Archived: Orchard Practice Also known as The Orchard Medical Practice C.I.C

Updated 22 March 2017

The Orchard Medical Practice is a GP practice based in Hillingdon in North West London area. The practice is based in a purpose built premises that is shared with other local NHS services.

The practice is registered as a Social Enterprise a Not For Profit Organisation Community Interest Company with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; diagnostic and screening procedures; surgical procedures; family planning services and maternity and midwifery services.

The practice provides NHS primary medical services through an Alternative Provider Medical Services (APMS) contract to around 5200 patients in the local community. At the time of our inspection the practice told us that the contract was coming to an end in September 2017 and were in the process of tendering for a new contract.

The practice has two female long term locums and a male principal GP working a total of twenty seven sessions amongst them. The practice has a full time practice manager; the rest of the practice team consists of one part time locum nurse practitioner working one session; a practice nurse working three sessions; a full time health care assistant and four administrative staff consisting of medical secretaries, reception staff, clerks and a typist.

The practice was open five days a week from 7:30am- 6:30pm on Mondays and Fridays and from 7:30am- 8pm on Tuesdays - Thursday. The practice were also open on Saturday mornings for pre-booked appointments with the GPs and Nurses between 8:30am-11am.

When the practice is closed, the telephone answering service directs patients to contact the out of hours provider.

Updated 22 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Orchard Medical Practice on 14 December 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 practice had a very active patient participation group with over 100 patients representative of the local population. The chairman of the PPG had been provided with office space by the practice which the PPG could use twice a week to hold sessions. This meant that patients had access to give feedback and make enquiries.

• We also saw that the PPG had worked with the practice in identifying social issues affecting patients; such as gambling and mental health issues. As a result the PPG arranged people from relevant support groups to attend the practice and offer information and advice.

The areas where the provider should make improvement are:

• Ensure all staff working in the reception area are clear with the process they follow when dealing with repeat prescription requests.

• Introduce and maintain the use of written consent forms for minor surgery.

• Continue efforts to reduce the exception reporting rate for diabetic patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for patients with diabetes, on the register, in whom the last blood test was 64 mmol/mol or less in the preceding 12 months, was higher than the national average (practice 90%; national 78%). The practices exception reporting rate was 22% which was higher than the national average of 12%. The practice were aware of this and were working with patients to improve uptake of diabetic care checks.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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 22 March 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 76%, which was comparable to the CCG average of 78% and below the national average of 82%.

• 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, health visitors and school nurses.

Updated 22 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 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.

• The practice kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles.

Updated 22 March 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.
• 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.

Updated 22 March 2017

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

• 80% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average. The practice had five patients who were eligible for the screening.

• 100% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented, in the last 12 months, with the national average being 88%.The practice had five patients who were eligible for this check.

• 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 22 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 including homeless people, 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.