The Argyle Surgery

Updated 8 November 2016

The Argyle Surgery is situated at 128 Argyle Road, West Ealing, London, W13 8ER in a semi-detached converted house. The practice provides primary medical services through a General Medical Services (GMS) contract to 8,100 people in the London Borough of Ealing. The practice in addition holds a alternative primary medical services (APMS) contract for 960 care home residents in the borough. The practice also provides services for three learning disability homes.

The ethnicity of the practice population is of mixed origin with a significantly higher than average number of people 25-39 years of age and a higher than average number of children under nine years of age. Life expectancy is 79 years for males and 85 years for females which is similar to national averages. The local area is the fifth less deprived in the London Borough of Ealing (people living in more deprived areas tend to have greater need for health services).

The practice team consists of two male GPs partners and four female GP partners (22 clinical sessions) three salaried GPs (7 clinical sessions), a nurse practitioner (8 clinical sessions), two practice nurses (9 clinical sessions), three healthcare assistants, eight phlebotomists and a practice manager who is supported by a large team of administration / reception staff. The nurse practitioner is also a practice partner.

The practice has an in-house pharmacy team including two clinical pharmacists, four prescribing pharmacists, four pharmacy technicians and one trainee pharmacist. The team of pharmacists provide prescribing support for the clinicians for patients under both the GMS and APMS contracts.

The practice is open between 8:00am and 6:30pm Monday to Friday. Appointments are from 8:30am to 12:00pm every morning and 2:00pm to 6:00pm daily. Extended hours appointments are offered between 8:15am and 12:30pm on Saturday mornings. Telephone lines are open throughout the opening hours. The nursing home service runs 8:00am to 8:00pm, seven days a week, 52 weeks a year.

The Argyle Surgery is an accredited training practice. Trainees include GP Registrars (doctors completing their final training to become a GP) and Foundation Year Two doctors (qualified doctors who, as part of their training, will work under the supervision of one of the partners) as well as medical students. The nurse practitioner and a second nurse are qualified nurse mentors and are active in mentoring trainee nurses.

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Argyle Surgery on 6 September 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they could make an appointment within a reasonable time with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs. However, the premises were in need of a general upgrade.
• 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 been awarded the contract to provide a nursing home service to 18 out of the 21 care homes in the London Borough of Ealing. ‘The Argyle Care Home Service’ started its multi-disciplinary team approach to deliver innovative primary care to over 900 care home residents in July 2013. The clinicians work with the in-house pharmacy team to deliver the service. The service is accessible 8:00am to 8:00pm, seven days a week, 52 weeks a year. Key achievements of the multi-disciplinary team work from 2013 to date include a 66% reduction in the use of antipsychotic medicines in nursing home based dementia patients, a 20% reduction in accident and emergency admissions and a reduction of more than 40% in admission to hospital for end of life care. The practice had won the British Medical Journal Primary Care Team of the Year award in 2015 for its care home service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 8 November 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.
• Quality and Outcomes Framework performance for diabetes related indicators in 2014/15 was 100% with exception reporting of 19% (CCG average 12%). Unpublished data from 2015/16 provided by the practice showed they had reduced exception reporting.
• 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 8 November 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’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 78% and the national average of 82%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• 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.

Updated 8 November 2016

The practice is rated as outstanding 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.
• The practice provided a care home service to 18 care homes in the London Borough of Ealing. The clinicians worked with the in-house pharmacy team to deliver an innovative service. Key achievements of the service included a 66% reduction in the use of antipsychotic medicines in nursing home based dementia patients, a 20% reduction in accident and emergency admissions and a reduction of more than 40% in admission to hospital for end of life care. The practice had won the British Medical Journal Primary Care Team of the Year award in 2015 for its care home service.

Updated 8 November 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 8 November 2016

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

• 90% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 88% and the national average of 84%.
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to the CCG average of 91% and 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 8 November 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, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability. The practice had 35 patients on the register including patients living in two specialist residential care homes. The practice pro-actively supported these patients through staff training, providing health checks at the homes for those who could not attend the practice and through working with local support groups.
• The practice regularly worked with other health 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.
• The practice provided a substance misuse service with four GPs trained to prescribe methadone.
• The practice worked with the local Mental Health Trust to reduce the number of smokers in patients experiencing poor mental health. A smoking cessation advisor worked at the practice once a week who contacted patients on the severe mental health register to provide smoking cessation advice.