Elliott Hall Medical Centre

Updated 28 March 2017

Elliott Hall Medical Centre is located at 165-167 Uxbridge Road, Hatch End, Pinner, Middlesex, HA5 4EA. The practice provides NHS primary care services to approximately 11,200 patients through a Personal Medical Services (PMS) contract (a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract). The practice is within the Harrow Clinical Commissioning Group (CCG) area.

The practice operates from a three storey purpose-built premises with access to nine consulting rooms on the ground floor and 10 consulting rooms on the first floor. The first floor was accessible by stairs and a patient lift. At the time of our inspection the practice were undertaking renovation having received primary care infrastructure funding. The refurbishment would provide three additional consulting rooms, reconfiguration of administrative space and create a new seminar and common room. On day of the inspection we observed the practice to be managing the building work with no apparent disruption to the day-to-day services.

The practice has a larger than average proportion of patients between the age ranges 75-79, 80-84 and 85 and above.

The practice staff comprises three male and one female partner (totalling 34 sessions per week), six female GP associates (salaried GPs) totalling 32 sessions per week, a GP returner (an induction and refresher scheme designed to support GPs who had previously been in practice back into the workforce), four trainee GPs and a medical student. The clinical team was supported by a nurse practitioner, four practice nurses, a healthcare assistant and two phlebotomists. The administration team consisted of a practice and deputy practice manager, administration staff and 12 receptionists.

The practice is a training and teaching practice and had GP registrars, a foundation year two doctor and a medical student attached to the practice. The practice supported the GP returner scheme and at the time of our inspection the practice had one GP returner. The practice also participates in undergraduate and postgraduate nurse placement training.

The practice premises are open from 8am to 6.30pm Monday to Friday. Extended hours are provided from 7am to 8am Monday to Friday.

The practice provides a range of services including childhood immunisations, chronic disease management, smoking cessation, sexual health, including intrauterine device (coil) fitting, cervical smears, minor surgical procedures and travel advice and immunisations.

When the practice is closed, out-of-hours services are accessed through the local out of hours service or NHS 111.

Updated 28 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elliott Hall Medical Centre on 17 November 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• There was a strong, open and embedded culture at the practice in respect of patient safety and the practice used every opportunity to learn from incidents. We observed a genuine open culture in which all safety concerns raised by staff were highly valued and integral to learning and improvement. All staff were encouraged to participate in learning and to improve safety as much as possible. We saw evidence that incidents were shared externally to enhance learning on a wider basis.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safeguarded from abuse.
• Comprehensive systems were in place to keep people safe, which took account of current best practice. For example, there was an effective system in place to review patients on high risk medicines which included a nominated lead, an alert on the clinical system, a recall system and regular patient audits to ensure prescribing was in line with safe and best practice.
• There was evidence of quality improvement including clinical audit. We saw that the practice had put in place a comprehensive audit programme which was driven by the needs of the practice population in order to improve patient outcomes.
• Feedback from patients about their care was consistently positive. Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs and there were innovative approaches to providing integrated patient-centred care. For example, patients over the age of 65 and with complex long-term conditions and multiple health problems were supported through the ‘Virtual Ward’ system which provided multidisciplinary care management of complex patients to prevent unnecessary hospital admissions and avoid readmissions.
• There was a strong, visible, person-centred culture. We observed staff members to be highly motivated to offer care that was kind and promoted people’s dignity.
• The practice had a very proactive and engaged Patient Participation Group (PPG) which the practice referred to as the Patient Association (PA). This worked closely with the practice to support and provide services to its patients, which included bereavement and carer support.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. The provider was aware of and complied with the requirements of the duty of candour.
• Leaders had an inspiring shared purpose and a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff and the Patient Association. There was a high level of constructive engagement with staff and a high level of staff satisfaction.
• There was a strong focus on continuous learning and improvement at all levels. The practice took pride in its role as a teaching and training practice and we saw that a learning and reflection culture was embedded in the organisation.

We saw several areas of outstanding practice:

• There was an holistic approach to assessing, planning and delivering care and treatment to people who use services. For example, the practice had developed over several years the ‘supportive care register’ (SCR) and anticipatory care plan which enabled patients to have choice and make decisions about their care. Both of which had been adopted within the locality and the latter being recognised locally for an award.

• The practice had a very proactive and engaged Patient Participation Group (PPG) which was known as the Patient Association (PA). This worked in conjunction with the practice through a team of volunteers to help support patients and reduce social isolation through carers’ groups, home visiting and bereavement support services. A patient transport service supported patients unable to use public transport with access to the practice.

• The partners led an innovative and committed team, and promoted a strong inclusive culture with a focus on continuous quality improvement. The partners encouraged effective communication within the team and demonstrated a comprehensive meeting structure which included daily clinical and non-clinical meetings to enhance their formal operational and governance frameworks.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 March 2017

The practice is rated as outstanding 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. The practice ran specialised diabetic and respiratory clinics and a dietician ran a clinic once a week.
• The practice had increased the routine doctor appointment time for patients with long-term and complex conditions to 15 minutes. 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.
• Performance for diabetes related indicators was higher than national averages. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 84% (national average 78%) with a practice exception reporting of 12% (national 12%), the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 80% (national average 78%) with a practice exception reporting of 9% (national 9%) and the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 86% (national average 80%) with a practice exception reporting of 11% (national 13%).
• The practice identified it had a large cohort of pre-diabetic patients (approximately 850) and coded them on its clinical system to ensure effective recall and monitoring. To engage with this cohort the practice held a pre-diabetes health fair which focussed on understanding what an HbA1c reading was, healthy eating, understanding what increases blood glucose levels and how exercise can reduce blood glucose levels. Over 300 patients attended. The practice collected qualitative feedback which was positive. 

Updated 28 March 2017

The practice is rated as outstanding 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. The practice also monitored children who failed to attend appointments in primary and secondary care.
• Immunisation rates were relatively high for all standard childhood immunisations. Data for the 1 April 2015 to 31 March 2016 for the under two year olds were above the standard of 90% and ranged from 92% to 93%. Immunisation rates for five year olds ranged from 89% to 93% which was comparable with the national average of 88% to 94%.
• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was 81% (exception reporting 1.6%) which was above the national average of 76% (exception reporting 7.9%).
• The practice’s uptake for the cervical screening programme was 82% (exception reporting 6.9%), which was comparable to the national average of 81% (exception reporting 6.5%).
• The practice provided intrauterine device (coil) fittings for contraceptive purposes.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Baby changing and breast feeding facilities were available.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice had run some ‘working together clinics’ where paediatric registrars from the local hospital ran joint clinics at the practice.

Updated 28 March 2017

The practice is rated as outstanding 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 maintained a supportive care register (SCR) for older patients most at risk, for example in care homes, patients with dementia, those with two or more non-elective admissions in the last 12 months and those with a predicted risk of emergency admission score of more than 50%. We saw that all patients had personalised care plans.
• The practice had a larger than average proportion of patients between the age ranges 75-79, 80-84 and 85 and above. Patients over the age of 65 and with complex long-term conditions and multiple health problems were supported through the local ‘Virtual Ward’ system which provided multidisciplinary care management of complex patients to prevent unnecessary hospital admissions and avoid readmissions.
• All patients over 75 had a named accountable GP acting as their care co-ordinator.
• The practice was responsive to the needs of older people and offered flexible appointment times, same day appointments, home visits and telephone consultations for those with enhanced needs.
• The practice met with the Macmillan Team and district nurses on a monthly basis to discuss its patients requiring palliative care. A member of the clinical team had worked for 17 years at a local hospice and provided an added resource for palliative advice and end of life care.
• All patients near the end of their life had a comprehensive anticipatory care plan (a plan that anticipates significant changes in a patient, or their needs, and describes action which could be taken to manage the anticipated problem in the best way) in place which included the preferred place of death.
• The practice Patient Association ran a carer’s group, offered home visits, ran social groups and arranged transport for its elderly patients to surgery and local clinics.

Updated 28 March 2017

The practice is rated as outstanding 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 offered a ‘Commuter’s Clinic’ from 7am to 8am Monday to Friday for working patients who could not attend during normal opening hours. The practice had also offered some Saturday morning influenza clinics for this cohort.
• 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.
• The practice utilised a social networking and social microblogging site to keep its patients up-to-date.

Updated 28 March 2017

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

• Performance for mental health related indicators was above CCG and national averages. 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 92% (82 patients) compared to the CCG average of 91% and the national average of 89% (practice exception reporting 7%; CCG 8%; national 13%) and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months months was 99% compared to the CCG average of 90% and the national average of 89% (practice exception reporting 6%; CCG 9%; national 10%).
• The percentage of patients diagnosed with dementia who had had their care reviewed in a face-to-face meeting in the last 12 months was 93% (91 patients) compared to the CCG average of 87% and the national average of 84% (practice exception reporting 4%; CCG average 5%; national 7%).
• The practice hosted a community primary care mental health worker once a week in the surgery and were able to make direct referrals.
• All the clinical team had undertaken Dementia Friends (an Alzheimer's Society initiative) training and the practice had a dementia champion. We saw evidence from minutes of attendance by representatives from the Alzheimer’s Society and Dementia Friends at practice meetings to increase awareness of services available.
• All patients diagnosed with dementia were on the supportive care register (SCR) and had a nominated GP. We saw evidence of comprehensive care plans for these patients.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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.

Updated 28 March 2017

The practice is rated as outstanding 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 and those with a learning disability. The clinical team had undertaken learning disability awareness training.
• The practice offered longer appointments for patients with a learning disability and those requiring an interpreter.
• 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.
• 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.
• The clinical team had undertaken domestic violence awareness training.
• The practice, in conjunction with trained bereavement volunteers working with the Patient Participation Group (PPG) which the practice referred to as the Patient Association (PA), offered a bereavement visiting service to patients’ homes or a location of their choice. This was on a referral basis by the practice’s clinical team to ensure suitability and was available for as long as the bereaving patient required it. The bereavement volunteers also ran a monthly friendship group for patients to have an opportunity to meet, have some refreshments and chat.