Roundwood Park Medical Centre

Updated 20 June 2016

Roundwood Park Medical Centre provides NHS primary medical services to around 3700 patients in the Willesden area of London, through a General Medical Services contract. The service is run from one surgery which is located within a larger purpose-built community health centre.

The current practice team comprises two GP partners (male) and a sessional GP (female),  a practice nurse, a practice manager and a team of receptionists. One of the receptionists is also a qualified health care assistant.

The practice is a training practice and at the time of the inspection had two specialist GP trainees ('registrars') in post. The practice was also a teaching practice and offered short-term placements to undergraduate medical students and other eligible health professionals.

The practice is open as follows:

• Monday 8.30am-7.15pm
• Tuesday 8.30am-6.30pm
• Wednesday 8.30am-12.30pm
• Thursday 8.30am-6.30pm
• Friday 8.30am-6.30pm

Appointments are available daily between 8.30-10.30am and when the practice is open, between 4.00-6.00pm. Evening appointments are also available between 6.00-7.00pm on Monday. The practice is closed on Wednesday afternoon and over the weekend.

The practice offers online appointment booking and an electronic prescription service. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, the website and on a recorded telephone message.

Brent clinical commissioning group runs a 'hub' surgery from the practice premises and primary care appointments are also available weekday evenings and at the weekends at this and two other locations within the borough. 

The practice has a lower proportion of patients aged over 65 than the English average and a mobile younger population. The practice population is ethnically diverse with the majority being black, Asian or from other minority ethnic groups. Income deprivation levels are higher than average in the area and male life expectancy is three years below the national average. The prevalence of some chronic diseases, notably diabetes, is high locally.

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

Updated 20 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roundwood Park Medical Centre on 2 February 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. The provider was aware of and complied with the requirements of the duty of candour.
• 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 and had expanded the range of services available to patients.  
• Patients said they were treated with care and concern and we received positive feedback about the practice. National patient survey results tended to be lower than average for patient involvement however.
• Information about services and how to complain was available at the practice and easy to understand although little information was available on the practice website. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to get through to the practice by telephone and their experience of making an appointment was good.  However, appointments quite often ran late and this created patient frustration. 
• Patients could consult a male or female GP and a translation service was available. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was located in the same building as a range of community health services which facilitated good coordination of care.
• There was a clear leadership structure, an open culture and staff said they were well supported. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice participated in locality-wide initiatives, for example opening at the weekend and providing insulin initiation for patients from the practice and the wider locality.
• The practice was a training and teaching practice. Feedback from trainees and students about the quality of clinical education at the practice was very positive.
• There was a strong focus on learning and improvement. The practice provided examples of how it had improved outcomes, for example, in cancer care.

The areas where the provider should make improvement are:

• The practice should review whether it can reduce the frequency of late running appointments while remaining accessible to patients in need.
• The practice should improve patient satisfaction with involvement in care.
• The practice should continue to focus on improving the control of diabetes within the practice population.
• The practice should provide information on the complaints process on the practice website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 June 2016

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

• The practice maintained registers of patients with particular long-term conditions. Individual clinicians had lead roles for specific conditions and the practice ran clinics for common long-term conditions such as diabetes.
• Practice performance for diabetes related indicators tended to be below average and the practice had identified type 2 diabetes control as an area for improvement. For example, the percentage of diabetic patients whose blood sugar levels were controlled (that is, their most recent HbA1c measurement was 64 mmol/mol or below) was 64% compared to the national average of 78%. 
• Patients with a long-term condition had a named GP and a structured annual review to check their health and medicines needs were being met. Longer appointments and home visits were available when needed.
• 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 practice participated in the Brent Integrated Care initiative and coordinated care with other community and social services teams and professionals as appropriate.

Updated 20 June 2016

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 standard childhood immunisations for all age cohorts. Non attendance was followed-up.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children and babies were prioritised and seen the same day.
• The practice was located in the same building as a range of community health services. We saw positive examples of joint working and information sharing with health visitors.
• The practice was participating in research into teenage depression

Updated 20 June 2016

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice maintained a register of housebound patients and carried out a face-to-face review with these patients at least once a year.
• The practice called patients over 65 for an annual flu vaccination. The uptake rate was higher than the national average at 78%. For patients over 75, the practice also carried out a health check at the same time if this was due.
• The practice recognised that continuity of care was important to for older patients and tried to facilitate this wherever possible.  
• The location of the practice in close proximity to a range of community health services was particularly valued by older patients.

Updated 20 June 2016

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

• The practice was proactive in offering a full range of health promotion and screening services reflecting the needs for this age group.
• The practice had invited 77% of eligible patients for an NHS health check within the last five years and 63% of eligible patients had attended. This was a higher achievement than average.  
• Cervical screening coverage was higher than the local and national average at 83%. 
• The practice offered an evening surgery on Monday. Local primary care 'hub' appointments were available at the practice and two other locations in Brent during the evening and at weekends. The practice informed patients about these services and how to make an appointment.
• The practice enabled patients to book appointments and request repeat prescriptions online. Patients were also able to consult a GP over the telephone.

Updated 20 June 2016

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

• The practice provided screening for dementia with referral for specialist diagnosis. The practice had ten patients on its dementia register. Six patients had received a review by the practice in the last 12 months.
• Thirty-two of 35 patients with a diagnosed psychosis had a documented care plan which was in line with the national average. Care plans included the views of carers where appropriate. The practice regularly monitored these patients' physical health.
• The practice acknowledged that some patients required longer and more frequent appointments. The practice had patients who attended the practice on a weekly basis.
• 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.
• The practice was aware of recent changes to mental health services in Brent and liaised with the relevant team when specialist input was required.

Updated 20 June 2016

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

• The practice held registers of patients in vulnerable circumstances including people with a learning disability. Patients were offered an annual or more frequent review.
• The practice screened new patients for alcohol dependency and dementia and asked whether they had caring responsibilities. Drug and alcohol rehabilitation services were available on site.
• The practice offered longer appointments for patients with communication difficulties. Patients known to the practice to be vulnerable could access appointments on a walk-in basis.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and also involved carers whenever appropriate. Patient and carers' views were included in their care plans.
• 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.