Dr JI Solomon's Practice

Updated 18 May 2016

Dr JI Solomon's Practice, also known as Queens Walk Medical Centre, provides GP led primary care services through a Primary Medical Services (PMS) contract to around 6,500 patients living in the surrounding areas of Ruislip Manor and South Ruislip. PMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS Hillingdon Clinical Commissioning Group (CCG).

The practice staff comprise of three GP partners (two male, one female); a salaried GP (male); a practice nurse; a practice manager; reception manager; and a team of reception/administrative staff. The practice is a training practice and currently has a GP registrar and a foundation year two doctor working there. The GPs (including the trainees) collectively provide 33 sessions per week. The nurse works 26 hours a week.

The practice is located in a purpose built property with six consulting/treatment rooms on the ground floor. The second floor has a large meeting room and administrative areas. The ground floor of the premises is accessible by wheelchair.

The practice is open from 09:00 to 13:00 every weekday morning, and from 16:00 to 18:30 every weekday afternoon except Wednesday when it closes at 13:00. The phones lines are open from 08:45 to 13:00 every weekday morning, and from 16:00 to 18:15 every weekday afternoon except Wednesday. If patients telephone the practice from 08:00 to 08:45 and 13:00 to 16:00 they are directed to an out-of-hours provider, who would contact the doctor on call in emergency cases. The practice opted out of providing out-of-hours services to their patients. Outside of normal opening hours (18:30 to 08:00) patients are directed to an out-of-hours GP or the NHS 111 service.

Appointments are available from 09:00 to 11:00 every weekday morning, and from 16:00 to 18:00 every afternoon (except Wednesday afternoon). Extended opening hours are available from 18:30 to 19:00 Monday, Tuesday and Thursday evenings for pre-booked appointments only. The telephones are not answered during this time. Appointments can be booked in advance over the telephone, online or in person.

The percentage of patients aged zero to four (7%), aged five to 14 (13%) and under 18 (24%) is similar to the local averages (7%, 12%, 23% respectively) and national averages (6%, 11% and 21% respectively). Patients aged 65+ represent 10% of the practice population, patients aged 75+ represent 4%, and patients aged 85+ represent 1% (local averages are 13%, 6% and 2% respectively; national averages are 17%, 8% and 2% respectively).

The percentage of people with a long standing health condition (44%) is below the local and national averages of 50% and 54%. The average life expectancy for the practice is 81 years for males (CCG average 79, national 79) and 85 years for females (CCG average 84, national 83).

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

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr JI Solomon's Practice, also known as Queens Walk Medical Centre, on 3 March 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.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment.
• 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, although we noted not all staff had received updated training in infection control.
• 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 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.

The areas where the provider should make improvements are:

• Ensure all staff have received appropriate training for safeguarding and infection prevention and control.

• Check all electrical equipment to ensure it is safe to use.

• Update the induction process to include the practice’s mandatory training schedule.

• Demonstrate an ongoing audit programme where continuous improvements to patient care have been made.
• Ensure the practice actively identifies and supports patients who are also carers.
• Advertise that translation services are available to patients on request.
• Keep patients and the patient participation group updated on changes made in response to feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 May 2016

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

• The percentage of patients at the practice with a long standing health condition (44%) was lower than the national average (54%).
• The GP partners and nurse had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority and discussed at clinical and multidisciplinary team meetings.
• Nationally reported data showed that outcomes for patients with long term conditions were good.
• All these patients had a named GP and a structured annual review to check that 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.
• Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions. For example, to the rapid response team, community matron, district nurses, or heart failure nurses.
• Longer appointments and home visits were available when needed.

Updated 18 May 2016

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

• The percentage of patients aged zero to four (7%), aged five to 14 (13%) and under 18 (24%) was similar to national averages (6%, 11% and 21% respectively).
• 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 were invited for an appointment.
• Urgent access appointments were available for children who were unwell.
• 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 we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered shared antenatal and postnatal services. There was joint working with midwives and health visitors.

Updated 18 May 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 percentage of older patients registered at the practice was lower than national averages. Patients over the age of 75 represented 4% (national average 8%), and patients over the age of 85 represented 1% (national average 2%).
• All patients over the age of 75 had a named GP who was responsible for their care.
• The practice offered a range of enhanced services which included the shingles and flu vaccinations, and avoiding unplanned admissions to hospital.
• The practice was responsive to the needs of older people, and offered longer appointments, home visits and urgent appointments for those with enhanced needs.
• The practice was involved in a local initiative designed to improve the coordination of care for patients over 75 years. This involved patient risk stratification, proactive care planning, case management in multidisciplinary groups, and improved sharing of medical information between service providers.
• Monthly multidisciplinary team meetings were used to review care plans and discuss those with enhanced needs.
• The practice was part of a local integrated care programme to improve services for vulnerable adults over the age of 65, who required GP care over the weekend.
• Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions. For example, to the primary care navigator, social services, and occupational therapy.

Updated 18 May 2016

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

• The number of patients in paid work or full-time education was higher than the national average, 73% compared to 62%.
• 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 had a website and facilities to book appointments and order repeat prescriptions online.
• Telephone consultations were offered for patients who could not attend the practice. Late appointments were available from 18:30 to 19:00 on Monday, Tuesday and Thursday evenings. These appointments were prioritised for working patients.
• There was a range of health promotion and screening that reflected the needs for this age group, including NHS health checks for patients aged 40 to 74.
• The practice’s uptake for the cervical screening programme was 85 %, which was above the CCG average of 78% and national average of 82%.
• Young people were offered chlamydia screening, and we were told the practice had the highest uptake in the locality.

Updated 18 May 2016

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

• 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. Data from 2014/15 showed 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Patients could also be referred to an in-house counsellor who attended the practice every week.
• Staff had a good understanding of how to support patients with mental health needs, including during times of crisis.

Updated 18 May 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 housebound patients, carers, those with a learning disability, and patients receiving end of life care.
• Housebound patients and those who could not access the practice were supported via home visits.
• 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.