Archived: The Warren Practice

Updated 20 December 2016

The Warren Practice is a well-established GP practice situated within the London Borough of Hillingdon which was originally founded in the early 1930’s. The practice lies within the administrative boundaries of NHS Hillingdon Clinical Commissioning Group (CCG) and is a member of the Clover Health Network in the Hayes and Harlington locality. The practice is an accredited training practice for GP trainees.

The practice provides primary medical services to approximately 7,100 patients living in Hayes. The practice holds a General Medical Services Contract and Directed Enhanced Services Contracts. The practice is located at Warren Medical Centre, Uxbridge Road, Uxbridge, with good transport links by bus services. The practice experiences a high turnover of patients due to a large influx of refugees and immigrants who are housed in the area for a short time period.

The practice operates from the Warren Medical Centre which is a purpose built building owned and managed by a local NHS Foundation Trust. The practice has occupied the premises for 20 years on a long term lease and shares the premises with another other health care organisation. The practice has eight consultation rooms, one treatment room and a reception and waiting area on the ground floor of the premises. There is wheelchair access to the entrance of the building and toilet facilities for people with disabilities. There are two designated disabled parking bays at the front of the practice.

The practice population is ethnically diverse and has a higher than the CCG average number of patients between five and 18 years of age and of patients 65 years plus. The practice area is rated in the fifth more deprived decile of the national Index of Multiple Deprivation (IMD). People living in more deprived areas tend to have greater need for health services. Data from Public Health England 2014/15 shows that the practice has a higher percentage of patients with a long-standing condition compared to CCG and England averages (60%, 50%, and 54% respectively).

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic & screening procedures, family planning, maternity & midwifery services, surgical procedures and treatment of disease disorder & Injury. At the time of inspection the practice was registered with the CQC as a joint GP partnership however one of the two GP partners had retired in March 2016 although CQC had not been correctly informed of the change. An application has since been submitted and approved for the principal GP as a sole provider.

The practice team comprises of one male GP partner, four female salaried GPs and one GP registrar who all collectively work a total of 33 clinical sessions per week. They are supported by three part time practice nurses, a practice manager and nine administration staff.

The practice opening hours are 8.45am to 6pm Monday to Friday with the exception of Wednesday when it is closes at 12.30pm. Consultation times in the morning are from 8.50am to 11.40am and in the afternoon from 2pm to 6pm Monday to Friday. Telephone consultations are offered daily and bookable appointments can be booked up to six weeks in advance. Extended hour appointments are offered form 7am to 8am Tuesday, Thursday and Friday. 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 provides a wide range of services including chronic disease management, minor surgery and health checks for patients 40 years plus. The practice also provides health promotion services including, cervical screening, childhood immunisations, contraception and family planning.

Updated 20 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Warren Practice on 9 August 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 felt the practice offered an excellent service and staff were helpful, caring, professional and attentive and treated them with dignity and respect.
• 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.
• Patients 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. Negative feedback commonly cited problems getting through to the surgery by telephone which the practice was trying to address.
• 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.

The areas where the provider should make improvement are:

• Revise the incident reporting form so that it supports the recording of notifiable incidents under the duty of candour.
• Display fire escape route posters in the waiting area.
• Formalise a system to document minutes of weekly clinical meetings.
• Continue to pro-actively identify carers to ensure that advice and appropriate support is made available to them.
• Display notices in the reception areas informing patients that translation services are available.
• Consider installing a hearing loop to assist people with hearing loss.
• Ensure all key policies and protocols are kept up-to-date.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 20 December 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 held regular chronic disease clinics, for example asthma/Chronic Obstructive Pulmonary Disease (COPD), hypertension and diabetes clinics.
• Patients with long term conditions were invited for annual health checks including medication review.
• Longer appointments and home visits were available when needed.
• The practice identified patients with long term conditions at high risk of unplanned hospital admission and invited them in for review to create integrated care plans aimed at reducing this risk. These patients were reviewed six monthly and after discharge following any unscheduled admission.
• The practice held monthly multi-disciplinary team meetings attended by members of the district nurses and community palliative care teams to discuss management and update care plans of patients with complex medical needs.
• QOF data for 2014/15 showed the practice was mostly below local and national averages for performance indicators relating to long term conditions. The practice was aware of this and attributed results in part to the high turnover of patients in their practice population due to a large influx of refugees and immigrants who were housed in the area for a short time period and cultural variances. Unpublished QOF data for 2015/2016 did show improvements in some indicators.

Updated 20 December 2016

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

• There was a named lead for safeguarding children, staff had received role appropriate training and were aware of their responsibilities to raise concerns.

• 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.

• The practice held monthly meetings with the health visitors to discuss management and update care plans for children at risk.

• Immunisation rates were similar to CCG averages 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, and we saw evidence to confirm this.

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

• GP and nurse-led family planning advice and contraceptive services were available.

Updated 20 December 2016

The practice is rated as good for the care of older people.

• All patients over the age of 75 years had a named GP to co-ordinate their care and ensure continuity.
• There was a named lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.
• The practice used risk stratification tools to identify older patients at high risk of unplanned hospital and invited them in for review to create integrated care plans aimed at reducing this risk. These patients were reviewed six monthly and after discharge following any unscheduled hospital admission. Data showed a reduction in emergency admissions following implementation of the care plan scheme.
• The practice held monthly multi-disciplinary team meetings attended by members of the district nurses and community palliative care teams to discuss management and update care plans of older patients with complex medical needs.
• Home visits were available for patients unable to attend the practice due to illness or immobility.
• The practice provided primary medical services to a local nursing home. One of the GPs was the named lead for the nursing home and provided regular review of patients in addition to urgent reviews as required.

Updated 20 December 2016

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

• The practice offered extended hour appointments three times a week for patients unable to attend the surgery during normal working hours.
• There was the facility to book appointments and request repeat prescriptions online and SMS text reminders were sent to patients with booked appointments.
• Health checks for new patients and NHS health checks for patients aged 40–74 were offered with appropriate follow-up of any abnormalities or risk factors identified at these checks.
• Patients were able to receive travel vaccinations available on the NHS as well as those only available privately. The practice was a registered yellow fever vaccine centre.

Updated 20 December 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 2014/15 was below the national average. 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 42% (CCG average 92%, national average 88%).

• 65% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months (CCG average 85%, national average 84%). Unpublished QOF data 2015/16 showed improvement for both these indicators.

• The practice maintained a register of patients experiencing poor mental health and these patients were invited for annual health checks and medication review.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice informed 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.

Updated 20 December 2016

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

• There was a named lead for safeguarding vulnerable adults. Staff knew how to recognise signs of abuse and 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.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• Patients with learning disabilities were invited for annual health checks and medication review. Longer appointments were available if required. At the time of the inspection 10 out of 22 (45%) of annual reviews had been completed.

• 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.