Dr Creme and Partners Also known as Paddington Green Health Centre

Updated 18 May 2016

Dr Purssell and Partners provides primary medical services through a Personal Medical Services (PMS) contract within the London Borough of Westminster. The practice is part of NHS Central London (Westminster) CCG. The services are provided from a single location, Paddington Green Health Centre to around 9,500 patients within the Church Street ward.

The practice serves a diverse population of registered patients. Church Street ward is one of the most deprived wards in England, yet sits next to affluent Little Venice where residents are also registered patients. The ethnic diversity of its patients is also wide, with significant proportions of Arabic (14%), Bangladeshi (11%) and African (9%) patients. There are a high number of patients registered who have severe mental health problems. 10% of those registered are unemployed, which is above the national average of 5%.

The practice is registered to carry on the following regulated activities: Diagnostic and screening procedures; Family planning; Maternity and midwifery services; Surgical procedures; and Treatment of disease, disorder or injury.

At the time of our inspection, there were 5.23 whole time equivalent (WTE) GPs comprising the four partner GPs (two female and two male), four assistant GPs (all female) plus one on maternity leave (0.45 WTE); a trainee Registrar GP (female - 1 FTE); a practice manager partner (1 WTE) assistant practice manager (1 WTE) and clinic manager (1 WTE). The practice also employed two practice nurses (both female, 2 WTE); a phlebotomist (0.47 WTE); and, a medical secretary, reception manager, four receptionists, a receptionist/administrator; a summariser, a document scanner and a handyman (a total of 7.45 WTE).

The practice is a teaching practice for GPs. Each year the practice has registrar and foundation year two (FY2) doctors working at the practice; the registrar was studying for a postgraduate qualification to become a general practitioner. The practice also taught medical students. There is a rota to ensure GP supervision of  learners at each of their sessions with patients.

The practice is open and offers appointments between 8.15am to 1.00pm and 2.15pm to 6.30pm. Monday to Friday. Extended surgery hours are offered between 6.30pm and 8.30pm Mondays and Tuesdays for booked appointments only. Routine appointments can be booked up to two weeks in advance, or within 48 hours, and urgent appointments are also available for people that need them. The practice offers daily telephone access between 8.00am and 6.30pm to named doctors for consultations, which enables patients to resolve problems without the need to come into the practice. The practice also offers an all-day emergency triage service; patients with an urgent need are assessed within hours of calling the practice and are offered telephone advice, a same day appointment or a future appointment, as appropriate.

There are also arrangements to ensure patients receive urgent medical assistance when the practice is closed. Out of hours services are provided by a local provider. Patients are provided with details of the number to call.

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Purssell and Partners on 3 March 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.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

We saw one area of outstanding practice:

The practice had developed a successful partnership with a local community trust. This was part of the practice’s strategy to attend existing patient groups outside the practice – to go to the patients. The practice has supported the group financially and practically to offer training to its members to give them the confidence to speak about their experiences of patient care and to be part of helping to improve it. There were plans for the trust to work with practice staff to help them to be aware of the different needs of patients from ethnically diverse backgrounds

The areas where the provider should make improvement are:

• Complete a written policy on safeguarding of vulnerable adults and arrange relevant formal training for all practice staff.
• Consider the completion of practice DBS checks for GPs, rather than relying upon the ‘GP Performers List’ for confirmation of such checks.
• When carrying out regular fire drills, identify in the evacuation reports who participated in the exercise and how long it took.
• Ensure arrangements in hand for the completion of outstanding staff appraisals are concluded by the end of the current reporting year.
• Advertise translation services are available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 May 2016

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

• The prevalence of patients with long term conditions such as Chronic obstructive pulmonary (COPD), diabetes, Chronic heart disease (CHD), and atrial fibrillation was above average for the CCG and reflected the social deprivation in the population locally.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. One of the practice nurses had respiratory expertise and undertook spirometry, asthma and COPD reviews.
• There was a twice weekly anticoagulation clinic for the practice’s patients and also patients from neighbouring practices.
• The practice performance for the majority of 2014/15 QOF indicators for long-term conditions was above average including diabetes related indicators.
• Longer appointments and home visits were available when needed.
• All these patients had a structured review at least annually with either the GP or nurse to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 18 May 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. The practice worked with the local Multi-Agency Safeguarding Hub (MASH) to provide information in a timely way.
• Immunisation rates were relatively high for all standard childhood immunisations.
• 78% patients with asthma, on the register, have had an asthma review in the last 12 months that includes an assessment of asthma control. This was comparable with the national average of 75%.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to 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. The practice provided child health surveillance with immunisations, baby clinics and regular multidisciplinary team meetings weekly with health visitors. The practice had a system of GP telephone triage of all acute requests for urgent or same day appointments, giving an opportunity for timely telephone advice and the ability to organise same day face to face assessments.
• The practice worked with local paediatricians to pilot and develop joint working. There was a monthly clinic at the practice for their patients, followed by a multidisciplinary team meeting. This subsequently evolved into the Connecting Care for Children initiative which had spread the model to CCGs in North West London.

Updated 18 May 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 provides support to patients living in supported housing who have complex needs.
• Regular 30 minute appointments are provided to elderly frail patients, in part to produce a more effective shared care plan with the patient, but also to deal with the multimorbidity problems of these patients and the fact that they need a more multidisciplinary intervention in order to stay well. These clinics may be held in the surgery or in the patient’s home according to need.
• There are weekly reviews of older people in the practice’s multidisciplinary team meetings and monthly at ‘village’ meetings (wider multidisciplinary team working across the immediate locality).
• The practice monitors admissions to hospital and ensures a review within 48 hours of discharge. They also make use of the local Rapid Response Nursing service to try and look after patients at home effectively and safely and if possible avoid hospital admission.
• The practice provides on the day telephone access to a clinician to all patients between 8.00am and 6.30pm, focussing in particular on the older patient group.

Updated 18 May 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 reflected the needs for this age group.
• There were two late evening surgeries weekly (6.30-8.30pm). The main surgeries started at 8.30am giving opportunities for early appointments for those who wished to attend before work. The practice also took regular telephone appointments.
• The practice offered NHS Health checks to 40-75 year olds and had had a good uptake, reaching 378 people.
• GP services were provided to the students from the Royal Academy of Music. The principal GP partner was an associate member of the British Association of Performing Arts Medicine and had expertise in diagnosing and treating performance related injuries. These patients were offered same day appointments and the practice worked regularly with the counsellor and teaching staff at the Academy to improve the service.

Updated 18 May 2016

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

• 73% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%. However QOF performance for mental health related indicators as a whole was above the CCG and the same as the national average.
• The practice had in-house counsellors and hosted the Improving Access to Psychological Therapies (IAPT) team within the building, with whom they discussed patients in the MDT setting They also worked closely with the psychiatry team for those patients with behavioural problems
• The practice carried out advance care planning for patients with dementia. Under a new local service from the CCG, the practice was organising an improved service with regular review, working with the local psychiatric primary care liaison nurse to provide a better quality of care plan, and also address physical health.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. There was 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. Staff had received dementia awareness and Mental Capacity Act training. The practice had identified 72 patients with dementia and referred them to the Memory Clinic for diagnosis as appropriate.
• The practice had undergone a dementia awareness audit and would shortly be introducing improved signage and patient friendly décor as part of their action plan.

Updated 18 May 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 homeless people, and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and carried out annual health checks on them.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Carers were identified and offered a connection to the local Carer’s’ Network, as well as influenza immunisation.
• The practice worked with two local hostels, mental health and alcohol teams to identify and support homeless people. They also worked with outreach workers for a small number of patients with Drug and Alcohol issues. This included substitute opiate prescribing, seeing them with the outreach worker on a fortnightly basis.
• 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.