The Lonsdale Medical Centre

Updated 18 September 2017

Lonsdale Medical Centre provides GP primary care services to approximately 14,500 people living in Queens Park, London Borough of Brent.

There are currently six full time GP partners, four male and two female and one salaried GP who provide a combined total of 36 sessions per week. The practice is a GP training practice with two trainees in place at the time of our inspection. The trainees undertake a combined total of approximately 12 sessions per week. The practice is also a training practice for physician associates.

There is a practice nurse, a healthcare assistant who is also a phlebotomist (Phlebotomistsare specialist clinical support workers who take blood samples from patients) a practice manager and thirteen administrative staff. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury, surgical procedures, family planning and maternity and midwifery services.

The practice opening hours are 8:00am to 6.00pm between Mondays and Fridays. The practice is closed on Saturdays and Sundays. Telephones are answered between 8:00am and 1pm and 2pm 6:30pm daily. GP and nurse appointments are available between 9:00am and 1:00pm and 2:00pm and 6:00pm daily.

The practice is a member of The Kilburn Primary Care Co-op and has dedicated appointment slots available at a local hub until 9:00pm every weekday evening as well as at weekends between 9:00am and 3:00pm. These appointments are available with GPs and nurses, include childhood immunisations and cytology, and can be booked in advance.

The practice has opted not to provide out of hours services (OOH). Patients needing urgent care when the practice is closed are advised to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on patients’ medical urgency.

The practice population comprises of fewer patients over 65 years of age (8%) than the CCG average of 10% and the national average of 17%, and more patients under 18 years of age (25%) than the CCG average of 19% and the national average of 21%.

Information published by Public Health England rates the level of deprivation within the practice population group as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. This information also shows that although the deprivation score for the practice profile as a whole has improved between 2012 and 2015, Income Deprivation Affecting Older People (IDAOPI) is higher (29.4%) than the CCG average of 28% and the national average of 16.2%. Average life expectancy is higher than the national average for males and females at 82 years and 87 years respectively.

The practice caters for a lower proportion of patients experiencing a long-standing health condition (37%) compared to the local average of 50%. The proportion of patients who are in paid work or full time education is higher (74%) than the CCG average of 67% and the national average of 62% and unemployed figures are significantly lower, 5.7% compared to the CCG average of 8.4%.

The practice provides level access to the building and is adapted to assist people with mobility problems. All treatment and consulting rooms are fully accessible including those on the first floor which is accessible by a lift.

The borough of Brent is ethnically diverse and the practice population reflects this diversity. In the latest census in Brent, 36% gave their ethnicity as white, 35% as Asian, 20% as Black and 4.5% as of mixed or multiple ethnicities, the remainder identifying as Arab or other ethnicity.

Updated 18 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lonsdale Medical Centre on 23 February 2016. The practice was rated as requires improvement for providing safe, services, good for providing effective, caring, responsive and well-led services and an overall rating of good. The full comprehensive report of the 23 February 2016 inspection can be found by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.

This inspection was carried out to check that action had been taken to comply with legal requirements, ensure improvements had been made and to review the practice's ratings. Overall the practice is now rated as good.

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

• The practice team included a GP with an advanced qualification in mental health and this GP had helped to develop a range of protocols which improved the care and treatment given to patients with mental health conditions.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their 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. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Continue to action areas for improvement identified in the infection prevention and control audit.
• Continue to monitor uptake rates for public health screening programmes, particularly breast cancer screening, with a view to improving uptake rates.
• Continue to review patient satisfaction levels around access to services and improve processes for making appointments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 September 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.
• Performance for diabetes related indicators were above CCG and national averages. For instance, 92% of patients had well controlled blood sugar levels (CCG average of 77%, national average 78%). The percentage of patients on the diabetes register with well controlled cholesterol was 88% (CCG average 80%, national average 80%).
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All patients had a named GP and the practice used an electronic diary management 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.
• Patients could choose to be emailed copies of letters sent to other care providers enabling them to be more involved in planning their own care and to feel reassured that referrals had been made.

Updated 18 September 2017

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

• From the sample of documented examples we reviewed we found 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 high for all standard childhood immunisations.
• The practice provided support for premature babies and their families following discharge from hospital.
• 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, post-natal and child health surveillance clinics.

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

Updated 18 September 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.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services, for instance with the local Short-Term Assessment, Rehabilitation and Reablement Service (STARRS).
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• Patients aged over 75 years were able to by-pass the main telephone switchboard to ensure they received a more responsive service.

Updated 18 September 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.
• 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.
• The practice provided an online e-consultation system and this was helpful to some patients who found it difficult to attend the surgery during working hours.
• The practice was a member of a primary care cop-operative and had dedicated appointment slots available at a local hub until 9:00pm every evening as well as at between 9am and 3pm on Saturdays and between 9am and 1pm on Sundays. These appointments were available with GPs and nurses, included childhood immunisations and cytology, and could be booked in advance.
• The practice was proactive in offering online services and over 80% of the practice had registered for an online account.
• The practice allowed students who have moved away from home to register as temporary patients during holiday time. People visiting or working locally for short periods could also be registered and seen in this way.

Updated 18 September 2017

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

• One partner had a special interest in mental health, including psychopharmacology and evidence-based nutritional approaches to mental health. This GP provided an expert service for patients with unstable and severe mental health problems and worked with GP colleagues in-house and providing bespoke management plans.
• We looked for evidence of impact and noted that performance for mental health related indicators were above CCG and national averages. For example, 93% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record compared to the CCG average of 91% and national average of 89%. The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 92% (CCG average 86%, national average 84%). The uptake rate for cervical cytology screening by eligible women with schizophrenia, bipolar affective disorder and other psychoses was 89% (CCG average 87%, national average 89%).
• The practice had developed links with secondary care providers, including cardiology specialists and hospital pharmacists to improve monitoring of patients taking medicines to treat mental health conditions whilst also prescribed medicines for high blood pressure. We saw two examples where the practice had identified lithium toxicity due to hospital initiated blood pressure medicines and had been able to help the patients to access emergency care. In both cases the practice had contacted the hospital to share their learning and had worked with the hospital to review their own procedures.
• The practice had developed a protocol through which every GP at the practice received a monthly mental health patient report. This report provided patient’s usual doctor with details of all health or medicine reviews falling due within the coming month as well as details of most recent pathology results and when blood tests were due to be repeated.
• Patients with the most complex mental health conditions were able to book joint consultant and GP appointments at the practice.
• 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which above the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs and had worked with the Institute of Psychiatry to improve how lithium usage was monitored in general practice.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. Patients with the most complex mental health conditions could have joint appointments with their GP and a consultant psychiatrist.
• 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.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 18 September 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, and those with a learning disability. Patient who were homeless were able to register at the practice address.
• The practice used an electronic diary management system to plan and monitor key dates for patients including follow-up appointments, test results and referrals. Patients with appointments falling due or who required blood tests were contacted and reminded and this helped patients with impaired cognition and those with memory loss.
• 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.