Chiswick Health Practice

Updated 17 November 2017

The Chiswick Health Practice is located in the London Borough of Hounslow. The practice has been operating within the Chiswick locality since 1978. The practice provides a general practice service to around 7160 patients from a medium sized health centre with two other medical practices, a dental surgery and a community service provider.

The practice area is rated in the third less deprived decile of the Index of Multiple Deprivation (IMD). People living in more deprived areas tend to have a greater need for health services.

According to the practice 63% of their population are of white British or mixed British origin. The practice area is rated in the third least deprived decile of the national Index of Multiple Deprivation (IMD). People living in less deprived areas tend to have a lesser need for health services.

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

The practice has a General Medical Services (GMS) contract and provides a full range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning, sexual health services and minor surgery.

The practice team comprises of four GP partners, three female and one male, working a total of twenty four sessions per week. Additional staff include one newly employed full time practice manager, a full time nurse practitioner, three practice nurses one part time health care assistant, and a team of eight administration staff.

Chiswick Health Practice has been a GP training practice for over six years for S1 and S2 medical students. The practice also supports medical students and in the last 12 months they have taken on the training of physician associates.

The opening hours were 8am to 8pm Monday and Wednesday, 8am -7pm on Tuesday and Friday and 8am to 6:30pm on Thursdays. The practice remained open during the lunch time period 1pm to 3pm. Appointments were available from 8.30am to 1pm each week day morning and from 3pm to 6:30pm on Tuesday and Friday and until 4pm on Thursdays. The out of hours services were provided by an alternative provider. The details of the out-of-hours service were communicated in a recorded message accessed by calling the practice when it was closed and on the practice website.

Updated 17 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chiswick Health Practice on 22 January 2016.The overall rating for the practice was requires improvement; the practice was rated as requires improvement for the safe and effective domains and good for the caring, responsive and well led domains. The full comprehensive report can be found by selecting the Chiswick Health Practice ‘all reports’ link for on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 2 October 2017 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 22 January 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 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 practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with 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 their care and 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 complaints and concerns.
• The majority of patients we spoke with 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 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

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

The provider should:

• Maintain the system introduced for nursing staff to follow up pathology results.

• Review their process of reviewing patients on high risk medicines to ensure that all staff are working in line with practice policy.

• Review and improve the process of identifying carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 November 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was comparable to other practices. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 71% compared to the CCG average of 73% and the national average of 78%. Exception reporting for diabetes was 6% which was below the CCG average of 7% and the national average of 9%.The practice followed up on 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.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check 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.

• In addition the practice were also part of the Hounslow Month of birth pilot programme. The programme had been developed to support the call and recall of patients currently coded with a long term condition.

Updated 17 November 2017

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

• From the sample of documented examples we reviewed we found 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.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for premature babies and their families following discharge from hospital.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The practice supported the BEAT the Street programme that encouraged families with young children to get out and about and the Sugar Smart App that supported families to monitor and reduce their sugar intake.

Updated 17 November 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 urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• The practice supported the use of the One You programme of support groups that include walks, green gyms and gardening and many more activities. The aim was to encourage getting active and socialising, as one of the most common concerns for their elderly patients was social isolation.

Updated 17 November 2017

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

• The needs of these populations 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, extended opening hours and Saturday appointments.

• 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 17 November 2017

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

• 89% 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 thirty -eight patients who were eligible for the screening. The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for mental health related indicators was comparable to other practices. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record in the preceding 12 months was 90% compared to the CCG average of 89% and the national average of 89%. Exception reporting for mental health was 8% which was below the CCG of 8% and national average of 12%.The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 November 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, travellers and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

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

• 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.

• 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.