The Mill Hill Surgery

Updated 15 August 2016

The Mill Hill Surgery is a well-established GP practice situated within the London Borough of Ealing. The practice lies within the administrative boundaries of Ealing Clinical Commissioning Group (CCG) and is part of the Ealing GP federation and a member of the Acton GP network within Acton and Central Ealing locality. The practice is an approved training practice for GP specialist trainees (GP Registrars).

The practice provides primary medical services to approximately 7,500 patients and holds a core General Medical Services Contract and Directed Enhanced Services Contracts. The practice is situated at 111 Avenue Road Ealing in the Mill Hill Park conservation area, with good links by bus and train transport services.

The practice operates from converted leasehold premises which the GP partners are responsible for repair. There are eight consultation rooms and one isolation room on the ground floor of the premises. The reception and waiting area are on the ground floor with ramp access to the entrance and rear of the building. There are accessible toilet facilities for people with disabilities and off site car parking in the surrounding residential area.

The practice population is ethnically diverse and has a higher than the national average number of patients between 0 to 14 years of age and between 25 and 44 years of age. There is a lower than the national average number of patients 55 years plus. The practice area is rated in the third 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.

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 male and four female GP partners, one female salaried GP who collectively work a total of 31 clinical sessions and a male GP registrar who works seven supernumerary sessions a week. They are supported by two practice nurses, two health care assistants, a practice manager and eight administration/reception staff.

The practice is open from 8.30am to 6.30pm Monday, 8.00am to 6.30pm Tuesday, Thursday and Friday and from 8.00am to 1.00pm on Wednesday. The practice is closed between 1.00pm to 2.00pm on Tuesday for staff training. Extended hour appointments are offered from 7.00am to 8.00am on the first Wednesday of every month and from 8.00am to 11.00am on alternate Saturdays. Consultations are offered daily from 9.00am to 11.30am Monday to Friday and from 3.00pm to 6.00pm Monday, Tuesday, and Thursday and from 2.30pm to 6.00pm on Friday. Appointments with the practice nurses and healthcare assistants are also offered daily from 9.00am to 11.30 am and from 2.00pm to 4.00pm with the exception of Wednesday afternoon.

The practice provides a wide range of services including chronic disease management, antenatal and postnatal care and over 75’s health checks. The practice also provides health promotion services including, cervical screening, childhood immunisations, contraception and family planning.

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Mill Hill Surgery on 12 April 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, with the exception of managing some medical emergencies and control of substances hazardous to health.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they felt the practice offered an excellent service and staff were helpful, friendly, caring, professional and treated them with dignity and respect
• 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.
• Patients said they found it easy to make an appointment with a named GP and 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.

The areas where the provider should make improvement are:

• Undertake a formal risk assessment for not having a defibrillator for use in a medical emergency.
• Undertake risk assessments for the control of substances hazardous to health (COSHH) and for looped cord window blinds installed.
• Ensure that separate receptacles are available for the disposal of sharps used to administer live vaccines.
• Implement a system to monitor and track the distribution of prescription pads kept at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 August 2016

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

• The practice ran nurse and GP led chronic disease clinics and patients were invited for annual health checks including medication review.

• QOF data for 2014/2015 showed the practice was performing at local and national averages for indicators related to chronic disease, for example in diabetes and hypertension.

• Longer appointments and home visits were available when needed.

• There were named clinical leads for a variety of chronic conditions, including diabetes, heart disease and asthma. Staff in these roles had received additional training to support in their chosen area.

• The practice engaged in local enhanced services to identify patients with long-term conditions at risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk.

• A dietician was employed by the practice and provided lifestyle advice to those with long-term conditions and also those at risk of developing a chronic condition.

• The practice held regular multi-disciplinary team meetings with district nurses and the community palliative care team to discuss the management of patients with complex medical needs.

Updated 15 August 2016

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.
• The practice had a higher than average number of patients below 14 years of age in their practice population and planned their services accordingly to meet their needs. They ran a daily children’s clinic from 11am to 12.00pm and any acutely unwell children were added to the list and seen on the day.
• The practice offered shared ante-natal care with the community midwives and performed routine post-natal mother and baby checks.
• Uptake rates for childhood immunisations were above local CCG averages.
• The practice had support from the Children’s and Adolescents Mental Health Services (CAMS) when managing young patients experiencing mental health issues and they referred to the local Service for Adolescents and Families (SAFE) if required.
• The practice offered well woman and family planning services, including fitting of long term contraceptive devices. Cervical screening uptake rates were in line with national averages.
• The practice had a weekly visiting health advocate from a local female genital mutilation (FGM) charity to encourage and support women through translation, to engage with the cervical screening programme and to assist in the onward referral to FGM clinics where the need was identified.

Updated 15 August 2016

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

• The practice had a named lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.
• They created chronic visit sessions for all GP partners that allowed housebound patients to receive health reviews at home by a GP who knew them well to address chronic disease issues and update care plans.
• The practice engaged in local enhanced services to identify older patients at risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk.
• They provided primary medical services to a local residential care home with one of the GP partners taking a leading role in providing medical care to the residents to maintain continuity.
• The practice held regular multi-disciplinary team meetings with district nurses and the community palliative care team to discuss the management of older patients with complex medical needs.
• Longer appointments were available for care plan reviews and for older patients with complex medical conditions.

Updated 15 August 2016

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

• The practice offered extended hour surgeries on the first Wednesday of every month and on alternate Saturday mornings for patients who were unable to attend the practice in normal working hours. Telephone consultation appointments were also available daily.

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

• The practice nurses offered travel advice and travel vaccination as required.

• The practice offered NHS health checks for patients aged 40 –74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.

Updated 15 August 2016

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

• One hundred per cent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.

• Alerts were placed on a patients electronic records if they were at risk of dementia. They used the GP Cognition Assessment Test (GPCOG) to screen patients at risk of dementia with referral on to local memory services if required. The integrated care plan template used by the practice also included a section on screening for dementia to prompt discussion when reviewing these patients.

• QOF data from 2014/2015 showed the practice was performing in line with local and national averages for performance indicators relating to mental health.

• The practice participated in the local Shifting Settings of Care scheme that facilitated the transition of patients with stable mental health conditions discharged from secondary care back to primary care services. They had a primary mental health worker who attended the practice to review these patients and provide support to the clinicians managing their conditions.

• The clinical team attended educational sessions offered by the community mental health team to keep up to date with local policies and new guidance.

Updated 15 August 2016

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

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

• The practice had participated in a scheme with a local homeless charity to provide healthcare for patients with no fixed abode. They allowed these patients to use the practice address for registration to facilitate hospital communications and appointments.

• They registered patients from a local women’s refuge to provided medical care if required.

• They maintained a register of patients with learning disabilities and they were offered annual health checks with extended appointments.