Oxgate Gardens Surgery

Updated 13 September 2016

Oxgate Gardens Surgery provides NHS primary medical services to around 6200 patients in the Neasden and Dollis Hill areas of North West London through a 'general medical services' contract. The service is provided from one surgery located in converted premises. 

The clinical team comprises four GP partners (male and female) providing 24 clinical sessions, a practice nurse and health care assistants. The practice also employs a practice manager, receptionists and administrators. The practice is a training and teaching practice and at the time of the inspection was hosting two medical students and had one GP trainee in post.

The surgery opens from 8.30am to 6.30pm every weekday except Thursday when the telephone lines close for the afternoon. Appointments are available from 8.30am to 12 noon each morning and at variable times in the afternoon depending on the day and the individual clinician. The practice offers extended hours appointments from 7.00am on Tuesday or Wednesday and until 7.00pm on Monday. Patients can book appointments online and the practice offers an electronic prescription service.

The GPs make home visits to see patients who are housebound or are too ill to visit the practice. When the practice is closed, patients are advised to telephone the out of hours service or the '111' helpline. The practice provides information about its opening times and how to access urgent and out of hours services in the practice leaflet, the website and on a recorded telephone message. 

The age distribution of the practice population is generally similar to the English average although it has a higher proportion of younger adults aged 25-34. The population is ethnically diverse and is growing, particularly in the youngest age groups. Area-based deprivation measures and unemployment rates are close to the English national average. 

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures, and treatment of disease, disorder and injury.

Updated 13 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oxgate Gardens Surgery on 21 March 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 a system in place for reporting and recording significant events. The provider was aware of and complied with the requirements of the duty of candour.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment and had expanded the range of services available to patients.
• Patients said they were treated well at the practice and we received positive feedback about the practice. The practice scored well on the national GP patient survey and other sources of patient feedback.
• Information about services and how to complain was available at the practice and 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 get through to the practice by telephone and their experience of making an appointment was good.
• Patients could consult a male or female GP and a translation service was available. Urgent appointments were 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, an open culture and staff said they were well supported. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• The practice should keep a log of all significant events to facilitate and focus team discussion and learning.
• The practice should review non-clinical safety alerts for relevance to the practice. For example, the practice had not risk assessed or secured looped blind cords in areas of the practice used by patients.
• The practice generally had robust systems of managing medicines. It should check that that it follows good practice guidelines in relation to monitoring high risk medicines.
• The practice should continue to seek ways to expand and strengthen its patient participation group as an effective mechanism for feedback and service development.
• The practice could make more efforts to obtain patient views about specific issues, for example the value of privacy curtains to patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 September 2016

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

• The clinicians took lead roles for managing specific long-term conditions related to their interests and qualifications.
• Patients with long-term conditions were called for regular health and medicines review. Newly diagnosed patients were offered education and support.
• Longer appointments and home visits were available when needed.
• Practice performance for managing long-term conditions tended to be above average. For example, the percentage of diabetic patients whose blood sugar levels were adequately controlled (that is, their most recent HbA1c measurement was 64 mmol/mol or below) was 82% compared to the national average of 78%.
• 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 in line with patients' identified goals.

Updated 13 September 2016

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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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.
• We saw positive examples of joint working with health visitors and other professionals to provide effective care to children, young people and families.

Updated 13 September 2016

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.
• All patients were assigned a named GP and this was listed on their records. Continuity of care was prioritised for older patients and carers. 
• The practice provided individual case studies demonstrating an empathetic approach and willingness to seek imaginative solutions to meet older patients' wishes.

Updated 13 September 2016

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 full range of health promotion and screening that reflects the needs for this age group.

Updated 13 September 2016

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

• Performance for key mental health related indicators tended to be above the national average. For example 31 of 34 (91%) practice patients with dementia had received a review within the last year compared to the national average of 84%. Ninety-two per cent of patients diagnosed with psychoses had a comprehensive care plan documented in their records compared to the national average of 88%.
• 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.
• 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 13 September 2016

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 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, for example conducting joint home visits on occasion.
• 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.