The Practice @ 188

Updated 21 January 2019

The Practice @ 188 is a practice located in the London Borough of Barnet. The practice is part of the NHS Barnet Clinical Commissioning Group (CCG). It currently holds a Personal Medical Service (PMS) contract with NHS England. This is a locally agreed alternative to the General Medical Services contract used when services are agreed with a practice which may include additional services beyond the standard contract.

The clinical team at the practice is made up of one male Lead GP and five part time salaried GPs (all female), a female practice nurse, a female health care assistant and a female phlebotomist. (Phlebotomists are clinicians trained to take blood samples from patients for testing in laboratories). There are nine administrative staff and a full time practice manager.

The practice is open between 8am and 8.30pm on Monday and between 8am and 6.30pm from Tuesday to Friday. Appointments are from 8.30am to 1pm and 2pm to 6.30pm. Extended hours surgeries are offered on Monday between 6.30pm and 8.30pm. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments are also available for people that need them. Patients are able to book appointments on-line. The practice opted out of providing an out of hours service and refers patients to the local out of hours service or the ‘111’ service.

The service is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and the treatment of disease, disorder or injury. The practice provides a range of services including child health and immunisation, minor illness clinic, phlebotomy, smoking cessation clinics and clinics for patients with long term conditions. The practice also provides health advice and blood pressure monitoring

Updated 21 January 2019

We had previously carried out an announced comprehensive inspection in October 2017, the practice was rated good for all domain and population groups at that time. The report for the comprehensive inspection can be found by selecting the ‘reports’ link for The Practice @ 188 on our website at: https://www.cqc.org.uk/location/1-2464509211/reports

We received concerns about the population group ‘older people’ from third parties. To ensure the care of older people was in line with the good rating the practice received in October 2017, we carried out an announced focused inspection at The Practice @ 188 on 13 November 2018 to review the care of older people. The practice were open and transparent during the inspection process.

We reviewed the population group ‘older people’ against the key questions:

Are services safe?

Are services effective?

Are services caring?

Are services responsive?

Are services well-led?

We found no patient safety concerns when reviewing this population group. We did find areas of good practice and we found the population group ‘older people’ was in line with the good rating awarded in October 2017.

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

• The practice had effective systems to manage medicines for older people including high risk medicines.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided for older people. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated older people with compassion, kindness, dignity and respect.
• Learning from incidents was identified and shared widely enough to result in improved outcomes for patients.
• Medical records we reviewed for older people were comprehensive and in line with General Medical Council guidelines.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 11 December 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators were comparable to CCG and national averages. For instance, 66% of patients had well controlled blood sugar levels (CCG average of 69%, national average 70%).
• The percentage of patients on the diabetes register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 72% (CCG average 71%, national average 70%). The exception reporting rate for this indicator was 16% (CCG average 10%, national average 13%).
• 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 11 December 2017

The practice is rated as good for the care of families, children and young people.

• 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.
• The practice’s uptake for the cervical screening programme was 70%, which was the same as the CCG average and comparable to the national average of 75%.
• 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 ante-natal, 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 21 January 2019

Updated 11 December 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• 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.
• Telephone consultations were available for patients who were unable to attend in person or for those who were unsure if their condition required a visit to the surgery.
• 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.
• The practice provided NHS Health Checks to all patients over 40 years of age.

Updated 11 December 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average than the national average.
• Performance for mental health related indicators was comparable to CCG and national averages. For example, 85% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record compared to the CCG average of 83% and national average of 79%. The exception reporting rate for this indicator was 11% (CCG average 8%, national average 13%).
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For instance, patients with mental health conditions who lived in a residential care home were prioritised for appointments and urgent same-day appointments.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• 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.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 11 December 2017

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 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.
• 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.