Archived: Ravenscroft Medical Centre

Updated 12 October 2017

Ravenscroft Medical Centre is located in Golders Green in the London Borough of Barnet, North London. The practice has a patient list of approximately 7,000 patients. Fourteen percent of patients are aged under 18 (compared to the national practice average of 21%) and 9% are 65 or older (compared to the national practice average of 17%). Forty two percent of patients have a long-standing health condition.

The services provided by the practice include child health care, ante and post natal care, immunisations, sexual health and contraception advice and management of long term conditions.

The practice holds a General Medical Services contract with NHS England. This is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The staff team comprises three male partner GPs (providing a combined 20 sessions per week), three salaried GPs (one female, two male providing a combined 18 sessions per week), female practice nurse (providing a combined 8 sessions per week), practice manager and administrative/reception staff.

The practice’s opening hours are:

• Monday to Friday: 8:30am -6:30pm

Appointments are available at the following times:

• Monday :8:30am-12:30pm and 2:30pm -6:30pm

• Tuesday: 9:30am-6:30pm

• Wednesday 8:30am-12:30pm and 2:30pm -6:30pm

• Thursday: 8:30am-12:30pm and 2:30pm -6:30pm

• Friday: 9:30am-12pm and 2pm-6:30pm

The practice offers extended hours opening at the following times:

• Monday: 7:15am-8:30am and 6:30pm-7:45pm

• Tuesday: 7:15am-8:30am and 6:30pm-7pm

• Wednesday: 6:30pm-7pm

• Thursday: 7:15am-8:30am and 6:30pm-7:45pm

• Friday: 6:30pm-7pm

Saturday & Sunday morning appointments are also offered through the Pan-Barnet Federation.

Outside of these times, cover is provided by out of hours provider: Barndoc Healthcare Limited.

The practice is registered to provide the following regulated activities which we inspected:

Diagnostic and screening procedures; Maternity and midwifery services; and Treatment of disease, disorder or injury.

Updated 12 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ravenscroft Medical Centre on 14 and 19 July 2016. During the inspection we identified that governance arrangements did not always operate effectively in that there was limited evidence of sharing learning from significant events and also risks and performance were not always effectively managed (The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Ravenscroft Medical Centre on our website at www.cqc.org.uk).The overall rating for the practice was requires improvement.

An announced comprehensive inspection was undertaken on 10 August 2017. Overall the practice is now rated as good.

Our key findings of our inspection of Ravenscroft Medical Centre were as follows:

• Action had been taken to ensure that significant event reviews and investigations were sufficiently thorough. For example, meetings regularly took place to share learning from significant events and to take steps to maintain or improve patient safety.

• Action had been taken to ensure that governance arrangements operated effectively. For example, staff routinely met to identify, monitor and take mitigating actions against risks.

• Action had been taken to improve arrangements for the safe storage of vaccines. For example, the practice had revised its systems for recording fridge temperature readings.
• Staff were aware of current evidence based guidance.

• Staff had the skills and knowledge to deliver effective care and treatment.

• Data from the national GP patient survey showed that patients rated the practice higher than others on the extent to which they were treated with dignity and respect; and the extent to which they were involved in decisions about their care and treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with 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 the requirements of the duty of candour.
• Practice management arrangements promoted an open approach to safety which facilitated the delivery of safe and high quality care.

The areas where the provider should make improvement are:

• Continue to monitor and take action as necessary to improve cervical screening and child immunisation uptake rates.

• Ensure that water temperature monitoring takes place to control the risk from Legionella (a term for a particular bacterium which can contaminate water systems in buildings).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 12 October 2017

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

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

• 79% of patients with diabetes had a blood sugar level which was within the required range compared with the respective 77% and 78% CCG and national averages.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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 12 October 2017

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

• There were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively low for all standard childhood immunisations. Staff advised us that many patients were from the orthodox Jewish community whom, for religious reasons, declined to participate in child immunisation programmes. Staff further advised us that the practice continued to actively work to improve immunisations uptake by letter, phone call and through opportunistic engagement.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal and post-natal clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 12 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 12 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• 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 12 October 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 86% of patients diagnosed with dementia had 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 a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. For example, a Mental Health Link Worker (whose weekly attendance at the practice was funded by a local Mental Health Trust) spoke positively about how their role supported the practice’s GPs and nurses to understand issues around mental health and locally available resources.

Updated 12 October 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 those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.

• The practice had identified that many newly registered patients were using foodbanks. Consequently, it had recently started working with a local third sector organisation with the aim of starting a local foodbank for patients and the wider community.