Archived: Cavendish Health Centre

Updated 3 March 2016

Cavendish Health Centre provides GP primary care services to approximately 5,500 people living in Westminster. The practice is staffed by three partners and two salaried GPs, one male and four female who work a combination of full and part time hours. The practice is a training practice and employs three trainee GPs. Other staff included three nurses, a health care assistant, a practice manager and seven administrative staff. The practice holds a Personal Medical Services (PMS) contract and was 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 practices is open from 9.00am to 8.30pm Mondays and Fridays, 8.30am to 8pm on Wednesdays, but were closed for lunch between 12.30pm and 1.30pm. They open 9am to 6.30pm on Tuesdays and 9am to 8.30pm on Thursday, which was particularly useful to patients with work commitments. The telephones were staffed throughout working hours. Appointment slots were available throughout the opening hours. The out of hours services are provided by an alternative provider. The details of the ‘out of hours’ service are communicated in a recorded message accessed by calling the practice when closed and details can also be found on the practice website. Patients can book appointments and order repeat prescriptions online.

The practice provided a wide range of services including clinics for diabetes, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provided health promotion services including a flu vaccination programme and cervical screening.

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cavendish Health centre on 12 November 2015. 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 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.
• 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.
• 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.

We saw some areas of outstanding practice including:

• The practice held a Resilience away day which focussed staff on the ability to recover from setbacks, adapt well to change, and keep going in the face of adversity .

• The practice has a Health Advisor for the Elderly (HAFE) who is a highly qualified senior nurse. This is a practice-funded role.Their role is to look after the practice’s over 75’s. They undertook annual health and social care assessments and home visits as well as advice over the phone. They also liaised with social services and signposted patients to other health, social and voluntary services such as befriending. They provided anticipatory care and helped prevent hospital admissions by keeping patients well at home for longer. Patients are able to contact them directly

• The practice had led on a project to improve the use of a clinical records system so that information was entered and coded in a systematic and uniform way that allowed the user to see the key information about patients at a glance. They had created a screen cast which was shared with other local practices who had fed back to the CCG that they had found it very useful.

• Email consultations were provided as the practice was involved in the initial pilot with two other practices. Learning from the pilot has been disseminated to local practices as a report. 199 face to face consultations were saved. This was embedded securely within SystmOne (our GP records) to ensure secure information governance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

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

• The practice had clinical leads for a variety of long term conditions including diabetes and chronic obstructive pulmonary disease.

• The practice held registers for patients in receipt of palliative care, had complex needs or had long term conditions. GPs attended regular internal as well as multidisciplinary meetings with district nurses, social workers and palliative care nurses and consultants on occasions, to discuss patients and their family’s care and support needs.

• Patients in these groups had a care plan and would be allocated longer appointment times when needed. They were reviewed every six months and we saw where results were outside the normal range appropriate action was taken.

• Services such as spirometry, smoking cessation and phlebotomy are also provided by the practice. Virtual diabetes clinics were held monthly with the local diabetes nurse.

Updated 3 March 2016

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

• The practice took part in a mother and baby monthly Paediatric Hub Clinic in partnership with other GP practices and consultant paediatricians from the local hospital. We were told the clinic had proved successful in reducing the number of referrals to secondary care and had allowed patients to see a consultant quickly within the community.

• The practice ran a weekly mother and baby and baby immunisation clinics which provided an opportunity for mothers to express any concerns to the GP or nurse that they may have.

• The nurse told us they liaise regularly with health visitor who also attended Multi-Disciplinary Team Meetings.

• The practice offered appointments on the day for all children under 5’s when their parent requests the child to be seen for urgent medical matters.

• The GPs demonstrated an understanding of Gillick competency and told us they promote sexual health screening.

Updated 3 March 2016

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

• Patients over 75 years had a named GP to co-ordinate their care. The practice was part of the whole systems integrated care (WSIC) project and ran WSIC clinics for over 75s which were attended by GPs, district nurses and social services care coordinators.

• The practice has a Health Advisor for the Elderly (HAFE) who is a highly qualified senior nurse. This is a practice-funded role. Their role is to look after the practices over 75’s. They undertook annual health and social care assessments and home visits as well as advice over the phone. They also liaised with social services and signposts patients to other health, social and voluntary services eg befriending. They provided anticipatory care and helped prevent hospital admissions by keeping patients well at home for longer. Patients are able to contact them directly.

• A Primary Care Navigator was based at the practice two days a week, to support older patients and their carers to access timely care and community support. Their role included befriending, attending patients’ homes, liaising with social services and acting as advocates.

• The practice participated in the avoiding unplanned admissions Direct Enhanced Service (DES). Data confirmed all unplanned care areas (A&E, Non-elective admissions, Walk in Centre, Urgent Care Centre), had decreased in 2015 compared to 2014.

Updated 3 March 2016

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

• The practice ran evening clinics twice a week which they told us was particularly popular with their working age patients. They offered on-line services which included appointment management, viewing patient records, repeat prescriptions and registration.

• Email consultations were also provided as the practice was involved in the initial pilot with two other practices. Learning from the pilot has been disseminated to local practices as a report. 199 face to face consultations were saved. This was embedded securely within SystmOne (our GP records) to ensure maximum information governance.

• They provided Skype consultations twice weekly. The practice set up Skype pilot within the CCG and Learning from pilot was disseminated to local practices via educational meeting and a written report.

• LARC (Long acting reversible contraception) was available on site which reduced the number of medical/nursing appointments that working age women needed to attend regarding contraception.

• The practice also allowed out of area registrations for people who worked in the area.

Updated 3 March 2016

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

• The practice employed a psychologist whose role included supporting patients with mental illness. - These patients had clear treatment plans and we saw data that evidenced of the 17 patient who had completed treatment in October 2015, 14 had improved. The psychologist also provided telephone counselling and supported trainee psychologists on placement at the practice.

• There was also had a primary care liaison nurse for mental health based at the practice half a day a week. Their role was to support patients with mental illness transition from secondary care to primary care to ensure a safe discharge process. They would also see patients referred to them from the practice. We saw they would refer patients to Improving Access to Psychological Therapies (IAPT), support patients themselves or refer directly to the acute brief assessment team in the local hospital. Where appropriate, longer appointments were offered.

• Patients experiencing poor mental health were invited to attend annual physical health checks and 80% had been reviewed in the past year. They also took part in the shared care Direct Enhanced Services (DES) and had quarterly meetings to discuss these patients and address any concerns.

• There was a dementia lead for and the practice who was also the lead for the CCG. They carried out advanced care planning for patients with dementia and had achieved 100% of the latest QOF points. We saw the practice had carried out an environmental dementia friendly audit and had scored 92% for ‘t he environment encourages active engagement of people with dementia in their care’. Dementia friendly training had been arranged for all staff at the practice.

Updated 3 March 2016

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

• The GPs told us that patients whose circumstances may make them vulnerable such as the homeless, those under safeguarding or people with learning disabilities were offered regular health checks and follow-up.

• They offered longer appointments for patients with a learning disability.

• The practice care navigator informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.