The Stonebridge Practice

Updated 6 December 2017

The Stonebridge Practice provides primary care services to around 4700 patients living in the surrounding areas of Stonebridge, Harlesden and Wembley in North West London. The practice is part of the Brent Clinical Commissioning Group.

The practice population is characterised by some of the highest levels of income deprivation in England, with higher rates of unemployment and lower average life expectancy. The practice age-sex profile is similar to the English average but is young with a large percentage of patients aged under 55. The population is ethnically diverse.

The practice is led by two GP partners who also employ one salaried GP. The staff team includes a practice nurse (prescriber), two health care assistants one of whom is also phlebotomist, a practice manager, and reception and administrative staff. The GPs typically offer around 16-18 clinical sessions per week. Patients can choose to consult with a male or female GP.

The practice is located in a purpose built health centre and shares the premises with other NHS primary and community health care services. The practice is open every weekday from 8am to 6:30pm. Extended hours 'commuter clinics' also run from 6.30pm to 7.30pm from Monday to Wednesday.

Same day appointments are available for patients with complex or more urgent needs. Walk-in and pre-bookable appointments are also available daily with the practice recently increasing the number of same day appointments that can be booked online. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use the local out-of-hours primary care service or attend the local 'hub' primary care service which runs in the evening and weekends. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on its website and on a recorded telephone message.

The practice provides a wide range of primary care services including minor surgery, child health surveillance, phlebotomy and a travel service (including yellow fever vaccination). The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; maternity and midwifery services; family planning; surgical procedures; and treatment of disease, disorder and injury.

Updated 6 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Stonebridge Practice on 30 October 2017. 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 a system in place for reporting and recording significant events. The provider was aware of the requirements of the duty of candour.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff were trained and had the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of patient feedback.
• The practice performed well on the national GP patient survey on access to the service. Patients reported being able to make and appointment and there was continuity of care, with urgent appointments available the same day.
• The practice had suitable facilities, although the telephone system needed improvement, 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 areas where the practice should make improvement are:

• The practice should continue to improve access to the service, particularly telephone access, so that patients who need to contact the practice are able to do so.
• The practice should develop a programme of clinical audit that reflects practice priorities in addition to CCG-led prescribing work.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 6 December 2017

The practice is rated as good for people with long term conditions.

• There was a system to recall patients with long term conditions for a structured annual review to check their health and medicines needs were being met.
• The practice followed up patients with long term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long term conditions who experienced a sudden deterioration in health.
• The practice proactively identified patients at high risk of hospital admission. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice carried out home visits jointly with other health professionals to coordinate care when appropriate.

Updated 6 December 2017

Families, children and young people

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

• There were systems 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 accident and emergency (A&E) attendances.
• In 2016/17, the practice achieved the 90% immunisation targets for standard childhood immunisations.
• Appointments were available outside of school hours. The premises were suitable for children and babies and the practice had baby changing facilities and could provide a private area for breast feeding.
• The practice worked with midwives, health visitors and school nurses as appropriate to support this population group.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• Practice staff understood the importance of treating children and young people in an age-appropriate way and as individuals.

Updated 6 December 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and priority appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with advice and coordinated support to help them to maintain their health and independence.

Updated 6 December 2017

Working age people (including those recently retired and students)

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

• The needs of working age people 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, the practice opened in the evening up to three days a week.
• The practice had recently adjusted its appointment system and now offered daily consultations on both a pre-bookable and walk-in basis.
• The practice was proactive in offering online services including online appointment booking and an electronic prescription service. Several patients commented that they found the online appointment booking system helpful.
• The practice provided a full range of health promotion and screening services reflecting the needs for this age group, for example cervical screening and the meningitis ACWY vaccination for older teenagers and students.
• The practice provided a range of sexual health and contraceptive services and could signpost patients to local community NHS sexual health services available in the same building.
• The practice uptake rate for cervical screening was 81% in 2016/17 which was close to the overall clinical commissioning group (CCG) rate of 76% and the national rate of 81%. The practice exception rate for this indicator was 6% which was in line with the national exception rate of 7%.

Updated 6 December 2017

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

• Patients at risk of dementia were identified and offered a specialist assessment.
• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%. The practice did not report any exceptions for this indicator.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia and offered health checks to these patients.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 91% of patients diagnosed with a psychosis had a comprehensive care plan in their records compared to the national average of 90%. The practice did not report any exceptions for this indicator.
• The practice provided postnatal and baby checks to women admitted to a local mother and baby mental health unit.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice referred patients to a range of local mental health services and support groups depending on their needs, for example counselling services.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 6 December 2017

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

• The practice encouraged all patients to register regardless of circumstances.
• The practice had a relatively high number of patients living in vulnerable circumstances. The practice identified and regularly reviewed these patients.
• The practice offered longer appointments for patients with a learning disability and an annual health check.
• Staff were trained to consider the wider circumstances of vulnerable patients and the impact on other family members and carers.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. The practice referred patients to local voluntary organisations offering social, lifestyle, welfare and legal advice and support.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.