Archived: The Law Medical Group Practice

Updated 1 July 2016

The Law Medical Group Practice in Wembley, Brent is one of two practices owned and operated by The Law Medical Group Practice. Both practices are registered separately. The Wembley based practice provides GP primary care services to approximately 6,000 people living in the Wembley neighbourhood of Brent. The practice is in an area that is in the fourth more deprived decile and has a larger than average number of patients in the ages of 25 and 45.

The two practices share managerial and administrative resources. Doctors and nurses are primarily attached to one or other surgery but regularly move between surgeries depending on demand. In total, The Law Medical Group Practice has two GP partners, both male who work full time. In addition there are seven part time salaried GPs, four female and three male. It is a training practice with two GP registrars, one female and one male and two F2 trainee doctors.

The practice use a computer modelling tool to match resources and demand across the two locations with the number of sessions offered in each practice varying monthly. The number of sessions and appointments is prepared monthly in advance, and is calculated taking into account seasonal requirements, practice performance data and staff leave. The practice aims to provide appointments based on a ratio of 72 appointment slots per 1,000 patients, with some fine tuning at weekly practice meetings.

There are two nurse practitioners, one practice nurse, three healthcare assistants and a phlebotomist. There is a practice manager, a practice manager’s personal assistant, a reception co-ordinator and 18 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 7:30am to 8.00pm on Mondays, 8:00am to 6.30pm on Tuesdays and Wednesdays, 8:00am to 12:00pm on Thursdays and 8:00am to 5:30pm on Fridays. The practice is closed on Saturdays and Sundays. 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 ‘out of hours’ services are provided by Care UK. The details of the ‘out of hours’ service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website. The practice provides a wide range of services including clinics for diabetes, phlebotomy, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

Brent is the seventh largest of London’s 32 boroughs in terms of population and the population profile varies greatly from ward to ward. 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 1 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Law Medical Group Practice on 10 February 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 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 services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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 and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

The practice had responded to the high proportion of young families in its population group by creating in the waiting area, a large and engaging visual display about the background and benefits of childhood immunisations. The result was that the practice had immunisation rates which were consistently higher, by as much as 10%, than the CCG average for every age group and every vaccination type.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 1 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• Performance indicators for patients with diabetes were comparable to the national average. For example, 96% percentage of patients with diabetes had had influenza immunisation in the preceding 12 months compared to the national average of 94% and 82% of patients on the diabetes register had a foot examination and risk classification within the preceding 12 months compared to the national average of 88%.

• All patients with long term conditions had a named GP and 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.

• One GP had attended additional training on palliative care and disseminated their learning amongst other members of staff at the practice.

Updated 1 July 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.

• The practice had created a prominent and engaging visual display about the background and benefits of childhood immunisation. Immunisation rates were consistently higher than CCG and national averages 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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 80%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice provided a chlamydia screening programme.

• The practice had arranged an innovative two weekly joint clinic with a paediatric consultant from a local hospital. This benefitted patients by providing convenient local access to specialists.

Updated 1 July 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.

• Every patient aged over 75 had a named GP and patients could see that GP when required.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• There was a protocol which ensured that every patient who was on an ‘at risk’ register who had been discharged from hospital was contacted by a GP within 48 hours of discharge.

• The practice provided GP services for one care home and a named GP undertook weekly ward rounds and a practice nurse occasionally visited the care home to support care staff with wound care.

Updated 1 July 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. The practice provided alternative access arrangements for patients who found it hard to attend during normal opening times. There was one late evening clinic each week and every GP session had slots reserved for telephone consultations.

• The practice was involved in a Kilburn locality pilot programme using an online consultation system. This allowed patients to review their symptoms without coming into the practice and helped them to decide if they needed an appointment or not.

Updated 1 July 2016

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

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  The practice regularly worked with multi-disciplinary teams in the case management of people 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 1 July 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 homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.