S H Vaghela & Dr V N Patel Also known as The Old Surgery

Updated 26 April 2017

S H Vaghela and Dr V N Patel is based in The Old Surgery, 572 Green Lanes, London N8 0RP and is part of a network of five surgeries that share the same practice manager and are registered separately. The practice has limited parking in front of the building and wheelchair access to the waiting room and clinical areas.

The Old Surgery is one of a number of GP practices commissioned by Haringey Clinical Commissioning Group (CCG). It has a practice list of 2183 registered patients. Haringey is in the third most deprived decile out of 10 on the national deprivation scale. The practice has a higher percentage of unemployed patients (11%) compared to the local average of 10% and national average of 5%.

The clinical team has three GP partners, a practice nurse and two healthcare assistants. Two of the GPs are female and one GP is male. The clinical team provides 12 sessions per week. The non-clinical team includes a practice manager and a team of reception and administration staff.

Appointments are available during the following hours:

Monday – 8.30am to 1.50pm and 4pm to 6pm

Tuesday – 8.30am to 1.50pm and 4pm to 6pm

Wednesday – 8.30am to 1.50pm and 4pm to 7.30pm

Thursday – 8.30am to 1.50pm

Friday – 8.30am to 1.50pm and 4pm to 6pm

Saturday – 9am to 1pm (one day per month)

A local GP hub provides appointments on Wednesdays from 6.30pm to 8.30pm and on Saturdays from 8am to 1pm. Out of these hours, cover is provided by the NHS 111 service.

We had not previously carried out an inspection at this practice.

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Old Surgery on 17 January 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff used an effective system report and investigate significant events and the working culture encouraged openness and honesty to highlight areas for improvement.
• Risks to patients were assessed and well managed, including through medicines management and safeguarding processes.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was evidence of multidisciplinary working to meet the complex needs of patients, including vulnerable young people and those who received palliative care.
• Patients provided positive feedback about the caring nature of staff and said they took the time to listen to their concerns. We saw staff treated people with compassion, dignity and respect and involved them in care planning and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had adapted access to patient needs and demand such as by providing daily walk-in appointments.
• 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 improvements are:

• Ensure locum staff maintain knowledge of the location of emergency equipment.
• Ensure locum staff have access to clinical governance processes, including meetings and learning from significant events.
• Ensure language translation services are provided that do not compromise the quality of clinical information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 April 2017

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.
• A practice nurse contacted patients who attended hospital unexpectedly to support them in managing their condition.
• Performance for diabetes related indicators was similar to or better than the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 88% compared to the CCG average of 73% and the national average of 78%. The percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 88% compared with the CCG average of 75% and national average of 80%. 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, a named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 26 April 2017

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

• There were systems in place to identify and support children living in disadvantaged circumstances. This included those who were at risk such as children and young people who had a high number of emergency hospital attendances.
• Immunisation rates were relatively high for all standard childhood immunisations and the practice audited this to ensure continuity.
• The practice’s uptake for the cervical screening programme was 69% which was lower than the CCG average of 79% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered sexual health advice and services, including chlamydia screening.
• Child development clinics were offered at six to eight weeks old.
• We saw positive examples of joint working with midwives and health visitors, including a monthly meeting to discuss the care of children on the child protection register.

Updated 26 April 2017

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice invited all patients over 75 years to attend an annual health check which included a blood test, medicine review and advice regarding diet, nutrients, exercise a discussion of social care needs.
• Staff worked with a multidisciplinary care coordinator to ensure patients received timely specialist care, including when they were housebound, had complex needs or were discharged from hospital.

Updated 26 April 2017

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 as well as a range of health promotion and screening that reflected the needs of this age group, including electronic prescribing and sexual health.
• The practice offered extended hours to support those could not attend appointments during standard working hours.
• Access had been adapted to meet the needs of people in this population group, including daily walk-in sessions, extended evening appointments and weekend appointments available through a local GP hub.

Updated 26 April 2017

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was significantly better than the CCG average of 83% and national average of 84%. The practice had exception reported 0% compared to the CCG average of 5% and the national average of 7%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and drug addiction.
• The practice carried out advance care planning for patients with dementia.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 26 April 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 homeless people, those over 75 years of age living alone and those with a learning disability.
• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.
• Patients who were considered vulnerable were given same day priority appointments, including registered carers.