Shakespeare Health Centre

Updated 19 December 2016

Shakespeare Health Centre provides NHS primary medical services to around 4000 patients in Hayes, in the Hillingdon Clinical Commissioning Group area. The service is provided through a general medical services contract.

The current practice clinical team comprises two GP partners and two salaried GPs. The practice employs three part time practice nurses (one whole time equivalent), a clinical pharmacist who was an independent prescriber, and a phlebotomist. The practice also employs a practice manager and administrative and reception staff. The GPs typically provide around 21 sessions in total each week. Patients have the choice of seeing a male or female GP.

The practice is open from 8.30am until 6.30pm during the week with an additional early morning session between 7am-8am every Tuesday. Same day appointments are available for patients with complex or more urgent needs. The practice offers online appointment booking. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on its website and on a recorded telephone message.

The practice population profile differs from the national average in having a higher proportion of families with children under five. The population in the local area is characterised by average levels of income deprivation, life expectancy and unemployment. The practice population is ethnically diverse.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder and injury.

Updated 19 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shakespeare Health Centre on 14 July 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• Risks to patients were assessed and well managed.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment 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 the partners, the lead GP and management. The practice proactively sought feedback from staff and patients, which it acted on.
• The current practice partners had successfully turned around the performance of the practice, for example as measured by the Quality and outcomes framework. The practice was willing to experiment and trial new ideas for the benefit of patients.

We saw one area of outstanding practice:

• The partners were in the process of implementing a clear strategy to improve the management of long term conditions. The effective use of clinical audit, accredited training for the whole team and the employment of a pharmacist had transformed the management and control of diabetes within a year.

The areas where the provider should make improvement are:

• The practice should improve levels of patient uptake for cervical, bowel and breast cancer screening to reduce the risk of patients developing avoidable cancers or the late detection of cancers.
• The practice should improve its identification of patients who are also carers and ensure their needs are assessed.
• The practice should do more to protect vaccines and any other medicines required to be kept cold in line with current guidelines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 December 2016

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

• The practice kept registers of patients with long term conditions. These patients had a structured annual review to check their health and medicines needs were being met. The practice operated a call-recall system to encourage patients to attend for their review and attached a reminder to patients' prescriptions.
• The prevalence of diabetes was high locally at 12%. The practice had recently provided their administrative staff with diabetes awareness training to ensure the whole practice team understood the importance of diagnosis and regular monitoring.
• Practice performance for diabetes was above average. The percentage of diabetic patients whose blood sugar levels were adequately controlled was 83% compared to the clinical commissioning group average of 75%.
• The practice participated in a local scheme to avoid unplanned admissions which included patients with multiple long term conditions. Patients identified as at risk were reviewed and had a personalised care plan. Cases were discussed at regular multidisciplinary meetings.

Updated 19 December 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 higher than average for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. The premises were suitable for children and babies
• Appointments were available outside of school hours.
• We saw positive examples of timely communication and referral to health visitors and other community health services.

Updated 19 December 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 provided the seasonal flu vaccination for patients over 65 and the shingles and pneumococcal vaccinations for eligible older patients. The practice ensured that housebound patients received these vaccinations. 
• The practice had access to a named local care coordinator who could visit older patients at home and could signpost patients to other services, clubs and events, for example, to reduce social isolation. 
• One of the practice's clinical objectives was to reduce the ill-effects of polypharmacy (that is, where patients take multiple medicines).The practice employed a pharmacist who carried out medication reviews and liaised with local pharmacies to ensure prescription changes were actioned safely.
• However, some patients told us that the geographical relocation of the practice disproportionately affected older patients who were less likely to drive.

Updated 19 December 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 and flexible.
• The practice was open from 8:30am until 6.30pm during the week with an additional early morning session from 7am-8am every Tuesday following patient feedback. GP nurse and phlebotomy appointments were available in the early morning session.
• The practice offered a range of ways to access services, for example, daily telephone consultations with a GP, online appointment booking and an electronic prescription service.
• The practice offered a full range of health promotion and screening services reflecting the needs for this age group. The practice had identified a number of patients with previously undiagnosed diabetes through its programme of NHS health checks.
• 71% of eligible women registered with the practice had a recorded cervical smear result in the last five years compared to the CCG average of 80%.

Updated 19 December 2016

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

• 71% of patients with dementia had attended a face to face review of their care in the last year compared to the CCG average of 81%. 
• The practice engaged patients with dementia in discussions around advanced directives and involved carers in these discussions where appropriate. Interpreters were arranged for patients who spoke English as a second language before carrying out any memory assessment.
• The practice regularly liaised with specialist teams in the case management of patients experiencing poor mental health.
• The practice was able to advise patients experiencing poor mental health and their carers 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.

Updated 19 December 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 people with a learning disability.
• The practice offered longer and same day appointments for patients with a learning disability.
• The practice maintained a register of patients who were also carers. Carers were offered regular reviews and flu vaccination.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.