Sands End Health Clinic

Updated 19 June 2017

Sands End Health Clinic is a well-established GP practice situated within the London Borough of

Hammersmith & Fulham. The practice lies within the administrative boundaries of NHS Hammersmith and Fulham Commissioning Group (CCG) and is a member of the Hammersmith & Fulham GP federation and part of the south Fulham GP network.

The practice provides primary medical services to approximately 8,000 patients, 6000 of whom are working age. The practice holds a core General Medical Services Contract (GMS) and Directed Enhanced Services Contracts.

The practice is located at Bridge House Centre for Health, 1 Broughton Road Approach, London SW6 2FE, with good transport links by bus and rail services. The practice operates from a converted building owned by a private landlord and managed by Community Health Partnerships.

The building is shared with another GP practice and is arranged over three floors with stair and lift access and with accessible facilities.

The registered practice population is ethnically diverse and is characterised by a high proportion of working age adults. There is a higher than the national average number of patients between 0 and 9 years of age and between 25 and 49 years of age. There is a lower than the national average number of patients 50 years plus. The practice area is rated in the fifth less 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 2015/16 shows that the practice has a lower percentage of patients with a long-standing condition compared to CCG and England averages (44%, 42%, and 53% 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 female GP managing partner, a female and a male GP partner, one male and four female salaried GPs and a female GP retainer, who collectively work 39 clinical sessions. They are supported by two practice nurses, a health care assistant, a physician’s associate, systems manager, operations manager, two administrators and six receptionists.

The practice opening hours and consultation times are from 8am to 6.30pm Monday to Friday. The clinical sessions of individual doctors and nurses vary within these hours. Extended hour appointments are offered in the morning from 7am to 8am and in the evening from 6.30pm to 7pm Monday to Friday and from 8am to 10am on Saturday mornings. 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, child health surveillance and contraception and family planning.

Updated 19 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sands End Health Clinic on 20 April 2016. The overall rating for the practice was good but required improvement for providing safe services. This was specifically in relation to some aspects of medicines management and fire safety precautions. The full comprehensive report on the 20 April 2016 inspection can be found by selecting the ‘all reports’ link for Sands End Health Clinic on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 19 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 20 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated good for providing safe services and the overall rating remains as good.

Our key findings were as follows:

• Improvements had been made in the management and storage of medicines which now included an effective fridge temperature monitoring process and, a system to monitor that all medicines kept at the practice were in date.
• Effective fire safety arrangements were now in place including fire extinguishers that were fit for purpose.

We also reviewed the actions taken since the last inspection to the areas where we identified the practice should make improvement and saw that they had been addressed.

Our findings were as follows;

• Staff who undertook chaperone duties had undertaken additional training to expand their competency skills to effectively perform the role.
• Improvements had been made to the practice’s cervical screening uptake rates. Data for 2015/16 showed that the percentage of women aged 25 to 64 years of age who had a cervical screening test performed in the preceding 5 years was comparable with the Clinical Commissioning Group (CCG) and national averages.
• The practice had increased the number of patients identified as carers and currently had a carer’s register of 167 patients (2% of the practice list size).
• Information about interpreting services was now made available to patients.
• Arrangements were in place for the purchase of a new hearing loop to assist patients with a hearing impairment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 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.

• Performance for diabetes related indicators was better than the national averages. Performance for the percentage of patients on the diabetes register with a record of a foot examination was 91% in comparison to the national average of 88%; the percentage of patients with diabetes, on the register, who had received an influenza immunisation, was 98% in comparison to the national average of 94%.

• 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 4 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. Immunisation rates were relatively high 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.

• The practice’s uptake for the cervical screening programme was 68%, which was below the national average of 82%.

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

• We saw positive examples of joint working with midwives and health visitors.

Updated 4 November 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice worked with the ‘Older Person Rapid Access Clinic’ (OPRAC) which offers emergency department-style access to tests and diagnostics and providestreatment in a setting adapted for treating frail older patients; to meet the needs of older patients with specific medical problems.

Updated 4 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.

• 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.

Updated 4 November 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 was better than the national averages. 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had received a comprehensive, agreed care plan which was above the national average of 84%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face consultation in the last 12 months was 87% which was above the national average of 84%.

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

• The practice carried out advance care planning for patients 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 4 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.

• 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.