Queens Walk Practice

Updated 6 July 2017

The Queens Walk Practice is located in the London Borough of Ealing, and provides a general practice service to around 10000 patients from a purpose built building.

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 services at one location.

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 has two GP partners and five salaried GPs working a total of thirty four sessions amongst them. There is a good mix of female and male staff.

Queens Walk Practice is a teaching and training practice and hosts medical students.

The practice has a full time practice manager. The rest of the practice team consists of one full time practice nurse, three health care assistant and seven administrative staff consisting of medical secretaries’, reception staff, clerks and typist.

The practice is currently open five days a week from 07:30-17:00hrs Monday – Fridays. Consultation times are 07:30hrs until 12:00hrs and 14:00hrs until 17:00hrs. When the practice is closed, the telephone answering service directs patients to contact the out of hours provider.

Our previous inspection found areas that required improvements.

Updated 6 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queens Walk Practice on 16 February 2016. The overall rating for the practice was good. However, within the key question safe some areas were identified as ‘requires improvement’, as the practice was not meeting the legislation for Safe care and treatment; Good governance; Staffing & Fit and proper persons employed.

The practice was issued requirement notices under Regulation 12, Safe care and treatment; Regulation 17 Good governance; Regulation 18 Staffing; and Regulation 19 Fit and proper persons employed. The full comprehensive inspection on 16 February 2016 can be found by selecting the ‘all reports’ link for the Queens Walk Practice on our website at www.cqc.org.uk.

This inspection was a focused desk based review carried out on l June  2017 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection on 16 February 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall, the practice is rated as good.

Our key findings were as follows:

• The practice had implemented and was following a system to ensure all MHRA and medicines alerts were acted on.

• All staff acting as a chaperones had the appropriate Disclosure and Barring Service check (DBS check) completed.

• Locum staff at the practice had all the necessary employment checks.

• A cleaning schedule was in place and was being monitored.

• Staff had received appropriate infection control training and they were infection control audits in place.

• Health care assistants were working in accordance to Patient Specific Directions to ensure they delivered care safely.

• A risk assessment had been completed for the safe keeping of a large liquid nitrogen container used for surgical procedures to ensure it was stored safely.

In addition improvements had been made in the following areas we had recommended :

• Improvements had been made to the recording of patients care plans.

• The practice was ensuring that palliative care meetings were held.

• The recording of team meetings was consistent to ensure staff had access to them if they had been absent on the day of the meeting.

• The practice had developed and was following a formalised system of identifying carers.

We reviewed this information and made an assessment of this against the regulations.

The practice supplied an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation. Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment; Regulation 17 HSCA (RA) Regulations 2014 Good governance; Regulation 18 HSCA (RA) Regulations 2014 Staffing; and Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2016

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

• GP had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, who have a record of an albumin: creatinine ratio test (The urine albumin test or albumin/creatinine ratio ACR is used to screen people with chronic conditions, such as diabetes) in the preceding 12 months was comparable to the CCG and national average (practice 85%; national 77 %).

• Longer appointments and home visits were available when needed. However, not all these patients had a personalised care plan.

Updated 13 April 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.

• 80% of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was comparable to the national average.

• 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.

• The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 78% and the national average of 82%.

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 13 April 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 13 April 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 13 April 2016

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

• 80% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• 97% of patients diagnosed with schizophrenia, bipolar and other mental health conditions had a care plan reviewed in the last 12 months, which was higher than the national average.

• 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 13 April 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 homeless people, travellers and those with a learning disability.

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

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.