until 7.00pm four days a week. Local primary care 'hub' appointments were available at other locations in Brent during the evening and at weekends if no suitable appointments at the surgery were. The practice informed patients about these services and how to make an appointment.
• The practice enabled patients to book appointments and request repeat prescriptions online. Patients were also able to consult a GP over the telephone.

Updated 6 October 2016

The provider was rated as good for the care of people experiencing poor mental health (including people with dementia)

• The practice provided screening for dementia with referral for specialist diagnosis.
• Thirty-two of 35 patients with a diagnosed psychosis (across both the Preston Hill and its sister surgery) had a documented care plan which was in line with the national average. The practice regularly monitored these patients' physical health.
• The practice acknowledged that some patients required longer and more frequent appointments. The practice had patients who attended the practice on a weekly basis.
• 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.
• The practice offered six-week postnatal checks and screened mothers for post-natal depression.

Updated 6 October 2016

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

• The practice held registers of patients in vulnerable circumstances including people with a learning disability. These patients were offered an annual or more frequent review depending on their needs.
• The practice asked new patients when they registered whether they had caring responsibilities.
• The practice offered longer appointments for patients with communication difficulties.
• The practice facilitated registration for homeless patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and also involved carers whenever appropriate.
• 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.