The Nightingale Practice

Updated 22 March 2017

The Nightingale Practice is part of Wandsworth Clinical Commissioning Group (CCG) and exclusively caters to 162 residents who live at Nightingale House nursing and residential home. The practice is registered with the CQC for the following regulated activities Treatment of Disease, Disorder or Injury and Diagnostic and Screening Procedures.

The practice operates at Nightingale House which is a nursing and residential home serving elderly Jewish people. Nightingale House is comprised of two residential units, one nursing unit, one nursing dementia unit and a residential and nursing dementia unit. The practice has four non-clinical rooms within Nightingale House on the ground floor. Consultations and treatment are provided in residents’ own rooms.

The practice is a separate location registered by provider Balham Park Surgery. Governance arrangements are split between Balham Park (which handles personnel, finance and IT) and The Nightingale Practice which has its own clinical policies for topics like infection control. The practice is staffed by one Advanced Nurse Practitioner who works full time at the site and responds to the acute care needs of patients. The GPs who work at the practice provide five clinical sessions at the home per week. The practice also has one nurse who works two days per week.

The practice is open between 8 am and 5.30 pm Monday to Friday. Care home staff were directed to contact Balham Park Surgery between 5.30 pm and 6.30 pm if no clinical staff were on site. and the local out of hours provider outside of these times.

Care home staff are directed to contact the designated out of hours provider when the surgery is closed. The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These are: facilitating timely diagnosis and support for people with dementia and influenza and pneumococcal immunisations.

The practice is a member of Wandsworth GP federation.

Updated 22 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Nightingale Practice on 15 November 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 not always assessed and well managed.
• The practice was an outlier in respect of a number of clinical targets though this was largely attributed to the practice’s patient demographics. From the records reviewed we found that staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had received clinical training which provided them with the skills, knowledge and experience to deliver effective care and treatment. However, some essential training had not been completed at the time of our inspection.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was provided to all patients and their relatives and was easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to access clinical care when required.
• 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Improve mechanisms for gathering and acting upon patient and relative feedback.

• Monitor the vaccine fridge in line with Public Health England guidance.

• Review areas of QOF where the practice is an outlier and antibiotic prescribing with a view to bringing performance in line with local and national guidance.

• Ensure complaints responses follow practice policy and comply with statutory requirements.

• Ensure that all staff complete essential training in accordance with legislation and guidance.

• Undertake a risk assessment to ensure that the practice has an appropriate stock of emergency medicines to enable it to respond effectively in an emergency.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 March 2017

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

• The Advanced Nurse Practitioner led in the management of chronic disease. Patients at risk of hospital admission were identified as a priority.

• Performance related to the management of diabetic patients was mainly comparable to local and national averages though the proportion who had received a diabetic foot check was below the local and national average.

• All patients were allocated a named GP and had a structured annual multidisciplinary review to check their health and medicines needs were being met.

Updated 22 March 2017

Updated 22 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 provided visits in resident’s own rooms within the home when required.

Updated 22 March 2017

Updated 22 March 2017

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

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

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

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

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 March 2017

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff knew how to recognise signs of abuse in vulnerable adults. 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. However not all staff had received appropriate safeguarding training.