Archived: Charlton House Medical Centre

Updated 8 February 2018

Charlton House Medical Centre operates from 581 High Street, Tottenham, London, N17 6SB. The practice is situated in its own premises occupying two floors. Consulting rooms are accessible on the ground floor for those with a physical disability. Access for those who use a wheelchair is at the rear of the premises.

The practice provides NHS services through a General Medical Services (GMS) contract to approximately 7250 patients. It is part of the NHS Haringey Clinical Commissioning Group (CCG) which is made up of 39 general practices. The practice is registered with the CQC to carry out the following regulated activities - diagnostic and screening procedures, family planning, maternity and

midwifery services and the treatment of disease, disorder or injury.

The practice serves a diverse population with many patients for whom English is not their first language. The largest ethnic groups identified as other White 19%, African 18%, Caribbean 12%, British or mixed British 7%, other Asian 2% and White British 2%. The remaining 40% of patients are made up of approximately 29 ethnic groups and mixed backgrounds. The practice has a small population of older patients with 10% (national average 17%) of patients aged 65 years or older and only 4% (national average 8%) of patients aged 75 years or older. The number of patients aged 18 years or younger is 22% compared to the national average of 20%.

The clinical team at the practice is made up of two GP partners (one male and one female), two locum GPs (one male and one female), one female practice nurse, one female locum nurse and one female healthcare assistant. The non-clinical team at the practice is made up of eight administrations roles, one Operations Manager and one Practice Manager.

The practice is open between 8.30am to 6.30pm Monday to Friday. Telephone access to the practice is available between 9.00am to 6.30pm Monday to Friday. Appointments are from 8:30am and 6:30pm Monday to Friday. The practice provides extended hours appointments Tuesday, Wednesday and Friday from 7.30am to 8.00am and Tuesday evening between 6.30pm to 8.00pm. Outside of these hours 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.

The practice provides longer appointments for patients with learning disabilities and patients with long-term conditions. It offers telephone consultations for older patients and where clinical needs resulted in difficulty attending the practice, and text reminders of appointments.

There is information given about the out-of-hours provider and the NHS 111 advice service on the practice website - http://www.charltonhousemedicalcentre.co.uk/ .

We undertook a comprehensive inspection of Charlton House Medical Centre on 20 July 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as requires improvement in respect of the key questions of safe and well-led and overall. The full comprehensive report following the inspection on 20 July 2017 can be found by selecting the ‘all reports’ link for Charlton House Medical Centre on our website at http://www.cqc.org.uk/location/1-544583326 .

Updated 8 February 2018

Letter from the Chief Inspector of General Practice

At the previous inspection on 20 July 2017, the practice had been rated as requires improvement for being Safe and Well-led. We identified breaches of regulations and served requirement notices under regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an announced focused inspection at Charlton House Medical Centre on 9 January 2018. The purpose of this inspection was to follow up on breaches of regulations identified at our previous inspection, and to review the actions taken by the practice. We saw that appropriate and sufficient action had been taken to comply with the requirements of the regulations.

The practice is now rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. As we have now rated the practice as good for providing safe and well-led services, this has revised the rating for the six population groups, as follows:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

• The practice had carried out: a fire risk assessment; infection prevention and control audit; and legionella risk assessment, and acted upon any recommendations.

• It had re-stocked its emergency-use medicines cabinet, and instituted regular checking to ensure that all emergency medicines remained in stock and in date.

• Staff treated patients with compassion, kindness, dignity and respect and involved them in decisions regarding their care and treatment.

• The practice had ensured that all staff had completed all necessary training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 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 was above the CCG and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months was 86% compared to the CCG average of 73% and the national average of 78%.

• 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 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 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 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 had improved form the previous year for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals. For example, children under the age of five were given same day appointments.

• 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.

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

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 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. For example, patients aged 75 and over received same day appointments.

• 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.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• 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.

• The practice offered telephone consultations should they be required as well as follow up.

• NHS health checks offered for patients aged 40 to 74.

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

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

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for mental health related indicators was above the CCG and national averages. For example, 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 96% compared to the CCG average of 83% and the national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

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

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

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and 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.