Partnership Primary Care Centre

Updated 10 March 2017

Partnership Primary Care Centre (the practice) operates at 331 Camden Road, London N7 0SL. The premises are owned by the local NHS trust and the practice shares them with a number of other healthcare services. There are good bus services nearby and Caledonian Road tube station is within a ten-minute walk.

The practice provides NHS services through a General Medical Services (GMS) contract to approximately 3,000 patients. It is part of the NHS Islington Clinical Commissioning Group (CCG), which is made up of 38 general practices. The practice is registered with the Care Quality Commission as a partnership of five GPs, two of whom had recently joined. The other three partners also operate another general practice in a neighbouring CCG, with two of them working at both sites. The two newer GPs have not yet started clinical sessions; one was to become the registered manager. The practice is registered to carry out the following regulated activities - Treatment of disease, disorder or injury; Surgical procedures; and Diagnostic and screening procedures. The patient profile has a below average population of younger children and teenagers and adult patients aged over-55. There are significantly more working age patients, between 25 and 39 years old; and slightly above-average numbers of aged between 40 and 55. The deprivation score for the practice population is in second “most deprived decile”, indicating a higher than average deprivation level among the patient population.

The clinical team is made up of two of the partner GPs, both female and each working four clinical sessions at the practice, together with two salaried GPs - one female, one male - who work three and four sessions per week. There is a female practice nurse and the practice manager is a qualified healthcare assistant, who sees patients in that capacity. It is a training practice and there is currently a second-year foundation level doctor attached. The administrative team comprises the practice manager, assistant manager and four administrator / receptionists. In addition to the two partner GPs working at both practices, the nurse, assistant practice manager and most of the administrative staff also divide their time between the two sites.

The practice reception operates between 8.30 am and 6.30 pm Monday to Friday. Appointments are available with GPs each morning afternoon between 9.00 am and 11.30 am; each afternoon between 12.30 pm and 2.30 pm; evening sessions operate on Monday, Wednesday and Friday between 4.00 pm and 6.00 pm. A number of slots are kept free each session for same-day appointments and emergencies. Appointments with the practice nurse are available between 8.30 am and 1.00 pm on Monday and Tuesday; and between 2.00 pm and 5.00 pm on Thursday.

Routine consultations can be booked up to two weeks in advance and are 10 minutes long, but longer appointments may be booked if patients have more than one issue to discuss. Home visits are available for patients who may be house bound. The GPs and the practice nurse are also available for telephone consultations. Routine appointments with GPs may be booked online by patients who have previously registered to use the system. It can also be used to request repeat prescriptions.

The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. In addition, the CCG provides the “IHub” service, operating until 8:00 pm on weekdays and between 8:00 am and 8:00 pm at weekends at three sites across the borough. Appointments can be booked by patients contacting their own general practice. There is also a walk in service available to all patients at three sites. Information about the out-of-hours provider, NHS 111 service and the IHub service is given in the practice leaflet and on the practice website. It also gives the address of two nearby Accident and Emergency departments, together with contact details of the out-of-hours urgent dental service and local mental health services.

Updated 10 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 19 January 2017. Overall the practice is rated as good.

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

• Patient feedback suggested there were problems accessing the service. However, two new partners had recently joined the practice, with one taking over managerial responsibility, and it was anticipated that results regarding access would improve as a consequence.
• 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 how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.

However, there were areas of practice where improvements should be made:

• The practice should continue to monitor the national GP patient survey results and feedback relating to patients' access to the service and take appropriate steps to improve outcomes compared with local and national averages.
• It should review the activity of the patient participation group, relating to the size of membership and the frequency and timing of meetings, to ensure there is effective patient engagement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 10 March 2017

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

• The practice’s performance relating to patients with long term conditions was generally above local and national averages.
• The percentage of patients with diabetes in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2015 to 31/03/2016) was 92.52%, compared to the CCG average of 76.07% and the national average of 78.01%.
• The percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 83.46%, compared with the CCG average of 76.09% and the national average of 77.58%.
• In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage who were treated with anti-coagulation drug therapy. (01/04/2015 to 31/03/2016) was 89.66%, compared with the CCG average of 80.69% and the national average of 86.69%
• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less (01/04/2015 to 31/03/2016) was 81.37%, compared with the CCG average of 80.74% and the national average of 82.9%.
• The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (01/04/2015 to 31/03/2016) was 91.55%, compared with CCG average of 91.17% and the national average of 89.59%
• The percentage of patients with asthma who had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 RCP questions (01/04/2015 to 31/03/2016) was 74.82%, compared with the CCG average of 75.08% and the national average of 75.55%
• All 21 patients on the heart failure register had had an annual medicines review.
• Longer appointments and home visits were available when needed.

Updated 10 March 2017

The practice is rated as good for the care of families, children and young people.

• The practice worked closely with health visitors, 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 and maintained a register of vulnerable children.
• Childhood immunisation rates for the vaccinations given to under two year olds were below the national average. Immunisations rates for five year olds were above local and national averages.
• 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 of regular MDT meetings.

Updated 10 March 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 was responsive to the needs of older people, with home visits and longer appointments were available for those with enhanced needs.
• The practice maintained a case management register of patients at high risk of admission to hospital. There were 60 patients currently on the register, all of whom had had their care plans reviewed.
• There were eight patients on the practice’s palliative care register. We saw evidence of close working with the local palliative care team, with appropriate information being shared.
• One hundred and four patients identified as being at risk of developing dementia had received a cognition test or memory assessment in the year.

Updated 10 March 2017

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

• 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.
• Evening appointments were available throughout the week, together with weekend appointments under a local scheme at three locations across the borough for patients unable to attend during normal working hours.
• Telephone consultations with GPs were available each day.
• The practice’s uptake for the cervical screening programme 81.05% being above the CCG average of 76.67% and comparable with the national average of 81.43%.

Updated 10 March 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 90.91%, compared with the CCG average of 89.69% and the national average of 88.77%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months (01/04/2015 to 31/03/2016) was 94%, compared with the CCG average of 87.06% and the national average of 89.3%.
• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016) was 90.48%, compared with the CCG average of 83.07% and the national average of 83.77%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had completed online training relating to the Mental Capacity Act.

Updated 10 March 2017

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

• The practice held registers of patients living in vulnerable circumstances, including a register of homeless patients and travellers, who could register at the practice address to receive healthcare-related correspondence.
• It maintained a learning disability register of 13 patients, all of whom had received an annual health check.
• Appointments for patients with learning disabilities were 30 minutes long.
• 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.