Archived: Greenhill Park Medical Centre

Updated 10 September 2015

Greenhill Park Medical Centre is part of a practice providing GP-led primary care services to around 7,600 patients living in the areas of Harlesden and Neasden in North West London. The practice holds a General Medical Services (GMS) contract with NHS England to deliver primary care services to the local community.

Greenhill Park Medical Centre is the practice’s smaller branch surgery and is located in Harlesden. The practice also runs a larger surgery, Neasden Medical Centre, located around two miles away. Patients have the option of attending either surgery. We were told that around 3,400 patients regularly use Greenhill Park Medical Centre. At the time of the inspection, another GP practice was also sharing the premises at Greenhill Park Medical Centre by arrangement with the practice and NHS England.

The practice is owned by a GP principal who works at the main surgery. Greenhill Park Medical Centre is staffed by a female salaried GP and a receptionist. The practice manager also attends the practice regularly.

The practice opening hours are 08:00 – 18:00 every weekday except Thursday afternoon, when both surgeries close from 13:00. Appointments at Greenhill Park Medical Centre are available between 09:30 and 11:30 every weekday morning and between 16:00 and 18:00 on Monday, Tuesday, Wednesday and Friday. We were told that patients who required urgent attention could also be seen between 18:00 and 18:30 if necessary. Extended hours appointments are offered from 07:00 to 08:00 Monday to Thursday at the main surgery.

The practice has opted out of providing out-of-hours services to their patients. Outside of normal opening hours patients are directed to the local out-of-hours service or the NHS 111 service. Patients can also be seen out-of-hours at a local “hub”, that is, a designated practice in the locality providing primary care services, with additional evening and weekend hours available.

The practice has a relatively high proportion of patients between the ages of 20-39 and a lower than average proportion of patients over the age of 65 and serves an ethnically diverse population. The practice falls within the 20% most deprived areas in England.

Updated 10 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greenhill Park Medical Centre on 26 March 2015. The practice also provides services at another surgery at Neasden Health Centre. Patients registered with the practice may attend either surgery. On this occasion we inspected Greenhill Park Medical Centre which is the practice’s smaller, branch surgery and overall we rated the service at this location as requires improvement.

Specifically, Greenhill Park Medical Centre required improvement for providing safe and effective services and for being well-led. The practice also required improvement for its care of older people; people with long-term conditions; families, children and young people; people of working age; people whose circumstances may make them vulnerable; and, people experiencing poor mental health. The practice was rated as good for providing caring and responsive services.

Our key findings were as follows:

• The practice had effective systems in place to manage risks associated with staff recruitment, infection control, child protection and safeguarding and medical emergencies. Staff needed to be clearer on who was the lead for these areas in the practice however.
• The practice understood the needs of the population and had developed the service and skills of the staff team to meet patients’ needs. We found that care for long-term conditions such as diabetes was being managed effectively in the community and care was provided in partnership with other specialist and community services.
• Patient satisfaction scores for both this branch and the main practice were generally positive. Thirty-six patients completed Care Quality Commission (CQC) comment cards about the service before our inspection. All but three of these were wholly positive about the service and staff.
• Feedback was positive about access to appointments and the practice scored better than other practices in the local area for this aspect of care.
• Staff told us they were well supported and had access to the training they needed to develop in their role.

However, there were also areas of practice where the provider needs to make improvements.

Action the provider MUST take to improve:

Importantly, the provider must:

• Ensure that all prescription materials are stored securely and can be tracked.
• Ensure that patient group directions in use in the practice are correctly signed by the principal GP and practice nurse.

• Provide clinical staff, regular opportunities for effective clinical review, reflection and support.
• Ensure that staff are aware of the designated practice lead for child protection, safeguarding, health and safety, infection control and other key areas of practice.

Action the provider SHOULD take to improve:

The provider should:

• Develop an audit programme so that where appropriate audit cycles are completed and the results of clinical audit are shared across the clinical team.
• Expand its cytology service so that eligible patients routinely have the option of having cervical smears at the practice.
• Where appropriate, share relevant significant events with other health providers to help reduce the risk of reoccurrence.
• Develop a system to monitor the implementation of national safety alerts
• Do more to obtain patient feedback about the service, for example by setting up a patient participation group.
• Implement a reminder system to ensure that required updates, for example, in relation to staff members' mandatory training are not missed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 September 2015

The practice is rated as requires improvement for the care of people with long term conditions. There were aspects of care and treatment that required improvement that related to all population groups.

The practice had identified patients with long-term conditions and offered these patients a structured annual review to check that their health and medication needs were being met. The practice had a particularly strong track record in relation to diabetes care. For example it had actively encouraged patients to attend for an annual review for many years. The practice was also able to offer insulin initiation for appropriate patients at the main practice, avoiding the need for hospital attendance. The principal GP had liaised and shared their learning on the management of diabetes with other general practice providers locally. The practice had achieved a good uptake among patients with long-term conditions for flu vaccination.

Updated 10 September 2015

The practice is rated as requires improvement for the care of families, children and young people. There were aspects of care and treatment that required improvement that related to all population groups.

The principal GP was the safeguarding lead for the practice. There were systems in place to identify and follow up children living in disadvantaged circumstances and also cases of domestic violence. Records showed the lead GP liaised and sought advice from other health and social care professionals when necessary. The practice provided baby immunisations and six week post-natal checks. A nurse visited the practice twice a week and there were immunisation clinics available. Appointments were available after core school hours.

Updated 10 September 2015

The practice is rated as requires improvement for the care of older people. There were aspects of care and treatment that required improvement that related to all population groups. The practice offered personalised care to meet the needs of the older people in its population. The practice had a designated named GP for patients who are 75 and over and care plans were in place for patients with complex health conditions who were at risk of rapid deterioration and hospital admission.

Updated 10 September 2015

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). There were aspects of care and treatment that required improvement that related to all population groups. The needs of this group had been identified and the practice had adjusted the services it offered to ensure these were accessible. Appointments at the practice were available until the early evening. Patients were also free to attend the main practice which offered extended hours. Telephone consultations were available during opening hours. The practice was not yet providing health checks to adults aged 40-74 however.

Updated 10 September 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). There were aspects of care and treatment that required improvement that related to all population groups. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, and patients experiencing alcohol and substance abuse. The practice sign posted patients to the appropriate specialist services. The practice was participating in enhanced services for dementia and as a result its dementia screening and referral rates to the specialist integrated care service were increasing.

Updated 10 September 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. There were aspects of care and treatment that required improvement that related to all population groups. The practice had a register of patients with learning disabilities and offered annual health checks and longer appointments to this group. Almost all patients on this register had already had a health check in the previous 12 months. Staff knew how to recognise signs of abuse in vulnerable adults and children and the electronic system was tagged with information to alert staff to vulnerable patients when they attended the practice. An interpreter service was available for patients whose first language was not English.