The Cedar Brook Practice Also known as The Cedar Brook Practice

Updated 19 October 2016

Dr S Thurlow, Dr P Hurton, Dr J Carter, Dr RB Popat and Dr JS Sira (also known as The Cedar Brook Practice) is a well-established GP practice situated within the London Borough of Hillingdon. 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 Hillingdon locality. The practice is an approved training practice for GP specialist trainees (GP Registrars) and medical students. It is also a training practice for undergraduate and post-graduate nursing students.

The practice provides primary medical services to approximately 10,050 patients living in Northolt and Hillingdon and holds a core Personal Medical Services Contract (PMS) and Directed Enhanced Services Contracts. The practice is located at 11 Kingshill Close off Kingshill Avenue in Hayes Middlesex with good transport links by bus services.

The practice operates from a purpose built building owned and managed by the GP Partners. The building is set over two floors with lift access and has a total of 13 consultation rooms, 10 on the ground floor and three on the first floor. The reception and one waiting area are located on the ground floor and a second waiting area located on the first floor. There is wheelchair access to the front of the building. There are toilet facilities for people with disabilities and on site car parking facilities. The practice is the accommodation landlord for the local district nursing team, the Clover Health Network office and secondary care clinics for dermatology and familial hypercholesterolemia.

The practice population is ethnically diverse and has a higher than the national average number of patients between 0 and 19 years of age and lower than the national average number of patients 55 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 lower percentage of patients with a long-standing condition compared to CCG and England averages (47%, 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.

The practice team comprises of one male and four female GP partners, a female salaried GP, a locum female GP and a male GP Registrar who all collectively work a total of 44 clinical sessions per week. They are supported by one full time and one part time practice nurses, a practice manager, assistant practice manager, five administration staff, 10 receptionists and two cleaners.

The practice opening hours are from 8.00am to 6.00pm Monday, Tuesday, Thursday and Friday and from 8.00am to 5.00pm Wednesday. Consultation times are from 8.30am to 10.30pm, 11.10am to 12.10pm and 3.30pm to 6.00pm each day with the exception of Wednesday when afternoon consultations are from 2.30pm to 5.00pm. Extended hour appointments are offered from 6.30pm to 7.00pm Monday and Thursday evening, 7.30am to 8.00am Tuesday morning and 8.00am to 12.00pm on Saturday twice monthly. 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 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S Thurlow, Dr P Hurton, Dr J Carter, Dr RB Popat and Dr JS Sira (also known as The Cedar Brook Practice) on 9 June 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, including those associated with infection control, medicines management and health and safety.
• 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, staff were helpful, caring, polite, professional 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.
• 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:

• Conduct a formal risk assessment for the exclusion of administration staff receiving a Disclosure and Barring Service (DBS) check.
• Ensure that all staff receives basic life support training at the frequency recommended by current national guidelines.
• Display notices informing patients of interpreting services available at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 October 2016

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

• There were nurse led clinics for patients with asthma and Chronic Obstructive Pulmonary Disease (COPD) for annual health checks and review after exacerbation. In-house spirometry was available.

• Two of the GPs had a specialist interest in diabetes and one of the practice nurses had received additional training in the management of diabetes. The practice held weekly diabetic clinics and patients with diabetes were offered extended appointments for annual review. The clinics were organised by a member of the administration team who arranged for patients to have blood tests before their appointment and followed up on any patient who missed an appointment.

• The practice was involved in the Diabetes Wellbeing Project that used clinical psychologists working with patients with diabetes to improve their mental health and showed improvement in their diabetes management as a result.

• The practice used risk stratification tools to identify patients with long term conditions at high risk of hospital admission and invite them for review to create integrated care plans aimed at reducing this risk. Patients were contacted after any unplanned admission to follow up on discharge plans and update care plans as required.

• The practice held regular multi-disciplinary team meetings to discuss patients with complex medical needs and update care plans as required, which were appropriately minuted.

• QOF data for 2014/15 showed performance indicators related to long-term conditions, such as diabetes and high blood pressure, were similar to local and national averages.

Updated 19 October 2016

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

• There was a named GP lead and a deputy GP for safeguarding children. Staff had received role appropriate training and were aware of their responsibilities to raise concerns. Bi-monthly child protection meetings were held at the practice and attended by health visitors.

• The practice offered childhood immunisations in line with national guidance and uptake rates were similar to national averages.

• The practice offered GP-led routine antenatal and postnatal care. The first vaccinations for babies were administered by a GP at their eight week health check and thereafter by the practice nurses.

• Same day appointments were available for children under five years of age who were unwell as well as on the day telephone consultations. Appointments for children were available outside of school hours and on Saturday mornings.

• Contraceptive services were available including insertion of long acting reversible contraceptive devices.

• The practice offered primary medical care services to patients from a local children’s home for unaccompanied asylum seekers. These patients were given priority to by-pass the registration waiting list and were offered extended appointments with their key workers. The practice had previously treated fifty patients from the home but at the time of inspection had one patient on the register.

• The practice presented courses for parents about the management of minor ailments in children.

Updated 19 October 2016

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

• There was a named lead and deputy for safeguarding vulnerable adults and staff were aware of their roles and responsibilities to raise concerns.

• The practice used risk stratification tools to identify older patients at high risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk. Patients were contacted after any unplanned admission to follow up on discharge plans and update care plans as required.

• Patients over the age of 65 years with one or more complex medical problems were also eligible for a care plan and were offered an appointment with the health and social care worker assigned to the practice as part of the Integrated Care Plan (ICP) scheme.

• All patients on the admission avoidance and ICP lists were discussed at monthly practice meeting and care plans updated.

• The practice held monthly multi-disciplinary team meetings to discuss older patients with complex medical needs and update care plans as required.

• Patients were referred to local community support services in the voluntary and statutory sectors as required.

• Pneumococcal and shingles vaccination were offered when appropriate.

• Older patients were triaged as a priority for same day appointments and home visits were available if required.

Updated 19 October 2016

• The practice is rated as good for the care of working-age people (including those recently retired and students).
• There were extended hour appointments available for patients unable to attend the surgery during normal working hours. Daily telephone consultations were also available.
• There was the facility to book appointments and request repeat prescriptions online.
• The practice sent text messaging reminders for booked appointments.
• The practice offered health checks for new patients and NHS health checks for patients aged 40–74 and any abnormalities were followed up on appropriately.

Updated 19 October 2016

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

• QOF data 2014/15 showed the practice performance indicators relating to mental health were similar to local and national averages.

• On the day appointments were available for patients experiencing poor mental health. Extended appointments were also offered if required.

• The practice proactively referred patients to local community mental health services including counselling.

• Hospital ‘did not attend’ letters for patients with dementia or experiencing poor mental health were followed up with a telephone call by the GP or administration team to invite the patient to attend for review.

• Dementia screening was offered opportunistically as well as to those patients at risk of dementia with referral to local memory services if appropriate. 

Updated 19 October 2016

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

• There was a named lead and deputy for safeguarding vulnerable adults and staff were aware of their roles and responsibilities to raise concerns.

• The practice maintained a register of patients with learning disabilities and these patients were invited for annual health checks including medication reviews.

• Homeless patients were able to register with the practice and they provided housing letters and advocacy letters if required.

• The practice used language line for patients who did not speak English as their first language and offered extended appointments.

• Staff were trained to signpost patients to community based services, such as addiction recovery support, counselling and citizens advice.