Blue Wing Family Doctor Unit

Updated 16 October 2017

Blue Wing Family Doctor Unit is a well-established GP practice situated within the London Borough of Hounslow. The practice lies within the administrative boundaries of NHS Hounslow Clinical Commissioning Group (CCG) and is a member of the Heart of Hounslow and Maswell Park GP locality.

The practice provides primary medical services to approximately 8,150 patients living in Hounslow within the practice boundary. The practice and holds a core General Medical Services Contract (GMS) and Directed Enhanced Services Contracts. The practice is located at Heart of Hounslow Centre for Health, 92 Bath Road, Hounslow, TW3 3EL with good transport links by bus and rail services.

The practice operates from a purpose built building owned and managed by NHS Property Services. The building is set over four floors with lift and stair access, there is wheelchair access to the entrance of the building, toilet facilities for people with disabilities and on site pay and display car parking amenities. The practice has a total of seven consultation rooms, reception and waiting area on the first floor of the building. The practice shares the first floor accommodation with three other GP practices and the whole building is shared with other local community services.

The practice population is ethnically diverse and has a higher than the national average number of patients between 25 and 44 years of age and lower than the national average number of patients 50 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 2015/16 shows that the practice has a lower percentage of patients with a long-standing condition compared to CCG and England averages (49%, 46%, and 53% respectively).

The practice team comprises of one female and two male GP partners, a male salaried GP, a female sessional GP who collectively work a total of 30 clinical sessions per week. They are supported by one full time practice nurse, two part time health care assistants, a part time phlebotomist, a practice business manager and eight administration staff

The practice opening hours are from 8.30am to 6.30pm Monday, Tuesday, Thursday and Friday and from 8.30am to 1.30pm Wednesday. Consultation times in the morning are from 8.30am to 11.30am Monday to Friday and in the afternoon from 2.30pm to 5.30pm each day with the exception of Wednesday afternoon when the practice is closed. Telephone consultations are available daily. Extended hour appointments are offered from 8am to 12pm every Saturday including one combined GP and practice nurse clinic once a month. Pre-bookable appointments can be booked up to six weeks in advance. 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.

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 was previously inspected under the new methodology on 20 October 2016 and achieved an overall rating of good but required improvement for providing well led services.

Updated 16 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blue Wing Family Doctor Unit on 11 November 2014. The practice was rated as requires improvement for providing safe and caring services and good for providing effective, responsive and well led services. The overall rating for the practice was requires improvement.

We carried out a follow up announced comprehensive inspection on 20 October 2016. The overall rating for the practice was good but required improvement for providing well led services. The full comprehensive reports for 11 November 2014 and 20 October 2016 inspections can be found by selecting the ‘all reports’ link for Blue Wing Family Doctor Unit on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 1 September 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 October 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 well led services and the overall rating remains as good.

Our key findings were as follows:

• The practice had a clear strategy and business plan to deliver the practice vision and values.
• The practice had developed a systematic programme of quality improvement including audit to assess, monitor and drive improved outcomes for patients.

We also reviewed the actions taken since the last inspection to the areas where we identified the practice should make improvement, some of which we had been addressed.

Our findings were as follows;

• The practice had implemented a written schedule and log for the cleaning of medical equipment.
• Protected time was allocated for nurse administration duties.
• Since our last inspection some improvement had been made to the number of patients the practice had identified and included on the carer’s register which had increased from 38 to 57 patients (0.5% to 0.7% of the practice list size). The practice had implemented additional processes to assist in the identification of patients who were carer’s, including promotion of information about support services available and posters displayed in the waiting area.
• Patient feedback about telephone access to the practice remained an on-going issue. Results from the national GP survey published July 2017 demonstrated that 33% of respondents found it easy to get through to the practice by telephone compared to the CCG average of 70%. This represented a 16% decrease in patient satisfaction of telephone access from the previous national GP survey results published in July 2016. The practice had remained dependent on the telephone hardware available in the building premises up until April 2017 when a new telephone system sourced by the practice had been installed. It was anticipated that the new system would improve patient telephone access experience. Patients were also encouraged to use on-line services to improve access to the practice and 22% of patients had registered for this. 
• Notices informing patients that translation/interpretation services were now displayed in the reception area.
• In addition the practice had considered and implemented the NHS England Accessible Information Standard to ensure that patients received information in formats that they can understand and receive appropriate support to help them to communicate.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Continue to review how carers are identified to ensure information, advice and support is made available to them.
• Continue to monitor patient satisfaction with making appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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

• The practice offered GP and nurse led review of patients with long-term conditions and these patients were invited to annual health checks including medication review. Medication reviews were also performed following a secondary care outpatient appointment attendance or hospital discharge. Longer appointments and home visits were available if required.

• QOF data 2014/15 showed the practice was better or similar to local and national averages for performance indicators relating to long term conditions.

• With patient consent the practice shared their care record with community services to avoid duplication of investigations and promote continuity of care.

• Patients with Chronic Obstructive Pulmonary Disease (COPD) were provided with rescue medicine packs in the event of an exacerbation to reduce the risk of unplanned hospital admission.

• The practice encouraged patient education and engagement with self-management of conditions through referral to local and national educational programs and support services. Patients were pro-actively referred or sign posted to local stop smoking services which were held in the same building that the practice was located.

• Regular multi-disciplinary team meetings with members of the community nursing and palliative care teams were held to discuss management and review care plans of patients with complex medical needs.

Updated 26 January 2017

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

• There was a named GP lead for safeguarding vulnerable children, staff had received role appropriate training and were aware of their responsibilities to raise concerns.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Children’s electronic records were linked to their parents to follow up in case of missed appointments or safeguarding queries.

• The practice offered routine antenatal, postnatal and child health surveillance services.

• Immunisation rates were similar to CCG averages for all standard childhood immunisations.

• Students were offered immunisations as per national catch-up programmes.

• The practice’s uptake for the cervical screening programme 2014/15 was 77%, which was similar 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.

Updated 26 January 2017

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

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

• Patients over the age of 75 years had a named GP to co-ordinate care and promote continuity.

• Home visits and longer appointments were available if required, including home visits for care planning and flu vaccinations.

• The practice carried out care planning for patients over the age of 75 years and those at risk of hospital admission. Patients were involved with the care planning process and they were regularly reviewed and updated.

• The practice actively referred older patients at risk of hospital admission to the local Integrated Community Response Service (ICRS) to support patients at home and reduce the risk of admission.

• Regular multi-disciplinary team meetings with members of the community nursing and palliative care teams were held to discuss management and review care plans of older patients with complex medical needs.

• The practice offered a variety of in-house services including phlebotomy and INR monitoring that reduced the need for patients having to travel to secondary care services.

Updated 26 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered extended hour appointments on Saturdays for patients unable to attend the surgery during normal working hours. Telephone consultations were also available in the morning and evening and the practice planned to trial Skype video consultations.

• There was the facility to book appointments and request repeat prescriptions online.

• Patients were able to receive travel vaccinations available on the NHS as well as those available privately.
• Health checks for new patients and NHS health checks for patients aged 40–74 were available with appropriate follow-up of any abnormalities or risk factors were identified.

Updated 26 January 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented in the record in the preceding 12 months was 95%, which was above the CCG and national averages of 88%.

• The practice carried out dementia screening and assessment opportunistically and for those at risk of dementia, with referral to local memory services if appropriate.

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

• The practice informed patients experiencing poor mental health how to access various support groups and voluntary organisations.

• Patients experiencing poor mental health were invited for annual health checks with longer appointments if required. Depot medication was provided by the practice for patients with some types of mental distress or illness.

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

Updated 26 January 2017

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

• There was a named GP lead for safeguarding vulnerable adults. 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 practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• Patients with a learning disability were invited for annual health checks with longer appointments if required. They provided easy read health check information if needed.

• The practice registered homeless patients and those living in temporary accommodation and proved care as required.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients how to access various support groups and voluntary organisations. For example, supporting patients with substance misuse issues through referral to the local drug and alcohol services.

• New patients registering with the practice were screened for possible alcohol dependency using a screening tool and were offered support and advice if required.