The Speedwell Practice

Updated 20 June 2018

The Speedwell Practice is located in an affluent suburban area with a low rate of unemployment and other social issues and provides GP Primary Medical Services (PMS) to approximately 11,400 patients living in Barnet, North London. The practice is one of 58 practices serving the NHS Barnet Clinical Commissioning Group (CCG) area. (PMS is one of the three contracting routes that have been available to enable the commissioning of primary medical services).

Although the list size has increased by 6% since the last CQC inspection in 2014, the age demographics have remained the same meaning a similar number of under 14 year old patients and a lower than average number of over 65 year olds when compared with national averages. The percentage of patients with long term conditions is also similar to the national average. Mental health registers, especially depression, are higher than the national average which is expected from affluent area as patients are more likely to seek help and are more open to mental health issues. There is a longer life expectancy than the national average which places different pressures on the practice. Thirty seven percent of the registered practice population were from Black, Asian and Minority Ethnic groups with the remaining 63% being white.

Information published by Public Health England rates the level of deprivation within the practice population group as seventh on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

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

The practice provides a range of services including maternity care, childhood immunisations, chronic disease management and travel immunisations and also a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract) including minor surgery, coil fitting and learning disability health checks. Private travel vaccinations are offered in addition to those available free of charge on the NHS.

The practice team is made up of two male and two female GP Partners, two male and one female salaried GPs, two nurse practitioners, two practice nurses, a health care assistant, a business manager, a practice manager, a practice administrator, a reception supervisor and 12 administrative/reception staff. There was also a CCG pharmacist who worked in the practice half a day per week and who gave pharmacy and prescribing advice.

The practice is open between 8:00am and 6:30pm Monday to Friday with appointments being available between 8:00am and 1:00pm and 3:30pm and 6pm. Home visits are provided for patients who are housebound or too ill to visit the practice.

There are 12 nursing/residential homes within the catchement area of the practice with registered patients in each of them. The practice undertake weekly visits to each of them. This is rotated between the GPs and the rota is incorporated within the normal weekly clinic set up.

The practice has opted out of providing an out-of-hours service. When closed, patients are directed to the local out-of-hours service provider. Information regarding this is given on the practice website and the practice leaflet, together with details of the NHS 111 service.

Appointments can be booked online, some being available the next day. Urgent appointments are also available for patients who need them.

A GP Partner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Updated 20 June 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 9 October 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced inspection at The Speedwell Practice on 15 March 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

There was a strong focus on continuous learning and improvement at all levels of the organisation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

The practice is rated as good for the care of people with long-term conditions. Longer appointments and home visits were available when needed. Patients had a named GP and practice nurses regularly reviewed patients on long term condition registers to check that their health and medication needs were being met. Patients with long term conditions told us that clinicians provided sufficient information to enable them to make informed decisions about their care and treatment. We noted that unplanned hospital admission rates for patients with diabetes and coronary heart disease were lower than the practice averages for Barnet and England. Healthcare professionals such as health visitors and district nurses were based in the same building and we saw evidence of how practice staff worked with them to deliver a multidisciplinary package of care.

Reception and other administrative staff attended Cancer Research UK cancer awareness training to develop their knowledge of key messages around cancer prevention and screening. We noted that the practice also treated new patient cancer diagnoses as significant events and reviewed the process to diagnosis to see if improvements to care and treatment could be identified.

Updated 19 March 2015

The practice is rated as good for the care of families, children and young people. Immunisation rates at 12 and 24 months were better than the average for Barnet practices. Senior GPs attributed this to a proactive nursing team and weekly “drop in” mothers and babies clinic where immunisations could take place. Appointments were available outside of school hours and the premises were suitable for children and babies (for example baby changing facilities were available). The practice hosted a range of mother and toddler support groups including for specific communities such as for Japanese mothers living at a local university halls of residence. Health visitors were based in the same building and we saw evidence of how this facilitated joint working with practice staff. The practice also worked closely with midwifes and school nurses. Practice staff were aware of local safeguarding contacts and knew how to escalate concerns. The practice also ran a drop in sexual health clinic which was particularly responsive to the needs of young patients. Practice nurses specialised in women’s health and contraception.

Updated 19 March 2015

The practice is rated as good for the care of older people. An example of outstanding practice was how the practice used web based clinical software when visiting patients at local care homes. For further information please refer to the ‘outstanding practice’ and ‘detailed findings’ sections of our report.

Staff demonstrated knowledge of consent to care and treatment in line with legislation and guidance (including the Mental Capacity Act 2005). Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people such as diabetes. The practice was responsive to the needs of older people offering, for example home visits, rapid access appointments and extended appointment slots. Older patients spoke positively about how they were treated by staff and we noted that they were well represented on the Patient Participation Group. Patients aged over 75 had their own named GP and were offered annual health checks.

Staff had received training on how to care for people with mental health needs and dementia. For example, the practice hosted GP dementia training delivered by the local mental health trust and we also noted that it performed better than the Barnet average for the number of dementia care reviews that had taken place in the last 15 months. Practice dementia diagnosis rates were better than the national average. Records showed that the practice routinely reviewed the care of patients on its end of life register and that it worked with end of life nurses in the care and treatment of patients.

Updated 19 March 2015

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. This included, telephone consultations, early morning appointments and also online appointment booking and repeat prescriptions facilities. However, some patients fed back that it was difficult to get through to the practice by phone. The practice offered a full range of health promotion and screening that reflected the needs of this age group. Health promotion material was available throughout the practice including via a TV in the patient waiting area. The practice’s website contained links to NHS Choices healthy living advice webpages.

Updated 19 March 2015

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

The practice kept a register of patients experiencing poor mental health. GPs stressed the importance of reviewing patients’ physical as well as mental health and we noted that the practice performed better than the England and Barnet averages for cholesterol checks in the last 12 months for patients with poor mental health.

The practice offered flexible appointments such as evening appointments (when the practice was less busy) as we were told that this was preferred by many patients experiencing poor mental health. The practice also had systems in place to support patients presenting with acutely poor mental health and routinely referred patients experiencing poor mental health to local voluntary sector organisations for specialist support.

Staff had received training on how to care for people with mental health needs and dementia. For example, the practice hosted GP dementia training delivered by the local mental health trust and we also noted that it performed better than the Barnet average for the number of dementia care reviews that had taken place in the last 15 months.

Updated 19 March 2015

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. Patients with a learning disability were offered annual health checks and longer appointments. We also noted that “easy read” pictorial leaflets were available, outlining various treatments and conditions. Some patients with a learning disability lived at a local care home. The manager spoke positively about how patients were treated by reception staff and about how clinicians explained treatments.

The practice also kept a register of patients at risk of or experiencing domestic violence. A recent review had resulted in an action plan aimed at improving patient disclosure rates. We saw that the action plan included clinical staff awareness training (covering for example additional questions to ask during a consultation and an outline of local domestic violence support agencies).

Staff knew how to recognise signs of abuse in vulnerable adults and children. They were also 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.

The practice offered interpreting services in a range of languages including British Sign Language (BSL).