Ashville Surgery

Updated 15 April 2016

Ashville Surgery provides GP primary care services to approximately 10000 people living in Hammersmith and Fulham. Fulham is a mixed community and the practice is located in an area with predominantly professional families to the south, single occupancy and shared flats to the north and a number of social housing estates to the east.

The practice is staffed by five GPs, two males and three female doctors who work a combination of full and part time hours, totalling 4.5 WTE. Other staff included two nurses, a HCA and ten administrative staff. The practice holds a General Medical Services (GMS) contract and was commissioned by NHSE London. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury and maternity and midwifery services.

The practice was open from 8.30am to 6pm Mondays to Friday, except Thursday when they closed at 1pm. They had extended hours on Mondays, Tuesdays and Wednesday – between 6.30pm and 8pm. The telephones were staffed throughout working hours. Appointment slots were available throughout the opening hours. The out of hours services are provided by an alternative provider. The details of the ‘out of hours’ service were communicated in a recorded message accessed by calling the practice when closed and details can also be found on the practice website. Longer appointments were available for patients who needed them and those with long-term conditions. This also included appointments with a named GP or nurse. Pre-bookable appointments could be booked up to two weeks in advance; urgent appointments were available for people that needed them.

The practice provided a wide range of services for patients with diabetes, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provided health promotion services including a flu vaccination programme and cervical screening.

Updated 15 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashville Medical centre on 20 January 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 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.
• Patients said that 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 areas where the provider should make improvement are:

• Ensure regular staff meetings are held.

• Review the practices opening hours in light of patient feedback in the GP patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 April 2016

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

• The practice was pro-actively managing patients with long term conditions (LTC). The practice nurse was the lead on managing patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma. Annual reviews and spirometry for patients with COPD were carried out. Patients with COPD were all given self-management plans and had ‘rescue antibiotics’ and oral steroids at home. Patients had guidance on how and when to use them.

• Services such as spirometry, phlebotomy, ABPM and anticoagulation management service were carried out at the practice.

• The practice had scored 97.2% on the recent QOF report for diabetes which was above the CCG average.
• 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 15 April 2016

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

• Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were at risk. For example, they would refer families for additional support and had multidisciplinary meetings with health visitors where any safeguarding concerns would be discussed.

• 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 triaged all requests for appointments on the day for all children when their parent requested the child be seen for urgent medical matters, thus were able to offer appointments at a mutually convenient times, for example after school, when appropriate
• We saw positive examples of joint working with midwives, health visitors and school nurses. Monthly meetings were held, however health visitors were based relatively close to the practice which allowed them to discuss any concerns they had immediately.

Updated 15 April 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. Patients over 75 years had a named GP to co-ordinate their care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs

Updated 15 April 2016

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

• The practice offered working age patients access to extended appointments three times a week . They also had GP telephone triage for all requests for same day appointments, which enabled telephone consultations where appropriate, without patients having to take time off work .

• They offered on-line services which included appointment management, viewing patient records, repeat prescriptions and registration.

• Patients had access to NHS health checks for people aged 40–74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified .

Updated 15 April 2016

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

• The practice had a register of patients experiencing poor mental health. These patients were invited to attend annual physical health checks and all 55 had been reviewed in the last 12 months.

• There was a primary care mental health worker (PCMH) based at the practice one day a week, whose role included supporting patients with mental illness transfer from secondary care back to primary care. GPs could also refer new patients to them.

• There were monthly reviews of all patients being seen by the PCMH worker with the lead GP

• Reception staff we spoke with were aware of signs to recognise for patients in crisis and to have them urgently assessed by a GP if presented.

• The practice had achieved 100% of the latest QOF points for patients with Dementia which was above both CCG and national averages.

• The practice had annual reviews for patients with dementia, which included early consideration of advance care planning and discussing power of attorney issues. All dementia patients had a care plan which both they and carers had been involved in drafting.

• Dementia friendly training had been arranged for all staff at the practice.

Updated 15 April 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The GPs told us that patients whose circumstances may make them vulnerable such as people with learning disabilities and homeless patients, were coded on appropriate registers.

• These patients had ‘pop ups’ on their computer notes to alert all members of staff of vulnerable patients. GPs told us this was to allow them to meet their specific additional needs such as double appointments, interpreter, visual/hearing impaired, carer details, and risk assessment stratification.
• Patients with learning disabilities were invited annually for a specific review with their named GP. We saw all ten on the register had reviews carried out in the last 12 months.