Archived: Chalkhill Family Practice

Updated 28 March 2018

Chalkhill Family Practice is located in Brent, London and holds a General Medical Services contract and is commissioned by NHS England, London. The practice is registered with the Care Quality Commission to provide diagnostic and screening procedures; family planning and treatment of disease, disorder or injury.

The provider, who was a single-handed GP, had brought in two new partners in August 2017; Consequently, the practice was operating as a partnership staffed by a lead female GP and a male and female GP partner as well as another female salaried GP who provided a total of 28 sessions.

The practice also employs a practice manager who works 30 hours a week, an assistant practice manager, a practice nurse who works 22 hours a week, two part-time healthcare assistants (HCA), a practice secretary and seven reception and administration staff members.

The practice is open between 9.00am and 6.30pm Monday to Friday. Appointments are from 9.00am and 12.30pm and 1.30pm and 6.30pm daily. Extended hours appointments are offered on Tuesday and Wednesday between 7.00am and 8.00am and 6.30pm and 7.00pm. The practice is part of the Kingsbury and Willesden network to provide a GP HUB service in the premises between 6.00pm and 9.00pm as part of the network. They also offer an extended GP HUB service for pre-booked appointments on Sunday. Outside of these hours, the answerphone advises patients of the number of their out of hours provider, Care UK.

The practice has a list size of 6,400 patients and is located on the first floor of the Welford Centre at 113 Chalkhill Road, Wembley, HA9 9FX. Access to the practice is via an access lift and stairs. The practice provides a wide range of services including phlebotomy, spirometry, ECG monitoring, joint injections, cryotherapy, child health surveillance, family planning and contraception, coil insertion, sexual health screening, cervical screening, chronic disease management including insulin initiation, travel clinic and NHS health checks. They also provide healthcare to three local care homes.

The practice is located in a very deprived area and demographically diverse area with a large proportion of the practice population being from the black and ethnic minority (BME) community. The practice has a higher proportion than average of young people aged between 15-44 years of age.

The practice has not been inspected before. An initial site visit was carried out on 25 October 2017, however; due to difficulties experienced at this inspection, a second site visit was carried out on 10 November 2017.

Updated 28 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chalkhill Family Practice on 25 October 2017 and a second site visit was carried out on 10 November 2017 in order to collect further information. Overall, the practice is rated as Inadequate.

Our key findings across all the areas we inspected were as follows:

• We were not assured that staff were able to identify and report significant events and incidents. There was also no evidence that the reported significant events were communicated widely enough and so safety was not improved.

• Patients were at risk of harm because systems and processes were not in place to keep them safe. Areas of concern were found in relation to recruitment checks, medicines management and dealing with emergencies.

• Staff were aware of current evidence based guidance although we did not see evidence that NICE guidance was always discussed in meetings.

• Governance arrangements had systemic weaknesses and did not ensure the practice was run safely and effectively, and performance was not being monitored in all areas.

• The practice understood its population profile and had used this understanding to meet the needs of its population.

• The practice worked closely with other organisations and with the local community in planning services that met patients’ needs.

• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Establish effective systems to ensure that there are no gaps in employment records.

In addition the provider should:

• Provide practice information in appropriate languages and formats.
• Display PPG information in the practice.
• Proactively identify and support patients who are carers.
• Review and update infection control audit and act on recommendations from the audit.
• Take action in response to patient feedback with regards to staff attitude.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 March 2018

The provider was rated as inadequate for safety and well-led, requires improvement for effective and rated good for caring and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• The practice shared relevant information with other services in a timely way, for example when referring patients for two-week wait appointments, verbal safety netting was carried out only.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Outcomes for patients with diabetes were similar to local and national averages. For example, the percentage of patients with diabetes on the register whose cholesterol levels were within normal range was 82%, compared to the CCG and national averages of 80%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

Updated 28 March 2018

The provider was rated as inadequate for safety and well-led, requires improvement for effective and rated good for caring and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation uptake rates for the standard childhood immunisations were relatively high and similar to the national average of 90%. The nurse followed up children who did not attend their vaccination appointments.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of antenatal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 28 March 2018

The provider was rated as inadequate for safety and well-led, requires improvement for effective and rated good for caring and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice offered home visits and urgent appointments for those with enhanced needs.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the hospital at home as well as the WSIC (Whole Systems Integrated Care) team.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, the practice worked with the care navigators who provided patients with extra support in the community.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to local and national averages.

Updated 28 March 2018

The provider was rated as inadequate for safety and well-led, requires improvement for effective and rated good for caring and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Sunday appointments.
• 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.
• Patients had access to the practice website and could book appointments and order repeat prescriptions online. A Brent Health mobile phone application system was available for patients to promote self-management of their own care.
• The practice offered health checks and health screening.

Updated 28 March 2018

The provider was rated as inadequate for safety and well-led, requires improvement for effective and rated good for caring and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• The practice carried out advance care planning for patients living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice regularly worked with multi-disciplinary teams in the case management of patients living with dementia. They worked closely with primary care dementia nurses, social services and old age psychiatry to manage dementia patients in the community.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, mental health patients were invited for annual health checks, drug monitoring and ECG’s as required.

• Complex mental health patients were referred to the Complex Patient Management Group (CPMH) for further input from the multi-disciplinary team.

• 93% of patients with mental health conditions had a comprehensive agreed care plan and this was higher than the CCG average of 91% and national average of 89%.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. Alerts were added to patient records where there classified as high risk to inform clinicians when assessing patients.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 March 2018

The provider was rated as inadequate for safety and well-led, requires improvement for effective and rated good for caring and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including a learning disability liaison nurse, health and social care co-ordinators and care navigators. Care navigators provided patients with extra support in the community such as obtaining blue badges, personal alarm pendants and arranging transport.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.