Archived: GP at Hand Also known as Dr Jefferies & Partners, Lillie Road

Updated 9 March 2018

GP at Hand (previously named Dr Jefferies and Partners) is located at The Medical Centre, 139 Lillie Road in the London Borough of Hammersmith & Fulham. The practice lies within the administrative boundaries of NHS Hammersmith & Fulham Clinical Commissioning Group (CCG) area and is a member of the GP locality Southern Network. The current CQC registered provider Dr Jefferies and Partners also provides primary medical services from a neighbouring GP practice at 292 Munster Road and operate a centralised call centre at adjacent premises for processing telephone calls for both practice sites.

GP at Hand provides primary medical services to approximately 2,500 patients living within Hammersmith and Fulham and holds a core General Medical Services (GMS) contract. (GMS is a contract between NHS England and general practices for delivering general medical services). Recently the practice substantially changed its model of care and now has an additional list of approximately 7,500 patients. These patients are registered for a service whereby their first contact is online. They may be treated using online services or may have a face to face consultation. The face to face consultations are offered at five locations across London.

The practice population of 2,500 patients registered for general GP services is ethnically diverse and includes a higher than the national average number of patients aged between 25 and 39 years of age and lower than the national average number of patients 50 years plus. The practice area is rated in the third most deprived decile of the national Index of Multiple Deprivation (IMD). Data from Public Health England 2015/16 demonstrates that the practice profile has a higher percentage of patients with a long-standing condition compared to CCG and England averages (56%, 42%, and 53% respectively).

Practice staff work across both practice sites and are rotated according to need. The whole practice team comprises nine GPs, two Advanced Nurse Practitioners (ANPs), a clinical pharmacist, three practice nurses, four health care assistants, two business managers, a patient services manager and twelve administrative staff. The practice team at 139 Lillie Road is typically staffed by four salaried GPs who collectively work a total of nine clinical sessions per week and two salaried GPs provide three hours of telephone consultations a week.

The practice opening hours are from 9am to 1pm and from 3pm to 6.30pm Monday to Thursday and 9am to 1pm on Friday. Appointments in the morning are from 9am to 12:30pm and in the afternoon from 3pm to 6.30pm Monday to Thursday and 9am to 12.30pm on Friday. Extended hour appointments are available for patients registered for general GP services to access at the other practice site at 292 Munster Road from 6:30pm to 8pm Monday to Friday and from 8am to 5pm on Saturday. Patients from other GP practices within NHS Hammersmith & Fulham CCG can also access extended hour appointments provided at this location as part of the Out of Hospital Weekend Plus Service. Telephone consultations are offered daily and pre-bookable appointments can be booked four weeks in advance. 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 is registered with the Care Quality Commission to provide the regulated activities of diagnostic & screening procedures, family planning, maternity and midwifery, surgical procedures and treatment of disease disorder & injury. The practice was previously inspected under the new methodology on 21 April 2016 and achieved an overall rating of good but required improvement for providing safe services.

The changes in the service and partnership arrangements will require a new application to register to provide the regulated activities.

Updated 9 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jefferies & Partners, Lillie Road on 21 April 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.

• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, all actions identified as part of a recent fire risk assessment had not been completed.

• The practice had not risk assessed their decision not to provide a defibrillator as part of their medical emergency equipment.

• The seating facilities in the practice waiting area required improvement.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• The majority of patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment and all of the comment cards we received aligned with these views.

• 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.

• 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 must make improvement are:

• Ensure all recommendations made as a result of the fire risk assessment are completed and a fire alarm system is installed within the practice.

• Ensure the availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site.

• Ensure waiting area seating is clean and the scuffed and broken wooden panels under the seating and the tears in the fabric of the seating are addressed.

The areas where the provider should make improvement are:

• Ensure all staff understand their responsibilities when acting as chaperones, including where to stand to be able to observe the examination.

• Consider improving communication with patients who have a hearing impairment.

• Advertise the interpreting service within the practice to inform patients this service was available to them.

• Consider ways to actively identify carers and provide appropriate support for them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 May 2016

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.

• Performance for diabetes related indicators was better than the national averages. For example, the percentage of patients on the diabetes register with a record of a foot examination was 92% in comparison to the national average of 88%; the percentage of patients with diabetes, on the register, who had received an influenza immunisation, was 100% in comparison to the national average of 94%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

Updated 26 May 2016

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 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.

• The practice’s uptake for the cervical screening programme was 63%, which was below the national average of 74%.

• Appointments were available outside of school hours.

Updated 26 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 practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 26 May 2016

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.

Updated 26 May 2016

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

• Performance for mental health related indicators was better than the national averages. For example, 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had received a comprehensive, agreed care plan which was above the national average of 84%.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face consultation was 100% which was above the national average of 84%.
• 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.

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

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

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

Updated 26 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 those with a learning disability.
• 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 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.