The Doctor Hickey Surgery

Updated 6 October 2022

The Doctor Hickey Surgery is located in Westminster, London at:

The Cardinal Hume Centre

3-7 Arneway Street

Westminster

London

SW1P 2BG

The Doctor Hickey Surgery provides GP primary care services to approximately 2,200 homeless people in Westminster. The practice is staffed by four GP partners, three male and one female who work a combination of full and part-time hours. The practice employs two nurses (an advanced nurse practitioner and a clinical nurse specialist), a practice manager, a health care assistant, three administrative staff and cleaners. Attached staff include a clinical pharmacist, social prescriber, counsellors and a specialist hepatology nurse.

The practice holds a Personal Medical Services (PMS) contract and is commissioned by NHSE London. 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; surgical procedures; family planning; and maternity and midwifery services.

The practice opening hours are 9.30am to 4pm on Monday, Tuesday, Thursday and Friday and 9.30am to 12.30pm on Wednesday. The practice additionally undertakes out-reach visits to hostels and street homeless people at other times including evenings.

The practice offers a mix of bookable and walk-in appointments including telephone and face to face consultations. The ‘out of hours’ services are provided by an alternative provider and extended hours primary care appointments are available at other primary care locations in Westminster.

The practice is situated within the North West London Integrated Care System. The practice is part of a wider network of GP practices

Available published demographic information relates to the local residential population. The practice population is transient, predominantly male and predominantly working age with extremely high levels of unmet health need. A significant proportion of patients were born outside the UK and do not speak English fluently. The practice provides a wide range of medical services for homeless people and has an expertise in the primary care management of substance misuse, alcohol abuse and chronic severe mental illness. The Doctor Hickey Surgery has been providing services to homeless people in Westminster for over thirty years.

Updated 6 October 2022

We carried out an announced comprehensive inspection) at The Doctor Hickey Surgery from 26-28 July 2022. Overall, the practice is rated as outstanding.

Safe - good

Effective - good

Caring - outstanding

Responsive - outstanding

Well-led - outstanding

Following our previous inspection on 2 October 2018, the practice was rated outstanding overall and for the caring, responsive and well-led key questions. The practice was rated as good for providing safe and effective services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Doctor Hickey Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities. This was a comprehensive inspection covering all key questions.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.
• Socially distanced interviews with patients during the site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Patients were respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.
• The service was delivered in a way to ensure flexibility, choice and continuity of care.
• The practice worked with other agencies to provide effective care to patients wherever they were located and understood and worked to address the barriers to access faced by homeless patients.
• There were innovative approaches to providing integrated person-centred pathways of care, particularly for people with multiple and complex needs.
• The leaders inspired staff to provide patients with the highest quality, evidence-based, multidisciplinary primary care.
• The practice demonstrably acted on its vision, goals and values, including tackling the health inequalities and exclusion experienced by homeless people.
• The practice had designed the organisation of clinical care to provide a holistic service to patients with complex needs.
• There was strong collaboration across the team and with external stakeholders to tailor the service to individual needs.
• Staff at all levels expressed an enthusiasm and joy for their work.
• There were opportunities for staff to develop specialist knowledge and skills.
• There was a focus on learning, evaluation and impact and a willingness to try new ideas for the benefit of patients. Relevant results were shared widely, for example, through research meetings and publications.

Whilst we found no breaches of regulations, the provider should:

• Take action to improve patient participation in cancer screening programmes in line with any emerging evidence on the effective engagement of homeless patients in these types of programmes.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services