Preston Medical Centre

Updated 21 March 2018

Preston Medical Centre provides primary medical services in Wembley to approximately 3600 patients and is one of 66 practices contracted to Brent Clinical Commissioning Group (CCG). The practice provides NHS services through a General Medical Services (GMS) contract and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The clinical team at the surgery is made up of two male GPs who are partners and two female salaried GPs who provide a combination of 22 sessions. The non-clinical practice team consists of a practice manager and three administrative and reception staff members.

The practice reception and telephone lines are open from 8:00am to 6:30pm Monday to Friday. Appointments are available from 9:00am to 12:00pm Monday to Friday and from 4:00pm to 6:10pm Monday to Friday except Thursday. Extended hours surgeries are offered on Mondays from 6:30pm to 8:00pm. The practice patients have access to a local GP hub which offers appointments from 6:00pm to 9:00pm Mondays to Fridays and from 9:00am to 3:00pm on Saturdays and Sundays. The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8:00am and directs patients to the OOH provider for Brent CCG.

The patient profile for the practice indicates a population of a higher than average working age and older people.

Preston Medical Centre was inspected under our methodology on 16 November 2016 and they were rated Good overall, meeting all the standards inspected. The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services, surgical procedures and treatment of disease, disorder, or injury.

Updated 21 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Preston Medical Centre on 16 November 2016. The overall rating for the practice was Good, with a rating of Requires Improvement in the Safe domain. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Preston Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 25 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 November 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection..

Overall, the practice is now rated as Good.

Our key findings were as follows:

• The practice had taken significant steps to ensure that they met infection control standards as per recommendations from the infection control audit and findings at our previous inspection.
• Comprehensive infection control audits were now being carried out in conjunction with the designated infection control nurse.
• The practice had carried out a Control of Substances Hazardous to Health (COSHH) risk assessment.
• Disclosure and Barring Service (DBS) checks had been carried out on newly employed staff and non-clinical staff who undertook chaperoning duties.
• Patient identifiable information was securely stored and staff had signed confidentiality agreements and had undertaken information governance training.
• The practice had installed a pull cord in the disabled toilet for patients to call for assistance.
• The practice had addressed risk in all areas of the practice and had taken action to address this; for example, they replaced a damaged examination couch and replaced flooring in one of the clinical rooms.
• The practice had installed blind loop cords in the patient toilet.
• The practice had improved the monitoring of patients with diabetes. They carried out a monthly virtual ward round and worked together with the diabetes specialist nurse

However, there were also areas of practice where the provider should make improvements.

Importantly, the provider should:

• Ensure the arrangements for identifying and controlling substances hazardous to health (COSHH) include all hazardous substances in the practice.

• Consider improving communication with patients who have a hearing impairment and review the requirements of Accessible Information Standard (AIS) as per national guidelines.

• Continue to review staffing arrangements to ensure that there is sufficient nursing cover to meet patients’ needs.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 20 March 2017

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

• GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The national Quality and Outcomes Framework (QOF) data showed that 69% of patients had well-controlled diabetes, indicated by specific blood test results, which was below the Clinical Commissioning Group (CCG) average of 76% and the national average of 78%. The number of patients with diabetes who had received a foot examination in the preceding 12 months was 94% which was in line with the CCG average of 90% and above the national average of 89%. The practice offered an insulin initiation and titration service.
• The national QOF data showed that 80% of patients with asthma in the register had an annual review, compared to the CCG average of 81% and the national average of 76%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. 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 offered phlebotomy, spirometry, electrocardiography, ambulatory blood pressure monitoring and performed minor surgical procedures which reduced the need for referrals to hospitals.
• The practice was the highest in the local CCG for the screening of patients with tuberculosis; they had a 40% positive rate for the patients screened.

Updated 20 March 2017

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 urgent care and Accident and Emergency (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.
• The practice’s uptake for the cervical screening programme was 74%, which was in line with the Clinical Commissioning Group (CCG) average of 77% and below the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice prioritised appointments for children.
• The patients had access to antenatal and postnatal care provided by GPs.

Updated 20 March 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 urgent appointments for those with enhanced needs. Longer appointments and priority access were available for elderly patients.
• The practice had a named GP for all patients over the age of 75 years.
• The practice provided one stop appointments consisting of GP consultation, long-term condition review, phlebotomy and medication review performed at a single attendance which reduced inconvenience for patients and their carers.
• The practice took part in the ‘Whole Systems Integrated Care Programme’ where the most vulnerable 3% of the patient population had personalised care plans written in partnership with their named GP.
• The practice cared for 10 patients in a local nursing home.

Updated 20 March 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 full range of health promotion and screening that reflects the needs for this age group.
• The practice offered extended hours appointments with GPs which suited working age people.
• The practice patients had access to a local hub service which offered evening and weekend appointments.

Updated 20 March 2017

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

• 94% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was in line with the Clinical Commissioning Group (CCG) average of 91% and national average of 89%.
• 85% of patients with dementia had received an annual review which was in line with the CCG average of 86% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice referred patients experiencing poor mental health to the local mental health service and had told patients about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice offered a depot injection service (antipsychotic medicine) for patients.

Updated 20 March 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, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for vulnerable patients and patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.
• The practice had set up alerts for vulnerable patients on their electronic patient management system.