Archived: Camden Health Improvement Practice

Updated 28 April 2017

Camden Health Improvement Practice is located in central London. The service is provided by the national charity -Turning Point. Turning Point provide services for people with complex needs, including those affected by drug and alcohol misuse, mental health problems and those with a learning disability. Many of the patients who attend the practice are homeless. The practice is located in the Margarete Centre, which is rented from Camden and Islington Foundation Trust and is co-located with the South Camden Drug Service. The practice has existed since 1991 and the current contract is held by Turning Point, in place for five years, due to be re-tendered in November 2017.

There are two female GPs and one male GP who work on a sessional basis at the practice. There are three part time GPs who work four sessions per week. There are three vacant sessions. These sessions are covered by GPs from a pool of locum GPs the practice has used for several years. The practice has two long term locums covering three sessions per week.

There are two full time female practice nurses who each provide five clinical sessions per week. There is a navigator post funded by the local Clinical Commissioning Group (CCG) whose role is to support patients access services for example attend outpatient appointments.

The practice is not a training practice but undergraduate medical students are able to gain experience at the practice :

The majority of sessions provided by the practice are drop in sessions. Patients can attend without making an appointment. There are seven drop in sessions and three appointment only sessions. The practice is open between 9.30 and 12.00 on Mondays, 10.30 to 12.45 on Tuesday, 9.30 to 12.00 on Wednesday, 9.30 to 12.00 on Thursday and 9.00am to 11.30 on Friday. There are booked appointment sessions on Tuesday Wednesday and Thursday afternoons between 2.00 pm and 4.30pm and drop in sessions between 2pm and 4.30 on Mondays and Fridays. Patients are encouraged to attend the drop in sessions as close to the beginning of the clinical session as possible to ensure they can be seen.

Patients could contact the Camden out of hour’s service when the practice is closed.

The practice, which has up to 630 patients on its list, provides services from the Margarete Centre and an outreach service to one hostel. However, the majority of patients who attend the practice are not registered and attend on an informal drop-in basis. Some patients have attended for several years however, the practice usually has a turnover of 40%. The practice works in partnership with a substance misuse charity and the Camden and Mental Health Foundation Trust, which provides shared care workers. Treatment is provided by GPs and nurses and will include assessment, diagnosis, treatment, onward referral, follow-up or discharge and prescribing of medicines as required.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Camden Health Improvement Practice on 05th January 2017. Overall, the practice is rated as good.

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

• There was an effective system in place for reporting and recording significant events. Incidents were reviewed by the provider’s Risk and Assurance Team at the charity’s headquarters.

• Lessons were shared to make sure action was taken to improve safety in the practice.

• When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

• There were a range of quality and safety audits carried out based on the provider’s Internal Quality Assessment Tool.

• The practice provided a range of evidence based services designed to meet the needs of the patients served by the practice.

• A health navigator was employed by the practice, funded by the local CCG to support patients to ensure they attended hospital or other appointments. Patients released from prison or a mental health hospital sometimes needed help to understand where and how to access services.

• The practice liaised with the Camden out of hour’s service (OOH). The practice received information daily about patients who had attended the out of hour’s service overnight and they alerted the OOH service about any patients concerns identified during the day.

• GPs and nurses told us they encouraged patients to have tests, investigations and treatment. They said it was important to respect patient’s wishes if they declined to have a test or treatment even if they were at risk of developing a condition.

• GPs and nurses told us they used every opportunity they saw patients to check their general health.

• One doctor co-ordinated the care for patients approaching the end of life. The practice held a palliative care register. The care of patients on the register was discussed a clinical review meetings

• Patients’ needs were discussed at a weekly meeting. Patients’ clinical and social needs were discussed.

• The practice employed a locum GP with funds from a homeless charity visiting homeless patients on the street and in hostels.

• The practice had a bank of locums they could call on to cover sessions during periods of sickness or other absences.

• The learning needs of staff were identified through a system of appraisals, meetings and reviews of practice development needs. Nursing staff had access to professional supervision.

• The practice could organise appointments for patients up to a year ahead. This meant patients could be monitored frequently for example to review their medicines.

• Reception staff kept an appointment slot free for emergencies in each of the afternoon clinic sessions. Nurses also help one urgent slot for seeing patients urgently.

• The appointment system was designed to allow patients to access service by use of drop in clinics.

• An on site phlebotomy so that patients did not have to go somewhere else they not know for tests.

• The practice analysed the complaints received identified any lessons learned and monitored any trends and actions taken to as a result to improve the quality of care.

• There was a range of quality and safety audits carried out based on the provider’s IQAT (Internal Quality Assessment Tool.

• The practice was participating in a safety improvement programme which developed capacity within the practice to pursue quality improvement.

The areas where the provider should make improvement are:

• The practice should ensure blank prescription forms are kept in a locked area at all times.

• Cupboards where clinical equipment is stored should be locked.

• The practice should review Patient Group Directions which are beyond review date and ensure all PGDs are signed.

• The provider should carry out a comprehensive risk assessment of security or staff and patients at the service.

• The practice should ensure staff complete all mandatory training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

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.

• Patients at high risk of developing coronary heart disease and other conditions were identified and offered treatment and advice.

• Longer appointments and home visits were available when needed.

• All these patients 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.

Updated 28 April 2017

• The practice does not provide services for children and families. Practice nurses were trained to provide a women’s health and screening service.

• Practice staff were aware some patients were parents and watched out for any risks of abuse. Staff had level 3 safeguarding training for adults and children.

Updated 28 April 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 had a palliative care lead who reviewed and co-ordinated the care provided to patients approaching the end of life.

Updated 28 April 2017

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

• There were GP leads for long term conditions. Each GP lead developed a care plan for the management of each long term condition including prescribing and further investigations including referrals that may be required.

• The practice had developed a range of services in response to the needs of the working age population, for example tissue viability for patients with venous ulcers, a consultant specialising in liver disease saw patients at the practice and a specialist COPD nurse who provided an assessment and treatment service.

The practice was proactive in assessing and reviewing patient’s health needs for example when reviewing repeat prescriptions.

Updated 28 April 2017

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

• The practice regularly worked with local mental health teams to co-ordinate the care of patients experiencing poor mental health, including those with dementia.

• Some staff were trained to support patients with cognitive behaviour therapy.

• The practice referred patients with more minor mental health conditions to the local psychological therapy service (IAPT).

• The practice was able to direct patients to access 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.33 % of the practice's patients have an alcohol problem, 43% of patients have a substance misuse problem and 25 % of patients have a mental condition.

Updated 28 April 2017

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

• The appointment system was designed to allow patients to access service by use of drop in clinics, patients can register and see GP on same day. The practice was able to provide longer appointments including double appointments to accommodate patients’ needs.

• The practice had one GP dedicated to dealing with the high demand for medical reports for benefits, housing, and solicitors supported by a benefits advisor funded by the practice.

• The practice employed a locum GP who visited homeless patients on the street and in hostels. This included visits to patients the practice were concerned about and meeting with the complex care nurse. In some cases they met with a patient daily to make sure they took their medicines.

• The practice offered regular health checks to patients to monitor their condition.

• Practice staff visited patients in the hostel when they needed medical attention.

• The practice arranged for homeless patients to receive their medicines.

• The practice reviewed the care vulnerable patients at weekly clinical meetings.

• The practice provided seven drop-in sessions each week for patients to access medical services.

• The practice offered longer appointments for patients on a regular basis to assess their health needs.

• The practice regularly worked with other health and social care professionals in the case management of vulnerable patients.

• 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.