Archived: Brookfield Park Surgery

Updated 3 October 2016

Brookfield Park Surgery operates from 68 Chester Road, London N19 5BZ, having moved from nearby premises at the end of April 2016. The newly-opened premises are purpose-built and have good facilities. They are leased from the local authority and occupy the ground floor and basement of a block of flats. The practice is located a short distance from Archway underground station and is served by one bus route.

The practice provides NHS services through a General Medical Services (GMS) contract to approximately 3,250 patients. It is part of the NHS Camden Clinical Commissioning Group (CCG) which is made up of 40 general practices. The practice is registered with the Care Quality Commission to carry out the following regulated activities - Maternity and midwifery services; Family planning; Treatment of disease, disorder or injury; and Diagnostic and screening procedures. The patient profile has a slighter higher than average young children and young teen population, as well as adults in the age range 35-64 years. The practice has a mid-range deprivation score, being in the fifth “less deprived decile”.

The practice has a clinical team of two female partner GPs. The lead partner GP works six clinical sessions per week; the other partner GP works three sessions. A male long-term locum GP also works three sessions. There is a female practice nurse and a healthcare assistant, who both work one clinical session a week. The practice manager has just begun an extended period of leave; their work is being covered by a temporary practice manager. There are three receptionists. The practice had recently been accredited as a teaching practice, with GP registrars (qualified doctors gaining general practice experience) due to start work over the coming months.

The practice’s opening hours are as follows - it does not close at lunch time:

Monday 8:00 am to 6.30 pm

Tuesday 8:00 am to 6.30 pm

Wednesday 8:00 am to 6:30 pm

Thursday 7.30 am to 1:00 pm

Friday 7:30 am to 6:30 pm

GPs consultation times for morning and afternoon sessions are as follows:

Monday 8.30 am to 12.30 pm 3.30 pm to 6.30 pm

Tuesday 8.30 am to 12.30 pm 3.30 pm to 6.30 pm

Wednesday 8.30 am to 12.30 pm 3.30 pm to 6.30 pm

Thursday 7.30 am to 12.00 pm Closes at 1.00 pm

Friday 7.30 am to 12.00 pm 3.30 pm to 6.30 pm

Routine appointments are 10 minutes long, although patients can book double appointments if they wish to discuss more than one issue. Appointments are usually offered within 48-hours, although this period may be extended if a patient wishes to see a particular doctor. A number of same day appointments are available, for which patients need to phone the practice at 8.00 am for a morning appointment and at 1.00 pm for an afternoon appointment. The calls are triaged by one of the GPs. Appointments with the nurse are 15 minutes long.

If they have previously registered for the system, patients can also book appointments and request repeat prescriptions online.

The practice is closed at weekends, but a number of weekend appointments are available under a local scheme operating at three locations across the borough. The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. There is information given about the out-of-hours provider and the NHS 111 service on the practice website.

In October 2013, we had inspected the practice at its former premises, using our previous methods. We found that it was not complying with the regulations in force at the time. The practice did not have an emergency oxygen supply or a defibrillator for use in patient emergencies. There were also concerns regarding infection control, due to the state of decoration and repair of the former premises. We carried out a follow up inspection in August 2014, and found that the practice had taken sufficient and appropriate action to comply with the regulations then in force.

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 24 August 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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 how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

However, there were areas of practice where the provider should make improvements:

• Continue to monitor patients’ satisfaction with opening hours and continuity of care, implementing remedial action as necessary.
• Continue with efforts to recruit a nurse to work more clinical sessions, to reduce additional pressure on other members of the clinical team.
• Continue with efforts to increase the size of the patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 October 2016

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

• The practice held monthly meetings to discuss patients at higher risk of unplanned admission to hospital.
• Longer appointments and home visits were available when needed.
• The practice’s performance relating to diabetes care was comparable with local averages.
• The practice maintained a register of 145 patients with diabetes, of whom 134 (93%) had undergone a foot examination and 130 (90%) had had a retina check.
• The influenza vaccination rate for patients with diabetes was 96%, above local and national averages.
• The practice maintained of register of 20 patients with heart failure, all of whom had had an annual medicines review in the preceding 12 months.
• The practice’s performance relating to asthma, hypertension, and chronic obstructive pulmonary disease was comparable with local and national averages.

Updated 3 October 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 and maintained a register of vulnerable children.
• Take up rates for all standard childhood immunisations were comparable with the local average.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.

Updated 3 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 urgent appointments for those with enhanced needs.
• The practice maintained a case management register of patients at high risk of admission to hospital. There were 52 patients were currently on the register, all of whom had up to date care plans.
• Records showed that 416 patients were prescribed four or more medications, of whom 320 (77%) had had a structured annual review.
• The uptake for bowel cancer screening was above the local average.
• One hundred and ninety-one patients identified as being at risk of developing dementia had been offered cognition testing.

Updated 3 October 2016

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

• 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.
• Early morning appointments were available for those patients who could not attend during normal working hours.
• The practice’s uptake for the cervical screening programme was above the local average.
• Data showed that 218 patients (22% of those eligible) had received an NHS health check; whilst 1,325 patients (being 83% of those eligible) had undergone blood pressure checks in the last five years.

Updated 3 October 2016

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

• Ninety per cent of the 56 patients experiencing poor mental health had a comprehensive, agreed care plan documented in the record, in the preceding 12 months, comparable with local and national averages.
• All of the 15 patients registered with severe mental health problems had had an annual review.
• Thirteen of the 16 patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months, comparable with local and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• Continuity of care for patients experiencing poor mental health was prioritised.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 3 October 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 14 patients with a learning disability.
• All of the patients on the learning disability register had had an annual follow up and care plan review in the last 12 months.
• The practice offered longer appointments for patients with a learning disability.
• The practice informed vulnerable patients about how to access various support groups and voluntary 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 normal working hours and out of hours.