Cuckoo Lane Practice

Updated 18 June 2015

Cuckoo Lane Practice provides GP primary care services to approximately 4,400 people living in the London Borough of Ealing. The practice is owned by two nurse practitioners, who are the partners and as such holds an Alternative Provider Medical Services (APMS) contract and was commissioned by NHSE London. It is staffed by three salaried GPs, two males and one female who work part time hours. There are five nurse practitioners, four nurses, a healthcare assistant, a pharmacist, a practice manager and seven administrative staff. The practice was registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury, surgical procedures, family planning and maternity and midwifery services.

The practice opening hours are 8am to 6.30pm Mondays, Tuesday, Wednesday and Fridays and 8am to 8pm on Thursday. The ‘out of hours’ services were provided by an alternative provider. The details of the ‘out of hours’ service were communicated in a recorded message accessed by calling the practice when it was closed and details could also be found on the practice website. The practice provided a wide range of services including clinics for asthma, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provided health promotion services including a flu vaccination programme and cervical screening.

Ealing is the third largest of London’s 32 boroughs in terms of population. It has more people of working age than the UK as a whole, and fewer older people. Ealing has a very mobile population and evidence from patient registrations at GP practices consistently show Ealing to have a high level of international migration. The borough of Ealing is ethnically diverse. In the latest census 49% gave their ethnicity as white, 30% as Asian, 11% as Black and 4.5% as of mixed or multiple ethnicities, the remainder identifying as Arab or other ethnicity. This is similar to the practice patient population which is 50% white British, 15% white, 20% Asian and 15% Black. Ealing records a high deprivation score relative to the London average and has the 17th highest level of child poverty in London (out of the 32 boroughs in the capital). In addition, inequalities in skills and income levels causes social polarisation to exist within the borough.

Updated 18 June 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Cuckoo Lane Practice on 28 January 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for being well-led and providing responsive and effective services. We found they were good for providing safe and caring services. It was also outstanding for the care provided to older people, people with long term conditions, families, children and young people, people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia). They were good for the care and treatment they offered working aged people (including those recently retired) and people whose circumstances make them vulnerable.

Our key findings were as follows:

• Arrangements were in place to ensure patients were kept safe. The practice learnt when things went wrong and shared learning with all staff to minimise the risk of reoccurrence
• Patients’ needs were appropriately assessed and care and treatment was delivered in line with current legislation and best practice.
• We saw from our observations and heard from patients that they were treated with dignity and respect.
• The practice understood the needs of their patients and provided services that met their needs.
• The practice was well-led, had a defined leadership structure and staff felt supported in their roles.

We saw areas of outstanding practice including:

• One nurse practitioner at the practice carried out spirometry tests and also provided a weekly clinic for patients registered at other local practices. All COPD patients are given a self-management plan with particular reference to rescue medication. This has led improved symptom control and less hospital admissions for 25% of patients in this group over the last year.

• The practice took part in the ‘shifting settings of care’ program which supported patients with mental illness access better, more integrated care outside of hospital and transfer the care of people with ‘common mental illness’ or stable ‘severe and enduring mental illness’ from mental health services into primary care. One impact being 19 patients who would have previously received care in Secondary care setting in the past are now receiving their support and treatment from their GP surgery.

• An example of integrated care for older people is that an Age UK support worker attended the practice three days a week, to support older patients who live on their own. The practice also provided transport to improve access for those patients who are house bound or find it difficult to get to the surgery. Patients reported satisfaction and liked being able to attend the surgery. This improves socialisation and reduced the amount of home visits by 20 during its first month.

• The practice was instrumental in establishing an Ealing wide approach to the three tier model of shared care for diabetes. This pilot project was part of a major redesign of diabetes care across Ealing and led to more diabetic nurse specialist being appointed including a Diabetic nurse consultant for the borough and weekly satellite clinics.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 June 2015

The practice is rated as outstanding for the population group of people with long term conditions. Emergency processes were in place and referrals made for patients in this population group that had a sudden deterioration in health. Where needed, longer appointments and home visits were available. Patients with a long term condition had a named clinician, a care plan and structured annual reviews to check their health and medication needs were being met. For those people with the most complex needs the named clinician worked with relevant health and care professionals to deliver a multidisciplinary package of care. Nursing staff had received appropriate training to manage and support patients with long term conditions such as spirometry. The practice had GP leads for a variety of chronic conditions including diabetes, chronic obstructive pulmonary disease (COPD) and asthma. The practice carried out spirometry tests and liaised regularly with the respiratory consultant that managed the care of patients diagnosed with chronic obstructive pulmonary disease (COPD). They also provided a weekly clinic for patients registered at other local practices. The practice was instrumental in setting up an Ealing wide approach to the three tier model of shared care for diabetes. We saw the practice had scored 100% of their QOF target in most of the long term conditions indicators.

Updated 18 June 2015

The practice is rated as outstanding for the population group of families, children and young people. Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were at risk such as children subject to child protection plans. The safeguarding lead attended child protection case conferences and reviews where appropriate and reports were sent if staff were unable to attend. There were weekly immunisation baby clinics and immunisation rates were high in comparison to other practices in the CCG, for all standard childhood immunisations. Patients told us and we saw evidence that children and young people were treated in an age appropriate way and recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health. The clinicians offered family planning advice, fitted IUDs and prescribed the contraceptive pill

Updated 18 June 2015

Patients over 75 years had a named GP to co-ordinate their care. The named GP held regular meetings with other health care professionals to provide multidisciplinary care for older patients and liaised with appropriate health care professionals when required to ensure older patients received effective care. The practice had a list of older people who were housebound whom they would visit regularly, particularly frail older patients. They used a risk stratification tool designed to identify patients at highest risk of attending A&E or being admitted to hospital, and also to enable the GPs to have peer to peer discussions regarding patients with similar health concerns

An Age UK support worker attended the practice three days a week, to support older patients who live on their own. Their role included befriending, attended patients’ homes to carry out small repairs like replacing light bulbs and changing plugs, liaising with social services and acting as advocates. The practice also provided transport to improve access for those patients who are house bound or find it difficult to get to the surgery. Patients report satisfaction and report liking being able to attend the surgery. This improves socialisation and reduced the amount of home visits by 20 during its first month.

The practice had achieved and implemented the gold standards framework for end of life care. It had a palliative care register and had regular internal as well as multidisciplinary meetings to discuss the care and support needs of patients and their families

Updated 18 June 2015

The practice is rated as good for the population group of the 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. They had extended opening for one hour one day a week, offered phone consultations and online services for ordering repeat prescriptions, booking appointments and getting test results were available. The practice offered a full range of health promotion information and invited patients over 40 years of age to have an NHS health check.

Updated 18 June 2015

The practice took part in the ‘shifting settings of care’ program which supported patients with mental illness transition from secondary care to primary care to ensure a safe discharge process. A mental health worker, employed by the secondary care trust, would attend the practice every two weeks to meet with people recently discharged from hospital. The support offered was holistic which included information and advice about housing, income, social and general health. One impact being 19 patients who would have previously received care in Secondary care setting in the past are now receiving their support and treatment in their GP surgery.

The GP’s also had access to consultant psychiatrists help line at Ealing hospital where they would discuss concerns such as medication swaps and co-morbidities. Patients who experienced poor mental health were kept on a register and invited for annual reviews with extended appointments. Reception staff we spoke with were aware of signs to recognise for patients in crisis and to have them urgently assessed by a GP if they presented at the practice. The practice scored 100%of their QOF target for dementia

Updated 18 June 2015

The practice is rated as good for the population group 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 learning disabilities. There was a system to highlight vulnerable patients on the practice’s electronic patient records. The practice had carried out annual health checks for people with learning disabilities and 95% of these patients had received health checks last year. The practice offered longer appointments for people with learning disabilities.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours.

The practice used a telephone translation service and the automated checking in machine located in the waiting room was in five different languages.