Archived: Fortune Green Road Surgery

Updated 28 April 2017

Fortune Green Road Surgery is based at 80 Fortune Green Road, London, NW6 1DS and provides GP services under a General Medical Services contract. The surgery has limited parking behind the building and is situated on a main road served by several local bus routes. There is step-free access from the street to all waiting areas and clinical rooms.

Fortune Green Road Surgery is one of a number of GP practices commissioned by Camden clinical commissioning group (CCG). It has a practice list of 2902 registered patients. The practice is in the fourth least deprived decile out of 10 on the national deprivation scale. The practice has a higher percentage of unemployed patients (18%) compared to the local average of 7% and national average of 5% and 50% of the practice list is between 15 and 44 years old.

The clinical team includes a female principle GP, a male sessional GP, a locum practice nurse and a healthcare assistant. The clinical team offers 19 sessions per week. The practice is led by a practice manager and and the non-clinical team includes a team of three administrators and receptionists.

The practice is open during the following hours:

Monday 9am to 1pm and 4.30pm to 6.30pm

Tuesday 9am to 1pm and 3pm to 6.30pm

Wednesday 9am to 4.30pm

Thursday 9am to 1pm

Friday 9am to 1pm and 3pm to 6.30pm

Appointments are available during the following hours:

Monday 9am to 12pm and 4.30pm to 6pm

Tuesday 9am to 12pm and 4.30pm to 6pm

Wednesday 9am to 12pm and 1pm to 2pm

Thursday 9am to 1pm

Friday 9am to 12pm and 4.30pm to 6pm

Out of these hours, cover is provided by a local GP federation and the NHS 111 service.

We had not previously carried out an inspection at this practice.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fortune Green Road Surgery on 20 January 2017. Overall the practice is rated as good.

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

• Staff used an effective system to report and investigate significant events and the working culture encouraged openness and honesty to identify areas for improvement.
• Risks to patients were assessed and well managed, including through medicines management and safeguarding processes.
• 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.
• There was evidence of multidisciplinary working to meet the complex needs of patients, including vulnerable young people and those who received palliative care.
• Patients provided positive feedback about the caring nature of staff and said they took the time to listen to their concerns. We saw staff treated people with compassion, dignity and respect and involved them in care planning 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 that walked in without an appointment were seen on the same day. The practice operated a policy that no patient would be turned away without being seen.
• 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.

The areas where the provider should make improvement are:

• Ensure a system is in place to monitor the training updates, clinical competencies and clinical supervision of locum staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

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

• The clinical team shared responsibility for chronic disease management depending on their expertise and patients at risk of hospital admission were identified as a priority.
• A practice nurse contacted patients who attended hospital unexpectedly to support them in managing their condition.
• Performance for diabetes related indicators was better than the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 83% compared to the CCG average of 76% and the national average of 78%.
• The percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 84% compared with the CCG average of 82% and national average of 80%.
• Longer appointments and home visits were available when needed.
• 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, a named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 April 2017

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

• There were systems in place to identify and support children living in disadvantaged circumstances. This included those who were at risk such as children and young people who had a high number of emergency hospital attendances.
• Immunisation rates were variable high for standard childhood immunisations and the practice was proactive in offering vaccinations both in line with NHS England guidance and for individualised needs, including the meningitis ACWY and hepatitis B vaccinations.
• The practice’s uptake for the cervical screening programme was 71%, which was comparable to the CCG average of 72% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Prenatal and postnatal appointments were available and the principle GP had a lead role in child protection to address the shortage of local health visitors.
• The practice team worked closely with social services and collaborated with other services to conduct network checks in urgent situations.
• Staff offered support, guidance and rapid referrals for patients who disclosed domestic violence or where there was evidence of female genital mutilation.

Updated 28 April 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, and offered home visits and same-day appointments for those with enhanced needs.
• The practice invited all patients over 75 years to attend an annual health check, which included a blood test and medicine review.
• The practice offered immediate referrals to the complex care team and rapid response team.
• Older patients who were also vulnerable had a care plan in place to manage complex care.

Updated 28 April 2017

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 range of health promotion and screening that reflected the needs of this age group, including electronic prescribing and same-day online appointment booking.
• Travel advice and vaccinations was available.
• The practice offered extended hours to support those could not attend appointments during standard working hours.
• The practice offered a Wednesday afternoon service so patients could use their lunch break to collect prescriptions

Updated 28 April 2017

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was significantly better than the national average of 84%. The practice had exception reported 0% compared to the national average of 7%.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had a designated dementia support lead who was responsible for overseeing the treatment of all diagnosed patients.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health 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.
• A GP partner had a special interest in psychology and provided additional specialist services for this patient population group, including in relation to depression, anxiety and substance use.
• A psychologist from the Camden Team around the Practice (‘TAP’) service was available on site two days per week.This enabled GPs to discuss patient need together and reduce the time taken for referrals and joint appointments.
• Clinical staff used a national dementia toolkit to identify the early signs of dementia and provide proactive care planning and memory assessment.

Updated 28 April 2017

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, those over 75 years of age living alone and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability as well as an annual health check.
• 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.
• Patients who were considered vulnerable were given same day priority appointments.