Acrefield Surgery

Updated 17 November 2016

Acrefield Surgery is located at 700 Field End Road, Ruislip HA4 0QR. The practice provides NHS primary care services to approximately 2,600 patients living in the Ruislip area through a General Medical Services (GMS) contract (a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice operates from a converted end terrace property with access to two consulting rooms on the ground floor. The first floor is accessed via stairs. At the time of our inspection the practice were awaiting approval from a premises improvement grant application to add an additional consulting room, reconfigure the ground floor and make adaptations in line with the Disability Discrimination Act (DDA).

The practice is part of Hillingdon Clinical Commissioning Group (CCG) which consists of 48 GP practices.

The practice has a larger than average proportion of adults on its patient list in the age ranges 30-39 and 40-49.

The practice is registered as an individual with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services; and family planning.

The practice staff comprises one male and one female partner (totalling five clinical sessions per week) and two female salaried GPs (totalling four clinical sessions per week). The clinical team is supported by a part-time practice nurse and healthcare assistant, a part-time practice manager, a medical secretary and four receptionists.

The practice premises are open from 8.30am to 6.30pm Monday, Tuesday, Wednesday and Friday and from 8.30am to 1.30pm on Thursday. Extended hours are provided on Monday and Tuesday from 6.30pm to 7.30pm.

The practice provides a range of services including chronic disease management, smoking cessation, sexual health, cervical smears and childhood immunisations and travel advice and immunisations.

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

The practice is part of a 16 GP consortium (MetroHealth) in North Hillingdon working together to provide greater access for patients and providing services closer to a patient’s home and where possible, outside of a hospital setting.

Updated 17 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acrefield Surgery on 13 October 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to get an appointment 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.

We saw one area of outstanding practice:

We saw evidence that the partners drove continuous improvement and staff were motivated to participate in change. There was a clear proactive approach to seeking out and embedding new ways of delivering the service. For example, the practice participated in Productive General Practice (PGP), an organisation-wide change programme, developed by the NHS Institute for Innovation and Improvement which supports general practices to promote internal efficiencies, while maintaining quality of care. The practice shared with us several examples of positive impact on patient care and experience. For example, aligning annual blood recall for each chronic disease for patients with multiple co-morbidities and coordinating with the repeat prescribing process which resulted in integrated continuity of care, reduced the frequency of attendance at the surgery and provided better appointment efficiency for the practice. All staff we spoke with told us this had been a worthwhile exercise, had provided an insight into how their contribution to a process impacted on other members of the team and had, overall, improved efficiency. The practice additionally organised annual external facilitator-led team retreats which focussed on enhancing the efficiency of the practice, improving patient satisfaction and optimising staff teamwork and collaboration. Comments from a post-event staff survey included ‘very inspiring and informative’ and ‘very good everyone got their say’.

The areas where the provider should make improvement are:

• Ensure there is an effective system to track blank printer prescriptions through the practice in line with national guidance.
• Continue to review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Consider improving communication with patients who have a hearing impairment and how people who use the accessible toilet facility would alert staff in the event of an emergency.
• Undertake a health and safety risk assessment of the practice premises and display an appropriate warning sign on the door where the oxygen cylinder is stored.
• Develop an ongoing audit programme that demonstrates continuous improvements to patient care.
• Ensure all staff have completed all identified mandatory training, specifically fire awareness and infection control.
• Develop a system to monitor patients referred via the two-week wait referral pathway and consider providing patients referred with information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 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.
• 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 similar to the national average. 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 82% (national average 78%).
• The practice provided extra doctor-led influenza vaccine clinics on some Saturday and Sundays between September and November for its long-term condition cohort.
• One of the lead GPs provided insulin initiation in the management of type two diabetes under the diabetes management local enhanced service (schemes agreed by commissioners in response to local needs and priorities, sometimes adopting national service specifications).
• The practice was the designated centre for 24-hour ambulatory BP monitoring for 16 practices in North Hillingdon. One of the lead partners was the clinical cardiology lead for the CCG.
• The practice had installed a ‘Surgery Pod’ in the waiting room. This enabled patients to measure their own vital signs, including blood pressure. The information gathered was integrated into the practice’s clinical system.

Updated 17 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 comparable to national averages for standard childhood immunisations.
• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was above the national average (practice 86%, national 75%).
• The practice’s uptake for the cervical screening programme was 76%, 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, health visitors and school nurses.

Updated 17 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.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice referred patients to H4All (a free health & wellbeing service for Hillingdon residents aged 65 and over in need of support to better manage long-term health conditions, frailty and social isolation).
• The practice utilised the local primary care navigator (supporting patients in the high risk care group take an active role in supporting the management of their care and social needs and working towards self-care) in its management and care of elderly patients.
• The practice provided extra doctor-led influenza vaccine clinics on some Saturday and Sundays between September and November for its elderly cohort.
• The practice utilised the Coordinate My Care (CMC) personalised urgent care plan developed to give people an opportunity to express their wishes and preferences on how and there they are treated and cared for. One of the partners was the Macmillan GP End of Life Care (EOLC) Lead for Hillingdon.

Updated 17 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.
• The practice offered a ‘Commuter’s Clinic’ on Monday and Tuesday from 6.30pm to 7.30pm for working patients who could not attend during normal opening hours. The practice also provided extra doctor-led influenza vaccine clinics on some Saturday and Sundays between September and November for working patients within the long-term condition cohort.

Updated 17 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 above the national average. For example, 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 94% (national average 88%).
• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 100% (national average 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 and 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 17 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 and 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.