Archived: Islip Manor Medical Centre

Updated 29 July 2016

Islip Manor Medical Centre is a GP practice situated within the London Borough of Ealing. The practice lies within the administrative boundaries of Ealing Clinical Commissioning Group (CCG) and is a member of the North North Ealing GP network.

The practice provides primary medical services to approximately 3,500 patients living in Northolt and holds a core General Medical Services Contract and Directed Enhanced Services Contracts. The practice is located in Islip Manor Road at the south end of Northolt with good transport links by bus and rail services.

The practice operates from a converted semi-detached house. There is one consultation room on the ground floor of the premises and a treatment room and another consultation on the first floor with stair access. The reception and waiting area are on the ground floor with wheelchair access to the entrance of the building. There are disabled toilet facilities and off site car parking in the surrounding residential areas.

The practice population is ethnically diverse and has a higher than the national average number of patients under 14 years of age and between 30 to 39 years of age. There is a lower than the national average number of patients 55 years plus. The practice area is rated in the fourth more deprived decile of the national Index of Multiple Deprivation (IMD). People living in more deprived areas tend to have greater need for health services.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic & screening procedures, maternity & midwifery services and treatment of disease disorder & I injury.

The practice had undergone significant staffing changes in the preceding six months with the retirement of two GP partners following illness, which had proved challenging with respect to GP capacity. Additionally the practice manager had left three months prior to the inspection and one of the practice nurses had recently returned to work following a period of absence. The practice has recruited two regular locum GPs to augment the clinical team and a temporary part time practice manager has recently been appointed until a permanent replacement is secured.

At the time of inspection there was one GP partner remaining of the three partners registered with CQC. An application is now in progress for the remaining GP partner to be registered with CQC as a sole provider.

The practice team is made up of one male principal GP covering seven clinical sessions per week and one male and one female locum GP each covering one clinical session per week. They are supported by two part time female practice nurses, one working 18 hours per week over a five day period and the other working eight hours one day a week. The nursing team are supported by a healthcare assistant who covers a dual role as a receptionist working in total 30 hours per week. The practice manager works part time on a remote access basis, assisted by four part time reception staff.

The opening hours are 8.00am to 6.30pm Monday, Tuesday, Wednesday and Friday and from 8.00am to 1.30pm on Thursday. GP appointments in the morning are available from 9.30am to 11.50am Monday, Wednesday and Thursday and from 9.00am to 11.50am Tuesday and Friday. GP appointments in the afternoon are available from 4.00pm to 5.50pm Monday, Tuesday, Wednesday and Friday. Extended hours appointments are offered from 6.30pm to 8.00pm every Wednesday for pre booked appointments. The out of hours services are provided by an alternative provider. The details of the out-of-hours service are communicated in a recorded message accessed by calling the practice when it is closed and on the practice website.

The practice provides a wide range of services including chronic disease management and antenatal and postnatal care. The practice also provides health promotion services including, cervical screening, childhood immunisations, contraception and family planning.

The practice has not previously been inspected by CQC.

Updated 29 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Islip Manor Medical Centre on 8 March 2016. Overall the practice is rated as requires improvement.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, documentation of significant events was not thorough and did not include evidence of shared learning.
• Risks to patients were assessed and managed, with the exception of those relating to medicines management, health and safety and management of medical emergencies.
• Data showed patient outcomes were low compared to the national average. Although some CCG led audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• Patients said they felt the practice offered an excellent service and staff were helpful, caring, friendly, considerate and treated them with dignity and respect.
• The practice did not have good facilities and was in need of refurbishment.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice did not have an effective system in place to manage and learn from complaints received.
• The practice had policies and procedures to govern activity, but some of these required review.

The areas where the provider must make improvement are:

• Ensure that the processes for monitoring fridge temperatures are followed in line with national guidance.
• Ensure that risks are effectively assessed, monitored and mitigated across all areas of the practice. Including those for health & safety and not having an automated external (AED) defibrillator for use in a medical emergency.
• Ensure that the need for DBS checks are risk assessed, or DBS checks are completed for all staff required to undertake chaperone duties.
• Implement a system to ensure all locum clinical staff are kept up to date with national guidance and guidelines.
• Ensure an effective system for the recording, management, review and shared learning of all complaints received including those raised verbally.
• Implement a programme of clinical audit including re-audit to demonstrate quality and improvement.

The areas where the provider should make improvement are:

• Improve the process for recording significant events including documentation clarity of shared learning and outcomes.
• Improve the systems in place for the management of blank prescription forms to ensure they meet recommended guidance.
• Ensure clinical staff completes Mental Capacity Act (MCA) training.
• Advertise within the practice the provision of the translation service for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 July 2016

The practice is rated as requires improvement for people with long term conditions. The provider was rated as requires improvement for safe, effective, responsive and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice offered GP and nurse-led review of chronic disease management. They maintained registers of patients with long-term conditions and alerts on their electronic records prompted clinical staff to invite them for health checks.

• Quality and Outcomes Framework data from 2014/2015 showed the practice was performing below the CCG and national averages for indicators related to chronic disease, such as diabetes and hypertension.

• The practice used risk stratification tools to identify patients with long-term conditions at high risk of hospital admission, however they were not proactively inviting these patients for review to create integrated care plans aimed at reducing this risk.

• There was limited evidence that the practice worked with the multi-disciplinary team to support patients with complex medical needs. The practice did not hold regular multi-disciplinary team meetings, however we were told twice monthly meetings with the district nurse team were due to recommence in the coming month.

• The principal GP attended bi-monthly CCG led multi-disciplinary group meetings with local GP practices and community services that provided the opportunity to discuss complex cases and share advice on management.

• Home visits were available for patients unable to attend the practice due to illness or immobility.

• The practice had purchased a spirometer and were in the process of training staff to use this in order to screen smokers opportunistically, for Chronic Obstructive Pulmonary Disease (COPD).

Updated 29 July 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safe, effective, responsive and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The principal GP was the lead for safeguarding children and staff had received role appropriate training and were aware of their responsibilities to raise concerns. There was a system to highlight vulnerable children on electronic records and cases were discussed with the health visitor team as required.

• The practice offered GP led shared ante-natal and post-natal care including six week mother and baby checks.

• Childhood immunisations were offered in line with national guidance and uptake rates were at or above the CCG average.

• Same day appointments were available for un-well children and appointments after school hours were made available.

• Contraceptive and family planning advice was available as required.

• Cervical screening uptake was above the CCG average.

Updated 29 July 2016

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for safe, effective, responsive and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Older patients at high risk of hospital admission were identified using risk stratification tools and alerts were placed on their electronic records. At the time of inspection the practice were not using this information to create formal integrated care plans aimed at reducing avoidable hospital admissions, however we were told this would be completed over the next year.

• The practice offered same-day telephone consultations or urgent appointments to at risk patients.

• Home visits were available for patients unable to attend the practice due to illness or immobility.

• There was some evidence that the practice worked with the multi-disciplinary team to support older patients with complex medical needs. Face to face meetings with the district nurse had not taken place over the previous four months due to time constraints, but we were told these were due to recommence in the coming month.

• The principal GP attended bi-monthly CCG led multi-disciplinary group meetings with local GP practices and community services that provided the opportunity to discuss complex cases and share advice on management.

• The practice offered flu and shingle immunisations to older patients in line with national guidance.

Updated 29 July 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safe, effective, responsive and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Extended hour surgeries were offered once a week for patients unable to attend the practice during normal working hours.

• There was the facility to book appointments and request repeat prescriptions online.

• The practice offered NHS health checks for patients aged 40–74 with appropriate follow-ups for any abnormalities or risk factors identified.

• The practice offered certain travel vaccinations as required and directed patients to other services for any vaccinations not performed.

Updated 29 July 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as requires improvement for safe, effective, responsive and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• QOF data from 2014/2015 for performance mental health related indicators were at or above the national average.

• The practice maintained a register of patients experiencing poor mental health and they were invited for annual health checks.

• Opportunistic dementia screening was performed in patients at risk or those with concerns about their memory, with referral to local memory services if appropriate.

• The practice opportunistically screened for depression in patients with concerns or those at risk. Referrals were made to local counselling services if required.

• There was information displayed in the waiting area offering advice on wellbeing, managing stress and signposting to local mental health support services.

Updated 29 July 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safe, effective, responsive and well led services. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The principal GP was the lead for safeguarding vulnerable adults and staff had received appropriate training and were aware of their responsibilities to raise concerns. Alerts could be placed on electronic records to highlight concerns, however there was no specific register of vulnerable adults.

• The practice maintained a register of patients with learning disabilities and they were invited for annual health reviews with the nurse and GP. Extended appointment times were available if required.

• Alerts on electronic records highlighted if a patient was a carer and they were offered additional support if required, such as annual flu vaccinations and health checks and referral to local support services.