Archived: Harness Harlesden Practice

Updated 17 March 2017

The Harness Harlesden Practice provides NHS primary medical services to around 2500 patients in the Harlesden area of Brent in North West London. The service is provided through an alternative provider medical services (aPMS) contract.

The practice is small but benefits from being located within a purpose built modern health centre which also contains a number of practices, community health services and clinics.

The current practice clinical team comprises two regular salaried GPs (one wte in total), a practice nurse and a phlebotomist. Patients have the choice of seeing a male or female GP. The GPs typically provide 10 clinical sessions at the practice per week. The practice also employs a practice manager and assistant manager, receptionists and administrative staff. The practice team are also supported by the provider's central team who are based at a different location. 

• The practice opening hours are from 8am to 6.30pm, Monday to Friday and from 8.30am-12noon on Saturday. The clinical surgeries run from 9am-12noon and from 3.30pm-6pm during the week.
• The GPs make home visits to see patients who are housebound or are too ill to visit the practice. Same day appointments are available for patients with complex or more urgent needs.
• The practice is also piloting a dedicated on-call GP service for a number of local care homes in the locality. This runs from 8am-6pm from Monday to Friday.
• The practice offers online appointment booking (although uptake remains low) and an electronic prescription service.

When the practice is closed, patients are advised to use the local out-of-hours primary care service if they need urgent primary medical care or they can attend a local 'hub' primary care service between 5pm and 9pm in the evening and during the weekend. 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 falls within the 10% most deprived areas in England with lower than average levels of employment and male life expectancy and associated health needs. The age-sex profile is reasonably similar to the English average although the practice has a higher percentage of babies and young children and older people aged over 85 years. The population is ethnically diverse.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; family planning; surgical procedures and maternity and midwifery services.

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Harness Harlesden Practice on 20 October 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 a system in place for reporting and recording significant events. The provider was aware of the requirements of the duty of candour.
• The practice had clearly defined and embedded systems to minimise most risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had the skills and knowledge to deliver effective care and treatment.
• Patient feedback indicated that patients were treated with compassion and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The service was accessible. Patient feedback was positive about the ease of getting an appointment. Urgent appointments available the same day. The provider had recruited two regular GPs with the aim of improving continuity of care.
• 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 areas where the provider should make improvement are:

• The practice should ensure that key information for example, documented medicines reviews, are accessible in patients medical records including patients living in local care homes.
• The practice should increase the use of clinical audit to investigate its performance and drive improvement in relation to practice priorities.
• The practice should actively encourage eligible patients to attend for breast cancer screening.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 17 March 2017

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

• The practice maintained registers of patients with long-term conditions. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The GPs and practice nurse had lead roles in long-term disease management. 
• The practice had performed well on the Quality and Outcomes Framework (QOF) for aspects of long-term disease management. For example, the practice had improved its approach to managing diabetes by offering longer appointments and introducing practice-based clinics with the local specialist diabetic nurse. In 2015/16, the percentage of diabetic patients whose blood sugar levels were adequately controlled was 79% which was in line with the national average of 78%.
• The practice participated in a locality-based scheme to reduce unplanned admissions which targeted patients with complex or multiple long-term conditions. Patients at risk of hospital admission or sudden deterioration were identified as a priority. The GPs worked with health and social care professionals to deliver a tailored multidisciplinary package of care and participated in the local 'complex patient management' group.
• 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.

Updated 17 March 2017

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

• The practice had a higher proportion of young families in its population and the practice provided antenatal and postnatal services which exceeded its contractual obligations. We were told this was because the practice considered these services to be an integral component of good primary care.
• Immunisation rates were high for standard childhood immunisations.
• Patients told us 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 had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• 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 liaised with the local multiagency safeguarding hub (MASH).
• The practice liaised with midwives, health visitors and school nurses to support families and children, for example identifying new parents in need of psychological support and in following up potential safeguarding concerns.

Updated 17 March 2017

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 patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments as appropriate.
• The practice had secured a contract to provide a dedicated GP service to a number of local care homes in the area. We were told this had resulted in a reduced rate of ambulance call outs to these homes. In 2015/16, the practice achieved a significantly lower rate (age-adjusted) of prescribing of hypnotic medicines compared to the national average.
• The practice maintained a register of patients receiving palliative care. Patients receiving palliative care and, when appropriate, their carers were involved in planning their care, including their end of life care.
• The practice followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with  advice and preventive care to help them to maintain their health and independence. For example, the practice offered flu, shingles and pneumococcal vaccination to eligible older patients. 
• Staff were able to recognise the signs of abuse in vulnerable older patients and knew how to escalate any concerns.

Updated 17 March 2017

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

• The needs of working age patients had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible. For example, the practice was open on Saturday morning.
• 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 used a messaging service to communicate with patients and send appointment reminders.
• The practice offered health promotion and screening services reflecting the needs for this age group, for example NHS health checks for patients aged 44-75 years.
• The practice provided an oral contraceptive service and signposted patients requiring other forms of contraception to the family planning service located in the same building.
• In 2015/16, 80% of eligible women registered with the practice had a cervical smear test within the last five years, in line with the national average of 81%.

Updated 17 March 2017

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

• Patients at risk of dementia were offered screening and referral to the local memory services.
• The practice carried out advance care planning for patients living with dementia.
• In 2015/16, 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was statistically comparable to the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• In 2015/16, 60% of patients with a diagnosed psychosis had a comprehensive care plan in their records. This was lower than the national average but the practice had experienced a recent rapid increase in the number of patients on its mental health register. (The previous year, 100% of patients had a comprehensive care plan).
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 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 17 March 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 for example patients with a learning disability. Alerts were included on the electronic patient record system to ensure that staff were aware of patients who required additional assistance.
• The practice offered longer appointments for patients with a learning disability and annual health checks.
• 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 services, support groups and voluntary organisations for example drug and alcohol services and the local wellbeing coordinator.
• Staff interviewed knew how to recognise signs of abuse in children, young people and vulnerable adults. 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.
• The practice identified carers and provided them with carers' packs with information about available support.