The Heron Practice

Updated 28 November 2016

The Heron Practice operates at the John Scott Health Centre, Green Lanes, London N4 2NU. It shares the premises with another general practice and various other healthcare services. NHS Property Services is responsible for facilities management and maintenance. The premises are located a short distance from Manor House underground and station and have good transport connections nearby.

The practice provides NHS services through a General Medical Services (GMS) contract to approximately 11,000 patients. It is part of the NHS City and Hackney Clinical Commissioning Group (CCG), which is made up of 46 general practices, and of the North Hackney Consortium of 12 practices. The Heron Practice is registered with the Care Quality Commission to carry out the following regulated activities - Maternity and midwifery services; Diagnostic and screening procedures; Family planning; Treatment of disease, disorder or injury. The patient profile has a higher than average working age population, between 20 and 45, with fewer than average teenage and older patients. The deprivation score for the practice population is in second “most deprived decile”, indicating a higher than average deprivation level among the patient population.

The practice has a clinical team of five partner GPs and four salaried GPs. There are seven female GPs and two male. The partner GPs worked between seven and seven and a half clinical sessions per week; two of the salaried GPs work nine sessions, with the other two working five and a half sessions each. There are two female practice nurses, but both are currently on long-term leave. Their work was being covered by locums, averaging 12 clinical sessions a week. There is a part-time clinical pharmacist and two full time healthcare assistants, one female and one male. It is a training practice, with two GP registrars (qualified doctors gaining general practice experience) currently working there, and a trainee practice nurse on a part-time clinical placement.

The administrative team is made up of a practice manager and 13 other staff, with two current patient services assistant vacancies.

The practice reception opens from 8.00 am to 1.00 pm and from 2.00 pm to 6.30 pm, Monday to Friday. Clinical appointments are available during those times, with extended hours on Tuesday, Wednesday and Thursday evenings until 8.00 pm. Routine appointments can be booked up to four weeks in advance. General appointment slots during the day are 10 minutes long, but double slots can be booked by patients with more than one issue to discuss. Evening appointments are 15 minutes long. A number of emergency, same day appointments are available. These are triaged by the duty doctor, working between 8.00 am and 6.30 pm. The GPs also make home visits to patients who are unable to attend the practice for reasons of health or disability. The requests for home visits are also triaged by the duty doctor. In emergencies, babies and children under five years will be seen without appointment between 8.30 and 8.45 each morning. The practice also offers telephone consultations with GPs, which can be booked a week in advance. Patients are able to register with the practice to allow them to book appointments online. Patients can also cancel appointments and order repeat prescriptions using a link on the practice’s website.

The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. There is information given about the out-of-hours provider and the NHS 111 service on the practice website. Information is given in the practice leaflet regarding the urgent care centre operating in the borough.

Updated 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 5 October 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 and complied with the requirements of the duty of candour.

However, there were areas of practice where the provider should make improvements:

• Continue with efforts to recruit more nurses to reduce additional pressure on other members of the clinical team and improve patients’ access to services.
• Continue to monitor access arrangements for, and the care provided to, patients with learning disabilities to improve outcomes for the patient group.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 November 2016

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

• The practice’s performance relating to diabetes care was above local and national averages.
• A specialist diabetes nurse attended the practice each Friday morning.
• The practice maintained a register of 435 patients with diabetes, of whom 86% had received an annual eye check and 96% had received an annual foot check.
• The practice maintained of register of 85 patients with heart failure, of whom 82 had had an annual medicines review in the preceding 12 months.
• The practice’s performance relating to asthma, hypertension, and chronic obstructive pulmonary disease was comparable with local and national averages.
• Longer appointments and home visits were available when needed.

Updated 28 November 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 and maintained a register of vulnerable children.
• Take up rates for standard childhood immunisations for children aged under- two years old were above the local average. Those for five year olds were comparable with local and national averages.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice maintained a register of 42 vulnerable children.
• We saw positive examples of joint working with midwives and health visitors and of regular MDT meetings.
• Upon turning sixteen years old, patients were invited for a health check. So far, 171 patients had been contacted.

Updated 28 November 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 urgent appointments for those with enhanced needs.
• The practice maintained a case management register of patients at high risk of admission to hospital. There were 183 patients currently on the register, all of whom had up to date care plans. Sixty patients on the register had been discharged from hospital in the previous 12 months and all had received a follow up consultation.
• The practice maintained a palliative care register of 23 patients, 21 of whom had had their care pans reviewed.
• Data showed that 3,530 patients being 76% of those on repeat prescriptions had had an annual review
• Records showed that 1,369 patients, being 88% of those who were prescribed ten or more medications, had had a structured annual review.
• Seventy patients identified as being at risk of developing dementia had received a cognition test or memory assessment.

Updated 28 November 2016

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

• 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.
• Evening appointments with both GPs and nurses were available for those patients who could not attend during normal working hours.
• Telephone consultations with patients’ usual GPs could be booked one week in advance.
• The practice’s uptake for the cervical screening programme was comparable with local and national average.
• Data showed that 610 patients had received an NHS health check and 2,614 patients had had their blood pressure monitored.

Updated 28 November 2016

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

• Eighty-seven per cent of the 174 patients experiencing poor mental health had a comprehensive, agreed care plan documented in the record, in the preceding 12 months, comparable with local and national averages. Ninety-five per cent of the patients had had their blood pressure and alcohol use recorded.
• All of the 22 patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months, comparable with local and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Continuity of care for patients experiencing poor mental health was prioritised.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had completed online training relating to the Mental Capacity Act.

Updated 28 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances, including a register of homeless patients, who could register at the practice address to receive healthcare-related correspondence.
• It maintained a learning disability register of 59 patients, of whom 20 (34%) had received an annual follow up and had their care plans reviewed. The practice had produced an action plan to better engage with this patient group and improve patient outcomes.
• 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.