St Margaret's Medical Practice

Updated 16 November 2017

St Margaret’s Medical Practice provides primary medical services in Hounslow to approximately 9,500 patients and is one of 54 practices in Hounslow Clinical Commissioning Group (CCG).

The practice population is in the third least deprived decile in England. The practice population has a lower than CCG average representation of income deprived children and older people. The practice population by age is comparable to national averages but has a smaller proportion of people aged 24-34 than the CCG average. Of patients registered with the practice, the largest group by ethnicity are White (75.4%), followed by Asian (13.7%), black (4.3%), mixed (4.2%) and other non-white ethnic groups (2.4%).

The practice operates from a converted residential premises over three floors. The practice had recently completed building work to provide a further consulting room on the ground floor and an extended administrative area. The practice has two GP consulting rooms, one nurse consulting room, and one multi-use consulting room on the ground floor, and five consulting rooms and one treatment room on the first floor; the second floor is used as an administrative area. The practice team at the surgery is made up of three full time male GPs who are partners; two full time female salaried GPs; and two female registrars (one full time, one part time). In total the practice provides 48 GP sessions per week. The practice has a full time nurse, a part time long-term locum nurse, and a healthcare assistant/phlebotomist. The practice team also consists of a practice manager, reception manager, secretary, six receptionists, and an apprentice receptionist.

The practice operates under a Personal Medical Services (PMS) 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 practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 12.30pm every morning apart from Tuesdays when appointments start at 9am, and 3.30pm to 6pm every afternoon. Extended hours surgeries are offered between 6.30pm and 7.30pm on Mondays, between 7am and 8am on Wednesdays, between 7.30am and 8am on Thursdays.

When the practice is closed patients are directed to the local out-of-hours service.

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

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of St Margaret’s Medical Practice on 27 January 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breaches of regulation 12 (Safe care and treatment), 13 (Safeguarding services users from abuse and improper treatment), 17 (Good governance), and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook an unannounced focussed inspection on 10 October 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. During this inspection we found that some areas had been addressed but that some actions had not yet been put in place; we also found some further areas of concern, which required further investigation. Therefore, the decision was made to extend the focussed inspection to a full comprehensive inspection, and we returned to the practice for an announced visit on 1 November 2016 in order to consider the areas which had not been covered during the focussed inspection and to look in further detail into the further areas of concern we had noted.

Following the further inspections, the practice submitted an action plan, outlining the further actions that they would carry-out to address the additional issues identified. On 23 August 2017 we contacted the practice and asked them to send us evidence that they had followed their action plan, in order for us to undertake a focussed desk-based inspection. This information was received on 25 September 2017. This report covers our findings from the desk-based inspection of 25 September 2017. You can read the reports from the previous inspections by selecting the ‘all reports’ link for St Margaret’s Medical Practice on our website at www.cqc.org.uk.

Overall the practice was rated as requires improvement following the initial comprehensive inspection on 27 January 2016. They were rated as requires improvement for providing safe and effective services and for being well led. Following the re- inspection in October & November 2016 we rated the practice as good overall. We rated them as requires improvement for providing a safe service and good for providing an effective service and for being well led. The inspection of 25 September 2017 looked only at the safe domain and rated this as good.

Our key findings were as follows:

• The practice had been pro-active in identifying patients with caring responsibilities, in order to provide these patients with additional support. Since the last inspection in October and November 2016, the practice had begun using a carers’ template which helped staff to record all relevant details about patients with caring responsibilities on the practice’s patient database. They had also started to ask patients whether they were a carer when they registered with the practice, and provided a box in reception where patients could leave their details to identify themselves as a carer. As a result of these measures, the practice had increased the number of carers from 19 to 80 (0.8% of the patient population).
• During the previous inspection in October and November 2016 we found that the practice had failed to ensure that a complete and contemporaneous record was kept in respect of each service user. The practice was aware of performance issues in this area in respect of one member of staff, which were being addressed externally; however, in the meantime they had failed to put measures in place to assure themselves that patients were not being put at risk as a result of this. When we re-inspected in September 2017, we were shown evidence of the systems put in place to support the member of staff and monitor and review their patient consultation notes which demonstrated improvements.
• During the previous inspection we found that two members of staff had received training to be repeat prescribing clerks, but that written guidance was not in place. When we re-inspected we found that the practice’s prescribing policy had been updated to include guidance for administrative staff.
• Data showed patient outcomes were below the local and national average in some areas; however, results from the Quality Outcomes Framework showed the practice’s performance had improved during the 2015/16 reporting year compared to the previous year, and the practice had introduced measures to further improve during the current reporting year.

The areas where the provider should make improvement are:

• They should continue to pro-actively identify patients with caring responsibilities in order to ensure that these patients receive the support they need.
• They should continue to monitor and improve their performance in relation to patient outcomes.

Professor Steve Field CBE FRCP FFPH FRCGPChief

Inspector of General Practice

Updated 27 March 2017

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. In order to address areas where the practice’s performance in managing patients with long-term conditions had been below average, they had appointed a second nurse on a long-term locum basis who had responsibilities relating to monitoring these patients.

• The practice’s overall performance in relation to long-term conditions was below the CCG and national averages in some areas; however results from the Quality Outcomes Framework showed the practice’s performance had improved during the 2015/16 reporting year (compared to the previous year), and the practice had introduced measures to further improve during the current reporting year.

• Longer appointments and home visits were available when needed.

Updated 27 March 2017

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

• Immunisation rates were comparable to the CCG average 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.

• The percentage of women aged 25-64 at the practice who had received cervical screening in the past 5 years was 75%, which was below the national average of 82%.

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

• We saw evidence that the practice regularly met with midwives and health visitors.

Updated 27 March 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were below CCG and national averages. For example, 74% of patients with hypertension were recorded as having well controlled blood pressure, compared to a CCG average of 82% and national average of 83%.

• Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

Updated 27 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.

• Early morning and evening appointments were available so that patients could attend before or after work.

• 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.

Updated 27 March 2017

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

• During the 2015/16 reporting year, 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting, which was comparable to local and national averages and showed an improvement compared to the previous year when the practice achieved 72% for this indicator. However, the practice's overall exception reporting rate for dementia indicators was 49% compared to a CCG average of 26% and national average of 21%.

• During the 2015/16 reporting year, 91% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting, which was better than local and national averages and showed an improvement compared to the previous year when the practice achieved 82% for this indicator. However, the practice's overall achievement for mental health indicators was below average at 80% compared to a CCG average of 91% and national average of 93%.

• We were told by carers that the practice involved them in the care planning for patients with dementia, and we saw evidence that care plans were in place for these patients and saved to the patient records system.

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

Updated 27 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 those with a learning disability.

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

• The practice held regular multi-disciplinary team meetings in order to ensure effective 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 and documentation of safeguarding concerns. A safeguarding policy was in place which listed contact information for relevant agencies, and this was available to all staff on the practice’s computer system.