Archived: Dr Jacqueline Bayer and Dr Jane Livingston Also known as The Surgery

Updated 6 August 2015

102 The Avenue Surgery provides GP primary medical services to approximately 3,000 patients living in the London Borough of Ealing.

Ealing has significant income related inequalities with a high proportion of unemployment and 19.2% of children living in poverty. The practice serves a population of mixed ethnicities and a cross-section of ages.

The practice team is made up of two female GPs, a practice nurse, practice manager, three receptionists, a secretary and an administrator.

Opening hours are between 8.00am - 6:15pm on Mondays, 8:30am - 6:00pm on Tuesdays, 8:30am -8:00pm on Wednesdays, 8:30am - 1:00pm on Thursdays and 8:30am - 5:00pm on Fridays. GP appointments are available between 9:00am - 6:00pm on Mondays, 9:00am - 4:00pm on Tuesdays, 9:00am - 8:00pm on Wednesdays, 9:00am - 11:00am on Thursdays and 9:00am - 4:00pm on Fridays. Telephone access is available during core hours and home visits are provided for patients who are housebound or are too ill to visit the practice. There are telephone consultations available daily. During out of hours care is provided through an out of hours provider and patients are also referred to the ‘111’ service.

The practice has a General Medical Services (GMS) contract (GMS is one of the three contracting routes that have been available to enable the commissioning of primary medical services).

The practice is registered with the Care Quality Commission to provide the regulated activities of

diagnostic and screening procedures, family planning, maternity and midwifery services and treatment of disease, disorder and injury.

The practice provides a range of services including maternity care, family planning, sexual health, chronic disease management, counselling, childhood immunisations and smoking cessation.

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 102 The Avenue Surgery on 20 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be requiring improvement for providing safe services, good for providing effective, caring, and well-led services and outstanding for providing responsive services. It was outstanding for providing services for people whose circumstances make them vulnerable and people experiencing poor mental health. It was good for providing services for older people; people with long term conditions; families, children and young people; working age people (including those recently retired and students) and people experiencing poor mental health.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed in a timely manner.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.

• 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.

We saw two areas of outstanding practice:

• The practice provided a specialised service for homeless people at a local hostel which included a drop-in clinic once a month at the hostel. This catered for residents registered with the practice who declined attendance at the practice or the local hospital. Service provision included treating severely mentally ill patients with complex mental, social and physical problems. The practice also operated an open surgery at the practice each morning between 10am-11am which particularly catered for homeless patients who did not have the resources to telephone the practice for an appointment.

• The practice had an in-house counselling service where patients could access weekly counselling sessions to treat bereavement, depression, anxiety, relationship issues, sexuality orientation and managing long term conditions such as Parkinson’s disease. The GPs worked closely with community psychiatrists to review mental health patients to facilitate better communication regarding patients overall care.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure Disclosure and Barring service (DBS) checks are undertaken for all staff who undertake chaperone duties at the practice or undertake a risk assessment if the decision is made not to perform DBS checks.

The provider should:

• Ensure all staff who undertook chaperone activities were suitably trained.

• Ensure availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

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

The practice kept a register to monitor the health of patients with known long-term health conditions, such as chronic obstructive pulmonary disease, diabetes, asthma, heart disease and hypertension. Longer appointments and home visits were available as required. Patients had a named GP and a structured annual review to check that their health and medication needs were being met. There was a recall system in place with monthly audits to identify patients to attend health check appointments.

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 6 August 2015

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

The practice allocated five appointments each morning at 10am for mothers with small children. The practice provides both antenatal and postnatal care, a baby clinic for new mothers and childhood immunisations. Audits were carried out to regularly check for compliance with the childhood immunisation programme. All staff were trained in safeguarding children and were aware of the procedures to follow if they were concerned about a child’s wellbeing and welfare.

Cervical smear tests were provided for women between the ages of 24-65 and there was a recall system in place. Educational material was available for patients regarding sexual health clinics and contraception. All young patients who registered with the practice are advised about genital examinations and the use of alcohol, drugs and smoking.

Updated 6 August 2015

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

We found older patients were treated with dignity and respect. The practice offered proactive, personalised care to meet the needs of the older people in its population. Patients over the age of 75 years had a named GP. The practice offered a home visit service for those patients who were housebound. The practice had undertaken care planning for older patients and their care reviewed appropriately. Care plans for those with complex needs were reviewed monthly and where appropriate, discussed at multi-disciplinary meetings to ensure multi-disciplinary input. Staff were able to recognise the signs of abuse in older patients and they were aware of the procedures to report any concerns. The practice worked with other specialists to provide effective care for older patients including end of life care.

Updated 6 August 2015

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. For example, telephone consultations were available and extended hours offered a wider choice of appointment times.

The practice participated in a catch up programme for students aged 17 and above for the measles, mumps and rubella (MMR) and meningitis C (MEN C) vaccinations.

Repeat dispensing was provided for patients with controlled medical conditions such as hypertension and hypothyroidism in which a six month supply of prescriptions are sent to a chosen pharmacist. The practice also communicated blood pressure readings via email or post where appropriate.

The practice was proactive in offering online information for patients through the use of the practice website, Facebook page and blog however there was no online provision for booking appointments and ordering repeat prescriptions.

Updated 6 August 2015

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

Patients with mental health conditions were provided with a full health check upon registration with the practice. The practice had a dementia register and patients on the register had received annual dementia reviews and medication reviews. Staff had received training in dementia to improve the awareness of the needs of patients with dementia. Dementia screening was carried out during the development of care plans or if staff members alerted GPs to any issues which might indicate the early onset of dementia.

All mental health patients had a three to six month review as appropriate. Care plans were in place for patients with poor mental health and these were reviewed annually. Longer appointments were available for those patients with poor mental health and the practice accommodated patients with acute mental health problems with appointments around midday for longer consultations in a less hectic atmosphere.

The practice used the IAPT (improving access to psychological therapies) service and an IAPT counsellor used one of the practice’s consultation rooms on a weekly basis to provide this service for both patients registered with the practice and other patients registered at GP practices within the GP network.

The practice also had an in-house counsellor who provided weekly counselling sessions for the practice’s patients on Wednesday afternoons and early evening. The counsellor treated patients for bereavement, depression, anxiety, relationship and sexuality issues and some patients with long term conditions such as Parkinson’s disease.

The GPs worked closely with community psychiatrists to review patients to facilitate better communication regarding patients overall care. The practice provided a specialised service for homeless people at a local hostel which included treating severely mentally ill patients with complicated mental, social and physical problems. These patients were closely monitored and where appropriate care plans were developed for them and their care discussed at multi-disciplinary meetings.

Updated 6 August 2015

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

The practice held a register of patients living in vulnerable circumstances including those with a learning disability and homeless people. It had carried out annual health checks for people with a learning disability and 100% of these patients had received a follow-up. GPs used Makaton resources to aid communication with patients with learning disabilities and where appropriate, patients were given a report with pictorial diagrams to take home following their annual review. Longer appointments were offered for people with a learning disability.

The practice provided a specialised service for homeless people at a local hostel. The practice worked closely with community psychiatrists and the hostel warden and to manage residents with complex mental, social and physical problems. Where appropriate, care plans were developed for residents and their treatment discussed at multi-disciplinary group meetings. The GPs provided a drop-in clinic once a month at the hostel which catered for residents who declined attendance at the practice or the local hospital. The practice operated an open surgery between 10am - 11am in which patients were offered appointments on a first come first served basis which catered for vulnerable patients such as homeless persons registered with the practice who were not able to telephone the practice for an appointment.

Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff members were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours.