Archived: Church End Medical Centre

Updated 9 November 2017

Church End Medical Centre provides NHS primary medical services to around 8000 patients in the Willesden and Harlesden area of North West London through a 'personal medical services' contract. The practice provides services from a single, purpose built surgery which is located on the Church End estate.

The practice team includes two GP partners, three salaried GPs, an advanced nurse practitioner, a practice nurse, health care assistants, receptionists and administrators and a practice manager. Patients can choose to consult with a male or female GP or nurse.

The practice population has a higher than average proportion of babies, children and young adults and a relatively low proportion of patients over 65. Registered patients are ethnically and culturally diverse with a high proportion of African-Caribbean patients by ethnicity. The area falls within the 10% most deprived areas of England (as measured by the index of multiple deprivation) with almost 40% of children in the area estimated to be affected by income deprivation.

The practice is a training practice and provides placements for GP registrars and student nurses.

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; family planning; maternity and midwifery services and surgical procedures.

Updated 9 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 27 May 2016 at Church End Medical Centre. At that inspection the practice was rated good overall. However, we rated the practice as requires improvement for being responsive to the needs of patients. This was because the practice could not demonstrate it was facilitating effective access to the service particularly for patients who found it difficult to attend during normal working hours.

The full comprehensive report of the 27 May 2016 inspection can be found by selecting the ‘all reports’ link for Church End Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review undertaken from 11 September 2017 to check that the practice had addressed the requirements identified in our previous inspection. This report covers our findings in relation to those requirements.

Overall the practice remains rated as good. Following this desk-based review, we have revised the practice’s rating for responsive services. The practice is now rated as good for providing responsive services.

Our key findings were as follows:

The practice had taken steps to improve access to the service including for those patients of working and school age. Action included:

• The promotion of a wider range of appointment booking options including online access.
• The restructure of the practice appointment system to include more advance booking availability in addition to urgent appointments and walk-in sessions.
• Investment in staff training and a programme of improvement which included improved access as a priority.

The practice's recent patient survey results suggested that patient access to the service had improved since our previous inspection.

However, there remains scope for further improvement. In particular:

• The practice should continue in its focus on improving access to the service and patient feedback in relation to telephone access and waiting times in the surgery.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 9 September 2016

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

• The practice kept registers of patients with common long term conditions and offered routine clinics including diabetes, asthma, chronic obstructive pulmonary disease, hypertension and rheumatoid arthritis. Patients in need of a review were invited by post, followed up by text and reminder letters.
• Patients attending long term condition clinics were offered longer appointments.
• The practice held weekly clinical meetings, in-house monthly multidisciplinary meetings and attended locality multidisciplinary meetings to review the care of patients with longer term conditions as appropriate.
• The practice participated in the locality 'complex patient management group' (CPMG) on a weekly basis to improve the care and experience of the most complex and vulnerable patients.
• The practice promoted patient self care for long term conditions through a multi-pronged approach including educational sessions at patient participation group meetings. Recent meetings had included sessions on diabetes, asthma and men's health. The meetings were well attended.
• There was a high prevalence of sickle cell disease locally. The practice had developed its service to meet the primary care needs of patients with sickle cell and reduce unplanned hospital admission.

Updated 9 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. The practice policy was to register children together with their parents or guardians.
• Immunisation rates were high for all standard childhood immunisations. The practice offered an MMR vaccine catch up programme.
• 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. Children under five were prioritised for same day appointments.
• The practice provided a range of services for this population group including antenatal and postnatal care, baby and immunisation clinics and phlebotomy for under 12 year olds.
• The practice was keen to encourage the younger population to attend the patient participation group for example presenting on contraception and sexual health for younger people. The practice provided free condoms and pregnancy testing..

Updated 9 September 2016

The practice is rated as outstanding for the care of older people.

• The practice was proactive in meeting the needs of the older people in its population. For example, one of the doctors made a weekly visit to practice patients who lived in a nearby nursing home.
• The practice had worked closely with the home, for example encouraging the nursing staff to develop competencies and skills such as catheterisation. The practice had directly trained nursing home staff on some aspects of care. As a result, the number of ambulance call outs and A&E admissions from the home had decreased by almost 70%.
• The practice had two clinical leads for the care of older patients. All older patients had been informed of their named doctor. The practice offered home visits and urgent appointments for those with enhanced needs.

• The practice used risk stratification tools and intelligence to identify older patients with one or more long-term conditions at risk of unplanned hospital admission. The practice developed care plans for patients identified at medium and high risk (4% of older patients). Any patient who had an unplanned admission to hospital was contacted within 72 hours of discharge.
• The practice worked as a team and with partner organisations to provide coordinated care. GPs and nurses held weekly in-house meetings to review older vulnerable patients. The practice also held monthly multidisciplinary team meetings with district nurses, palliative care nurses, health visitors and the care coordinator.
• The practice offered the full range of relevant NHS immunisations to older patients including the pneumococcal, shingles and influenza vaccines.
• The practice signposted and referred patients to a wide range of support groups tailored to their particular circumstances. We saw examples where the GP or care coordinator had contacted local voluntary organisations involved in advising older patients how to stay warm at home and tackling social isolation after visiting patients at risk at home.

Updated 9 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. The practice had exceeded its target for the uptake of NHS Health Checks and had identified patients with previously undiagnosed conditions.
• The practice offered extended hours appointments for the working age population and online appointment booking and repeat prescription services. One in five patients was registered for online services. Evening and weekend appointments were also available at other 'hub' practices in Brent if required.
• The practice offered meningitis C vaccinations to registered university students.
• The practice proactively offered chlamydia and gonorrhoea screening and a wide range of regular contraceptive options and emergency contraception. Patients could access free condoms and pregnancy tests.
• The practice explored new ways of engaging with patients for example, the 'Brent Health App' to promote self care and update on local services..

Updated 9 September 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing complex health problems including poor mental health and dementia.
• The practice had a proactive approach to dementia screening and referred patients at risk to the local specialist memory clinic, dementia cafes and support services
• The practice employed a mental health specialist nurse who ran dedicated clinics for patients with mental health problems and provided continuity of care and liaison.
• Patients experiencing poor mental health were signposted to various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency if they may have been experiencing poor mental health.

• Patients with mental health problems received a full health check at least once a year.

Updated 9 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 homeless people and those with a learning disability.
• The practice offered longer appointments and specialist clinics for patients with a learning disability. The practice provided all patients with a learning disability with health checks including physical health and healthy living.
• The practice GP lead for learning disability was also the CCG lead for this patient group, providing mentoring support to other practices across Brent. 
• 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 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. Discussion of vulnerable children and adults was a fixed agenda item at the practice weekly clinical meetings.
• The practice had developed its new patient registration template to include details about the social environment and safeguarding issues, child protection or other concerns.
• The practice provided interpreting and signing services to patients who did not speak English.
• The practice ran in house alcohol and substance misuse clinics.
• The practice had a register of carers who were prioritised for appointments and signposted to additional support and assessment.