Archived: Dr David Monkman

Updated 21 February 2017

Dr David Monkman provides GP primary care services to approximately 2,800 people living in East Barnet, London Borough of Barnet. The practice has a Personal Medical Services (PMS) contract for providing general practice services to the local population. PMS agreements are locally agreed contracts between NHS England and a GP practice.

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the very highest levels of deprivation and level ten the lowest. This information also shows that Income Deprivation Affecting Older People (IDAOPI) is 17% which is comparable to the clinical commissioning group (CCG) average of 18% and the national average of 16%. Income Deprivation Affecting Children (IDACI) is 18% (CCG average 18%, national average 20%).

There is one full time male GP supported by a long term female locum GP who works part time provides a total of 13 GP sessions per week. The practice is co-located in a purpose built health centre with two other GP practices. Both of these practices are registered as GP partnerships, one has a patient list of 3,300 and the other has a patient list of 4,000. Nursing and administrative staff are employed jointly by all three practices with resources allocated in direct proportion to patient list sizes. Patients wishing to register with a GP at the health centre are allocated in turn to one of the three practices unless a preference for a specific practice is expressed.

The shared clinical team at the health centre consists of two practice nurses, both of whom work part time and provide a full time equivalent of 1.2 nurses. There is a practice manager and an assistant practice manager, both of whom work part time and 15 administrative and reception staff.

The practice is located in a newly refurbished, purpose built health centre. All consulting and treatment rooms are located on the ground floor.

The practice opening hours for the surgery are:

Monday 8am to 6:30pm

Tuesday 7:15am to 6:30pm

Wednesday 7:15am to 6:30pm

Thursday 7:15am to 1pm

Friday 8am to 6:30pm

Saturday Closed

Sunday Closed

There are arrangements in place with a suitable provider (Barndoc) to deliver services to patients outside of the practice’s working hours.

Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to four weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

The practice has opted not to provide out of hours services (OOH) to patients and these were provided on the practice’s behalf by a nominated provider. The details of how to access the OOH service are communicated in a recorded message accessed by calling the practice when it is closed. Details can also be found on the practice’s website.

The practice provides a wide range of services including clinics for diabetes, weight control, asthma, contraception and child health care and also provides a travel vaccination clinic. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

The practice had not previously been inspected.

Updated 21 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr David Monkman on 30 November 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 services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Arrangements were in place so that patients who wished to speak with a female GP could do so.
• 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.

The areas where the provider should make improvement are:

• Review the current prescription management system to ensure that all repeat prescriptions include a review date and consider making contact with patients who have not collected prescriptions after a reasonable period.
• Put steps in place to improve monitoring of blank prescription pads.
• Review the process used to manage incoming correspondence to ensure that all actions are taken in a timely fashion and documents closed on completion.
• Continue to monitor patient satisfaction with the telephone service provided to determine whether actions taken have improved satisfaction levels.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 21 February 2017

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

• The GP was responsible for chronic disease management and was supported by the practice nurse. Patients at risk of hospital admission were identified as a priority.
• Outcomes for patients with long term conditions were comparable to or above local and national averages. For instance, 81% of patients diagnosed with diabetes had well controlled blood sugar levels (CCG average of 76%, national average 78%), whilst 96% had had a recent foot examination (CCG average 84%, national average 88%). The practice had zero exception reporting for all indicators.
• The practice had a programme in place to undertake early testing for patients at risk of developing long term conditions. For instance, for the period April - November 2016, 94% of patients identified as being at risk of developing diabetes had been invited to attend a health review with the GP.
• Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 21 February 2017

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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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.
• The practice’s uptake for the cervical screening programme was 82%, which was the same as the national average.

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

Updated 21 February 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 people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Outcomes for conditions often associated with older people were above local and national averages. For instance, 90% of patients with hypertension had well controlled blood pressure compared to the CCG average of 82% and the national average of 84%. The exception reporting rate for this indicator was zero (CCG average 3%, national average 4%).

Updated 21 February 2017

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For instance, the practice held early morning walk-in flu vaccination clinics from 7:15am so people could access these on their journey to work.
• 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 list included a significant number of young people who had a different address during university term time and ensured that these patients were kept on the list as temporary patients when they returned home for longer breaks.

Updated 21 February 2017

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

• 96% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
• 100% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses (15 patients) had a comprehensive, agreed care plan documented in the record compared to the CCG average of 91% and national average of 88%.
• 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.
• 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 21 February 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 travellers and those with a learning disability.
• 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 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.