Holly Road Medical Centre

Updated 21 November 2016

Holly Road Medical Centre provides primary medical services through a Personal Medical Services (PMS) contract within the London Borough of Hounslow. The practice is part of NHS Hounslow Clinical Commissioning Group. The services are provided from a single location to around 4250 patients. The practice serves a wide ethnic, cultural, demographic and socio-economic mix and has higher than average numbers of patients in the 25-39 age groups.

At the time of our inspection, there was one permanent GP, a sessional GP and two regular locum GPs (2.3 whole time equivalent - two male and two female) employed at the practice who normally provide 18 clinical sessions per week. The practice also employed a practice manager (1 WTE) and practice administrator (1 WTE), two part-time practice nurses (0.8 WTE), a phlebotomist (0.4 WTE), a practice secretary (0.7 WTE), a senior receptionist (1 WTE) and two reception staff (1.7 WTE).

The practice is open between 8.00am and 6.30pm Monday to Friday and 9.00am to 1.00pm Saturdays. Appointments are from 9.00am to 12.00pm every weekday morning and 3.00pm to 6.00pm every weekday except Thursday. Extended hours appointments are offered on alternate Monday and Tuesday evenings until 7.30pm, and alternate Saturdays between 9.00am and 11.00am. In addition to pre-bookable appointments that can be booked in advance, urgent appointments are also available for people that needed them. Telephone triage is available for patients who find it difficult to attend the practice, for example due to work and studying.

There are also arrangements to ensure patients receive urgent medical assistance when the practice was closed. Out of hours services are provided by a local provider. Patients are provided with details of the number to call.

The practice is registered to carry on the following regulated activities:

Diagnostic and screening procedures

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

Updated 21 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holly Road Medical Centre on 7 July 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 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.
• 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:

• Monitor and record the standard of cleaning utilising the detailed checklist recently introduced.
• Ensure pre-employment reference checks are documented in staff records for all staff.
• Ensure further clinical audits are completed through the full audit cycle where the improvements made are implemented and monitored.
• Arrange update training due for GP staff in fire safety, infection control and information governance to be completed.
• Continue to identify carers to ensure they are provided with information and support.
• Consider documenting discussions and agreed decisions and actions from the weekly clinical meetings to provide an audit trail.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 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.

• QOF performance for diabetes related indicators was below the CCG and national average for 2014/15 but the practice had put a number of measures in place to secure improved performance for diabetic patients. New diabetic patients could be seen by the in-house diabetic specialist nurse on Saturdays and referred to in-house expert diabetic sessions and podiatry services.
• 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 21 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. There was direct contact via personal mobile phone of the doctor for any urgent child protection issues.
• Immunisation rates were relatively high for the majority of standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 79%, which was comparable to 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. Prioritised same-day appointments were available, including double appointments where necessary.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Sexual health screening and family planning services were available in-house.

Updated 21 November 2016

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

• The practice offered proactive, personalised care, including care plans with family/carer input to meet the needs of the older people in its population.
• These patients had a named GP and were offered an annual health check, including a medication review. Medicines were managed via the delivery of dosette boxes.
• Specific services were offered to reduce unnecessary referrals to hospitals and community services via on-site phlebotomy, diabetic clinics, simple and complex wound care, extended hours and weekend hub cover.
• There were arrangements in place with local pharmacists enabling home delivery of medicines and electronic prescribing as necessary.
• Patients received prioritised same day appointments, including double appointments when necessary.
• The practice liaised with the district nursing team, palliative care and the community matron to support the care and treatment of older people.

Updated 21 November 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.
• Telephone triage was available for patients who found it difficult to attend the practice, for example due to work and studying.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 21 November 2016

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

• Mental health care plans were reviewed annually, including a medicines review.
• 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was slightly below the national average.
• Performance for QOF mental health related indicators was slightly below the national average.

• The practice liaised closely with the community mental health team (CMHT), including the crisis resolution team to support patients experiencing poor mental health, including those with dementia.
• There was an in house counsellor in the surgery and the practice encouraged referrals to local psychological support services through the Improving Access to Psychological Therapies (IAPT) programme.

• 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 21 November 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.
• Care management and planning was provided for patients in this group identified at-risk of hospital admissions.
• 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.