Grove Park Terrace Surgery

Updated 28 November 2017

Grove Park Terrace Surgery provides primary care services through a personal medical services (PMS) contract to 3750 patients in the local area. The practice has extended its catchment area beyond Chiswick to cover parts of Brentford and Kew in response to patient demand. The practice is part of the NHS Hounslow Clinical Commissioning Group.

The practice serves a young population group with almost half of patients aged between15 and 44 years old. Around quarter of patients are aged under 14 and only 6% are aged over 65. The practice population is predominantly white but has become increasingly culturally and ethnically diverse. The practice area is relatively affluent overall but this masks considerable variation at the individual level. There is a high local prevalence of diabetes, asthma and hypertension in the local population.

The practice has an informal reciprocal arrangement to offer private primary care consultations to patients registered at a neighbouring practice. This is a service sometimes requested for example, by patients with private health insurance.

The practice team comprises of the principal GP, a salaried GP, a nurse practitioner, practice nurse, health care assistant, practice manager and a team of reception and administrative staff. Patients have the choice of a male or female GP. The practice is a training practice and offers two working placements to GP registrars undergoing training. The practice typically provides 20 clinical sessions per week.

The practice is located in a converted property over two floors with lift access to the first floor. The practice is fully accessible to patients with physical disabilities.

The is open between 8am and 6.30pm during the week, apart from Wednesday when the practice closes between 1pm and 2.30pm for staff meetings or training. Appointments with a doctor are available morning and afternoon from Monday to Friday. Extended hours appointments are also available every Tuesday evening until 8pm.

When the practice is closed, patients are signposted to the NHS 111 service, the out-of-hours primary care service or in the case of a serious emergency they are directed to attend A&E. Information about how to contact the out of hours service is provided on the practice website and on a recorded telephone message.

The practice offers a range of clinics and services including well-person health checks, contraception, cervical smears, immunisations, travel vaccinations, blood tests, sexual health, blood pressure monitoring and diabetes and asthma checks. Minor surgery and IUD fittings are also offered.

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

Updated 28 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Grove Park Terrace Surgery on 18 November 2014. At that inspection we found the practice in breach of legal requirements and rated it as requires improvement for providing a safe service. The practice was rated as good overall. The full comprehensive report on the November 2014 inspection can be found by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow-up inspection on 27 September 2017. This report sets out our findings. The practice had made improvements in response to our previous inspection and the practice is now rated as good for all key questions and overall.

Our key findings 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 risks to patient safety.
• Staff were aware of current evidence based guidance. Staff were trained and had the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in 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 patient feedback.
• The practice performed well on the national GP patient survey on access to the service. Patients reported being able to make and appointment and there was continuity of care, with urgent appointments available the same day.
• The practice had suitable facilities and was well equipped to treat patients and meet their needs. The premises environment showed signs of wear and tear but, at the time of the inspection, was safe.
• 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 practice should make improvement are:

• The practice should document practice and patient group meetings promptly for ease of reference and to share with members unable to attend.
• The practice had identified 11 patients who were carers that is 0.3% of the practice list. The practice should continue to actively identify patients who are carers to ensure that they receive appropriate support and their needs are met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 28 November 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. 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.
• The principal GP had a specialist interest in diabetes. Nursing staff also had lead roles in long term disease management.
• Practice performance on diabetes was above average. For example in 2015/16, 87% of diabetic patients had blood sugar levels that were adequately controlled compared to the clinical commissioning group and national averages of 74% and 78% respectively.
• 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.
• Patients at risk of hospital admission were identified as a priority. There were emergency processes for patients with long term conditions who experienced a sudden deterioration in health.

Updated 28 November 2017

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

• 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 rates were relatively high for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. The practice was responsive to the sexual health needs of young people, for example encouraging chlamydia testing.
• 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 and post-natal checks.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 28 November 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice had a relatively small group of patients aged over 65 and was able to offer personalised care to meet the needs of the older patients in its population with continuity of care.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence. For example the health care assistants visited housebound patients at home to administer flu vaccinations.

Updated 28 November 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 and flexible. For example appointments were available until 8pm on Tuesday and Thursday evenings and from 7.30am on Wednesday morning.
• The practice was proactive in offering online services including 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, including offering the meningitis ACWY vaccine for older teenagers.
• The practice recognised the needs of students returning home during the holidays, and enabled them to use the service as 'temporary' patients when necessary.

Updated 28 November 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 identified and offered an assessment. The practice carried out advance care planning with patients living with dementia.
• All ten practice patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, 92% of patients diagnosed with a psychosis had a comprehensive care plan in their records, which was in line with the national average of 89%. 
• The practice monitored repeat prescribing for patients receiving medicines for mental health needs. The practice also monitored changes in patients' social circumstances for example, career or benefits changes.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health including the local mental health unit and specialist drug and alcohol recovery services.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations, for example local counselling services.
• 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 28 November 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 and called these patients in for an annual health check.
• 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.