Archived: The Bush Doctors

Updated 6 March 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 9 October 2014 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. 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.
• The practice hosted a diabetes nurse specialist clinic once a week for complex cases and for patients whose diabetes was poorly controlled and participated in a local out of hospital services (OOHS) initiative for insulin initiation for patients with type two diabetes.
• Performance for diabetes related indicators was statistically comparable with the national average. For example, the percentage of patients with diabetes, on the register (549 patients), in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 78% (national average 78%).
• The practice provided simple and complex wound services which included a daily walk-in dressing clinic.
• The practice hosted on-site clinics with the health trainers and the Midaye Somali Development Network to offer advice, support and education to its patients with long-term conditions.
• All patients had a named GP and a structured annual review to check their health and medicines needs were being met in conjunction with the in-house clinical pharmacist who oversaw repeat prescribing. 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.
• Longer appointments and home visits were available when needed.

Updated 6 March 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 9 October 2014 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. 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.
• The percentage of patients with asthma, on the register (516 patients), who have had an asthma review in the preceding 12 months that includes an assessment of asthma control was 72% which was comparable to the national average of 76% (practice exception reporting 2%; national 8%).
• The practice’s uptake for the cervical screening programme was 62% (3875 patients), which was similar to the CCG average of 71% but lower than the national average of 82% (practice exception reporting 4%; national 7%). The practice discussed with us the challenges of their ethnically diverse patient population and patients who were difficult to engage in the cervical screening programme. The practice were working with local groups supporting ethnic minorities to address this.
• Appointments were available outside of school hours and the premises were suitable for children and babies. There were baby changing and breast feeding facilities available.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice organised the six to eight week baby check and the first schedule of childhood immunisations at the same time to avoid multiple visits to the surgery. The health visitor ran a weekly clinic.
• Childhood immunisation data for the period 1 April 2015 to 31 March 2016 for the under two year olds ranged from 80% to 86% (national average 90%). Immunisation rates for five year olds ranged from 72% to 90% (CCG range 65% to 86%; national range 88% to 94%).

Updated 6 March 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 9 October 2014 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. 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.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits, double routine appointments and urgent appointments for those with enhanced needs.
• The practice had on-site the district nursing team and utilised referral into rapid access clinics and a community healthcare provider to prevent unnecessary admissions. The practice participated in the avoiding unplanned hospital admissions enhanced service and identified and managed the top 4% of their vulnerable patients at most risk of hospital admission.
• The practice utilised the Coordinate My Care (CMC) personalised urgent care plan developed to give people an opportunity to express their wishes and preferences on how and there they are treated and cared for.

Updated 6 March 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 9 October 2014 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. 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 which included booking and cancelling appointments and requesting repeat prescriptions. Telephone consultations were also available.
• The practice offered a ‘Commuter’s Clinic’ for working patients who could not attend during normal hours from 7am Monday to Friday, until 8.30pm on Monday to Thursday and on Saturday from 9am to 12 noon.

Updated 6 March 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 9 October 2014 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice had a higher prevalence of mental health than the national average (practice 1.84%; national 0.9%). Data from the CCG showed the practice had the fifth highest prevalence in Hammersmith and Fulham out of 31 practices. The practice had nominated a lead GP for mental health who undertook weekly designated mental health clinics. In addition to annual reviews, patients were reviewed regularly depending on need in conjunction with a primary care mental health worker who ran an on-site clinic twice a week. The practice had also signed up to a local out of hospital service (OOHS) for severe mental illness and complex common mental health.
• Data from the Quality and Outcomes Framework (QOF) for 2015/16 showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 37% (111 patients) which was significantly lower than the national average of 89%. However, we looked at the practice’s clinical system to see how they were achieving for mental health indicators for the 2016/17 QOF period (non-validated data) and found that 75 patient had completed care plans to date compared to 37 for the entire 2015/16 QOF period. The practice demonstrated a recall system for the remainder of the patients.
• Other mental health indicators were comparable to national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 86% (national average 89% ) and the percentage of patients with physical and/or mental health conditions whose notes record smoking status in the preceding 12 months was 95% (national average 95%).
• The percentage of patients diagnosed with dementia who had had their care reviewed in a face-to-face meeting in the last 12 months was 82% (31 patients) compared to the national average of 84% (practice exception reporting 10%; national 7%).
• 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 and we saw that clinical and non-clinical staff had undertaken dementia awareness training.

Updated 6 March 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 9 October 2014 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. 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 and those with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and informed them how to access various support groups and voluntary organisations.
• The practice offered longer appointments for patients with a learning disability. The practice held joint clinics with the community learning disability nurse to undertake annual health checks. The practice made adjustments to enable patients who lived alone or had limited or no support to have their health check at home and offered telephone consultations when face-to-face contact was too stressful. The community team shared anonymous feedback of positive patient outcomes as a result of the practice’s approach to the support of its patients with learning disabilities.
• The practice ran joint weekly substance misuse clinics with a lead GP and substance misuse key worker who was available in the practice three days per week. Clinics addressed physical, social and psychological wellbeing.
• 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.