Archived: Pearl Medical Practice

Updated 14 December 2016

Pearl Medical Practice provides NHS primary medical services to around 4000 patients in Wembley, in the Brent Clinical Commissioning Group area. The service is provided through a general medical services contract.

The current practice clinical team comprises two GP partners and one salaried GP. The practice employs a practice nurse (although the post was vacant and being covered by a temporary practice nurse at the time of the inspection) and a health care assistant. The practice also employs a practice manager and administrative and reception staff. The GPs typically provide around 16 sessions in total each week. Patients have the choice of seeing a male or female GP.

The practice is open from 9am-6.30pm during the week with the exception of Thursday when the practice is closed from 3pm and does not run an afternoon surgery. The practice is additionally open between 6.30-7.30pm on Monday and Wednesday evenings. Same day and longer appointments are available for patients with complex or more urgent needs. The practice offers online appointment booking and an electronic prescription services. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on its website and on a recorded telephone message.

The practice population profile differs from the national average in having a higher proportion of families with children under five and a relatively small population of patients aged over 65. The population in the local area is generally characterised by average levels of income deprivation, life expectancy, education and employment; although levels of income deprivation amongst older people are higher than average. The practice population is ethnically diverse with a significant number of patients originating from the Indian subcontinent.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; maternity and midwifery services and treatment of disease, disorder and injury. The practice has not previously been inspected by CQC.

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shakespeare Health Centre on 10 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Most patients said they found it easy to make an appointment 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 the partners, the lead GP and management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• The practice should ensure that it reviews non-clinical safety alerts. For example it should risk assess its use of vertical blinds with looped cords in line with the relevant alert issued by NHS England.
• The practice could improve its fire safety procedures by carrying out periodic fire drills.
• The practice should ensure that all sharps bins are checked and removed as appropriate.
• The practice had only identified ten patients who were carers and was not confident in the accuracy of this list. The practice should improve its identification of carers to ensure these patients receive appropriate assessment and support.
• The practice provided information in the waiting room and on its website about the service, the patient participation group, and recent patient feedback. It should also consider providing information about its vision and values.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 December 2016

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

• The practice kept registers of patients with long term conditions. These patients had a regular structured review to check their health and medicines needs were being met. The practice operated a call-recall system to encourage patients to attend for their review.
• Practice performance for diabetes was comparable to the CCG average. The percentage of diabetic patients whose blood sugar levels were adequately controlled was 75% compared to the clinical commissioning group average of 76%.
• The practice participated in a local scheme to avoid unplanned admissions. Patients identified as at risk were reviewed and had a personalised care plan. Cases were discussed at regular multidisciplinary meetings. Patients with complex problems requiring more intense support were case managed by a local complex patient multidisciplinary group.
• The whole practice team had roles in chronic disease management and prevention. For example, the practice had designated each GP to lead on specific conditions and the health care assistant had been trained on smoking cessation.
• Longer appointments and home visits were available when needed.

Updated 14 December 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 higher than average for all standard childhood immunisations. 
• Children and young people were treated in an age-appropriate way and were recognised as individuals. The premises were suitable for children and babies. 
• Appointments were available outside of school hours. 
• We saw positive examples of timely communication with and referral to health visitors and other health, social and education services. The practice invited their local health visitor to attend monthly multidisciplinary meetings at the practice.

Updated 14 December 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. Patients over 75 had been informed of their named GP.
• The practice was responsive to the needs of older people, and offered home visits, care planning and urgent appointments for those with enhanced needs. For example, certain patients (based on clinical need) had open access to telephone consultations or could telephone for repeat medications in special circumstances.
• All patients were offered annual flu vaccines either at the practice or at home if they were housebound. The practice also offered the shingles and pneumococcal vaccines to eligible older patients.

Updated 14 December 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 and flexible.
• The practice was open until 7.30pm on two evenings during the week.
• The practice offered a range of ways to access services, for example, daily telephone consultations with a GP, online appointment booking and an electronic prescription service.
• The practice offered a full range of health promotion and screening services reflecting the needs for this age group. For example it had achieved its target for uptake of NHS health checks for patients aged 40-74.
• The practice targeted its student vaccination campaign outside of term time when students were more likely to be at their locally registered address.
• 74% of eligible women registered with the practice had a recorded cervical smear result in the last five years compared to the CCG average of 77%.

Updated 14 December 2016

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

• All (six) of the practice patients with dementia had attended a face to face review of their care in the last year compared to the CCG average of 86%.
• Patients newly assessed to be at high risk of dementia were referred to the local memory clinic for diagnostic tests.
• The practice was alert to patients with mental health problems who were showing signs of distress or becoming unwell, for example, the practice monitored whether patients collected repeat prescriptions. 
• The practice regularly liaised with specialist teams in the case management of patients experiencing poor mental health.
• 96% of practice patients diagnosed with a psychosis had a comprehensive care plan which was comparable to the CCG average of 91%.
• The practice was able to advise patients experiencing poor mental health and their carers how to access various support groups and voluntary organisations.
• The GPs discussed how patients with mental health problems could access services urgently, for example, if they were experiencing a crisis.
• 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.

Updated 14 December 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 people with a learning disability. Patients with a learning disability were offered an annual health review. 
• The practice offered longer and same day appointments for patients in vulnerable circumstances and patients with a learning disability.
• The practice identified and flagged patients who were also carers. Carers were offered regular reviews and flu vaccination.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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