Dr Jezierski & Partners

Updated 2 September 2016

The practice is in The London Borough of Richmond Upon Thames, the building is situated in an area shared with the public library. At the rear of the practice is a small public car park that can be used by patients. The practice is located on the ground floor and first floor of a building which is a purpose built health centre and is shared with another GP practice and other services provided within the NHS. There are six consulting rooms and a room for baby consultations. Access to the surgery is via the main front entrance of the building on level flooring with automatic doors for wheelchair access. There is also lift access to the first floor.

The service is registered with the Care Quality Commission to provide regulated activities of; diagnostics and screening services, treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and family planning.

Four GP partners (two female and two male) run the practice. The partners are supported by; three salaried GP’s, two nurses, one healthcare assistant (HCA), one practice manager and reception staff.

The GP’s collectively provided 44 clinical sessions a week.

The practice is open between 8:00am – 6:30pm, Monday – Friday. Appointments are available from, 8:00am – 6:30pm. Extended surgery hours are offered from 6:30pm – 7:00pm Monday - Tuesday and 8:30am-10:30am on Saturdays. When the practice is, closed patients can call NHS 111 in an emergency or a local out of hour’s service.

The practice has a patient list size of approximately 9,368 patients. The practice is situated in an area, which is classified as the ninth least deprived decile. The majority of the patients within the practice are either young or of working age. A small percentage of patients are aged between 65 and 85.

Updated 2 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jezierski & Partners on 12 April 2016. 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.
• 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 services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.
• The provider was aware of and complied with the requirements of the duty of candour.

• Risks to patients were assessed and well managed, except that one medical equipment had not been calibrated in the last twelve months as required.

The area where the provider should make an improvement is to:

• Ensure that all medical equipment used at the practice is calibrated at regular intervals, in accordance with the practice policy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 2 September 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 71% of patients diagnosed with asthma had an asthma review in the last 12 months; this was comparable to the local average of 74% and national average of 75%.The exception reporting rate was 24%.

• Performance for diabetes related indicators was comparable to the local and national average, for instance:

• 78% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 77%, national average 77%). The exception reporting rate was 6% (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• 77% of patients with diabetes on the register had their cholesterol measured as well controlled (local average 79%, national average 81%). The exception reporting rate was 12%.
• 90% of patients with diabetes on the register had a recorded foot examination and risk classification (local average 91%, national average 88%). The exception reporting rate was 6%.

• Longer appointments, 15minutes were offered to all patients.

• Home visits were available for patients.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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 2 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. Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• 92% of women aged 25-64 had it recorded on their notes that a cervical screening test has been performed in the preceding five years; this was higher than the local average of 84% and national average of 82%. The exception reporting rate was 16%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.For example, the practice organised monthly meetings to discuss issues relating to children at risk.

Updated 2 September 2016

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, and offered home visits and urgent appointments for those with enhanced needs.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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 2 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 offered extended opening hours on Monday and Tuesday evenings and Saturday mornings.

Updated 2 September 2016

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

• Performance for mental health related indicators was comparable to the local and national average:

• 98% of patients diagnosed with dementia had a recorded review in a face to face meeting in the last 12 months (local average 86%, national average 84%).The exception reporting rate was 15%.

• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 92%, national average 90%).The exception reporting rate was 9%.

• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months (local average 93%, national average 88%).The exception reporting rate was 16%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 2 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, travellers and those with a learning disability.

• The practice was piloting the Rapid Access Team (RAT), a mobile GP service working alongside the dedicated multidisciplinary community team, which offered a rapid assessment of, and rapid treatment for, acutely unwell housebound patients.

• The practice offered longer appointments for patients with a learning disability.

  The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.