The Queens Crescent Surgery

Updated 2 March 2017

The Queen’s Crescent Surgery operates from 76 Queen’s Crescent, London NW5 4EB. The premises are located a short distance from Kentish Town West overground station, with good bus services nearby. The premises are shared with the Four Trees Surgery, a service which was taken over in April 2016 by the same four GP partners responsible for Queen’s Crescent. The partnership had taken over the Queen’s Crescent Surgery in 2013. The two practices will be merging in due course. The GP partners also operate another large practice nearby, the James Wigg Practice, from which some clinics and other healthcare services are provided to patients registered at the Queen’s Crescent Surgery.

The Queen’s Crescent Surgery provides NHS services through a General Medical Services (GMS) contract to approximately 3,700 patients. It is part of the NHS Camden Clinical Commissioning Group (CCG) which is made up of 36 general practices. The practice is registered with the Care Quality Commission to carry out the following regulated activities - Maternity and midwifery services; Surgical procedures; Diagnostic and screening procedures; Family planning; Treatment of disease, disorder or injury. The patient profile has a higher than average population of teenage and younger adults of working age, between 20 and 39 years, with fewer than average older patients. The deprivation score for the practice population is in the second “most deprived decile”, indicating a higher than average deprivation level among the patient group. Data showed that the practice had the most deprived population within the CCG area.

The practice has a clinical team of four partner GPs (three male and one female), one female salaried partner GP and two salaried GPs (one male, one female). One of the four partner GPs has overall management responsibility for the practice, working two admin / training sessions there. The salaried partner GP is the clinical lead, working four clinical sessions and two admin sessions per week; One of the partner GPs works one clinical session and another works half a session. One of the salaried GPs works six clinical sessions and the other works two. Other GPs from the James Wigg Practice cover two clinical sessions two per week. It is a teaching practice, with the salaried partner and two of the partner GPs being trainers. At the time of our inspection, there was one registrar (a qualified doctors gaining general practice experience) and one Foundation Year 2 medical student working at the practice. There are four practice nurses, a physician’s associate and two healthcare assistants.

The administrative team is made up of a practice manager and associate practice manager, and 13 other staff, some of whom are shared with the other two associated practices.

The practice reception operates between the following times -

Monday 8.30 am - 6.00 pm

Tuesday 8.30 am - 12.30 pm and 2.00 pm - 6.00 pm

Wednesday 8.30 am - 8.00 pm

Thursday 8.30 am - 6.00 pm

Friday 8.30 am - 6.00 pm

It closes between 12.30 pm and 2.00 pm on Tuesdays only for staff training.

Routine, pre-bookable and on the day appointments are available with GPs and nurses between 8.30 and 11.00 am and 2.30 pm and 5.30 pm Monday, Tuesday, Thursday and Friday and pre-bookable appointments are available up to 8.00 pm on Wednesday.

Routine appointments are 12 - 20 minutes long, although patients can book double appointments if they wish to discuss more than one issue. Appointments are usually offered up to six weeks in advance. Patients may request urgent appointments, when a receptionist will note the patient’s contact details and their health needs and pass them to the duty GP to triage and phone the patient back. Children younger than 12 months old can be brought to the surgery on a walk in basis.

If they have previously registered for the system, patients can also book appointments and request repeat prescriptions online. Emergency home visits are available for patients who for health reasons are not able to attend the practice.

The practice is closed at weekends, but a number of weekend appointments are available under a local scheme operating at three locations across the borough. The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. There is information given about the out-of-hours provider and the NHS 111 service on the practice website. Information is given in the practice leaflet regarding the two urgent care centres operating in the borough.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 26 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about how to complain was available and easy to understand. Comments and complaints were analysed and improvements were made to the quality of care as a result of complaints and concerns.
• 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 provider was aware of and complied with the requirements of the duty of candour.

However, there was area of practice where the provider should make improvements:

• Continue to monitor and review performance in respect of diabetes care and the uptake of cervical screening tests, implementing any remedial action as appropriate.
• Continue with efforts to increase the size of the patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 2 March 2017

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

• The practice had 42% more patients with chronic disease than the local CCG average.
• The practice’s performance relating to diabetes care was below local and national averages, but actions had been identified and implemented to secure improvement.
• The practice maintained a register of patients with diabetes, of whom 120 (81% of those eligible) had received an annual foot check and 129 (73% of those eligible) had received an annual retinal check.
• The practice maintained a register of 44 patients with heart failure, of whom 41 (95%) had had an annual medicines review in the preceding 12 months.
• The practice’s performance relating to patients with atrial fibrillation, hypertension, and chronic obstructive pulmonary disease and asthma was comparable with the national average.
• Longer appointments and home visits were available when needed.

Updated 2 March 2017

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 and maintained a register of vulnerable children.
• Of the 16 children on the child protection register who had attended Accident and Emergency or had been discharged from hospital, 10 (63%) had been seen by a GP within one month.
• Take up rates for standard childhood immunisations were generally comparable with averages.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 2 March 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 made provision for urgent appointments for those with enhanced needs.
• The practice maintained a case management register of patients at high risk of admission to hospital. There were 62 patients currently on the register, all of whom had up to date care plans. This included 19 patients on the register who had been discharged from hospital, all of whom had had their care plan reviewed.
• The practice had carried out follow up consultations of 43 patients aged over- 65 (72%) and 28 patients aged over-75 (78%).
• Records showed that 105 patients, being 93% of those who were prescribed ten or more medications, had had a structured annual review.
• Ninety-seven patients identified as being at risk of developing dementia had received a cognition test or memory assessment.

Updated 2 March 2017

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

• 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.
• Morning and evening appointments with both GPs and nurses were available for those patients who could not attend during normal working hours.
• Telephone consultations with patients’ usual GPs were available within 48 hours.
• The practice’s uptake for the cervical screening programme was below average, but it had taken action to remedy this. We were shown data that indicated a 9% improvement in uptake from September 2015.
• Data showed that 3,168 patients aged over-16 (83% of those eligible) and 1,529 patients aged over-45 (86% of those eligible) had undergone blood pressure checks in the last five years.

Updated 2 March 2017

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

• 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 (01/04/2015 to 31/03/2016) was 95.74%, being higher than the national average of 88.77%.
• The practice worked closely with a local mental health trust’s psychology team and the local Care Navigator providing co-ordinated care for patients.
• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016) was 81.82%, being comparable with the national average of 83.77%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Continuity of care for patients experiencing poor mental health was prioritised.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had completed online training relating to the Mental Capacity Act.

Updated 2 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice maintained a learning disability register of nine patients, of whom five had received an annual follow and had had their care plans reviewed, since April 2016.
• The practice offered longer appointments for patients with a learning disability.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Patients can be booked into specialist alcohol support clinics which operate twice a week at the sister practice.
• A Citizen’s Advice Bureau worker attends the practice every fortnight to assist patients with welfare issues.
• Homeless patients can register with the practice’s address to access healthcare and welfare services.
• 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.