Acre Surgery

Updated 17 March 2017

Acre Surgery is a single location practice which provides NHS primary care services to approximately 4,800 patients living in the Northwood area through a Primary Medical Services (PMS) contract. The practice occupies Northwood Health Centre which it shares with two other practices and is part of Hillingdon Clinical Commissioning Group (CCG). There are above average numbers of patients in the age ranges 0-14 and 30-39.

The practice staff comprises one male and one female partner (providing 10.5 clinical sessions per week) and four female salaried GPs (providing six clinical sessions per week). The clinical team is supported by a part-time practice nurse, two part time healthcare assistants, a part-time practice/business manager, a medical secretary, senior receptionist and six reception/administrative staff and a pharmacist/travel advice specialist.

The practice is open and appointments are available between 8.30am and 6.30pm Monday, Tuesday, Thursday and Friday, and between 8.30am to 2pm on Wednesday. Extended hours appointments are offered every Saturday. In addition to pre-bookable appointments that can be booked up to two weeks in advance, urgent appointments are also available for people that needed them.

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.

The practice is registered with the Care Quality Commission to carry on the following regulated activities:

Diagnostic and screening procedures

Family planning

Maternity and midwifery services

Treatment of disease, disorder or injury

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acre Surgery on 20 December 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.
• The majority of 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 adequate 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 had analysed and process-mapped existing processes such as patient registration, prescription requests chronic disease monitoring and made changes and efficiencies. For example, enabling the practice to align blood tests due for different chronic conditions and link this to the repeat prescription process. In addition the practice organised annual external facilitator-led team retreats which focused on enhancing the efficiency of the practice, improving patient satisfaction and optimising staff teamwork and collaboration. Staff commented positively on the value of the retreat in a post-event survey.

The areas where the provider should make improvement are:

• In carrying out regular checks of emergency equipment record which items have been checked.
• Continue to review national GP patient survey data to identify and implement areas for improvement.
• Engage more directly with the Patient Participation Group (PPG) and promote its activities to encourage wider patient membership.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2017

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, 89% compared to 90%. There were comprehensive follow up and recall procedures for diabetic patients, including eye screening and foot care.
• One of the lead GPs provided insulin initiation in the management of type two diabetes under the diabetes management local enhanced service scheme.
• The practice was the designated centre for 24-hour ambulatory blood pressure monitoring for 16 practices in North Hillingdon. One of the lead partners was the clinical cardiology lead for the CCG.
• There were structured asthma reviews with nursing staff and ongoing medication management reviews to identify high inhaler use.
• There was active screening of patients with shortness of breath and multidisciplinary reviews with a heart failure nurse.

Updated 17 March 2017

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 practice’s uptake for the cervical screening programme was 72%, which was lower than the national average of 82%. The practice was taking steps to improve uptake.
• 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.
• There was structured antenatal and post-natal care together with a full range of child healthcare services.
• Advisory services were offered on all aspects of family planning and contraception.

Updated 17 March 2017

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. Visits were prioritised around relatives’/carers’ availability to ensure good communication.

• 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 a CCG employed primary care navigator who collaborated with other teams to monitor outcomes and facilitate multidisciplinary care, including joint working between health and social care professionals.
• 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.

• Patients were offered specialised palliative and end of life care services through utilisation of a GP in the practice who was the CCG lead for palliative care.
• The practice was part of the metro health network multidisciplinary group where case management of complex high risk patients was discussed.

Updated 17 March 2017

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 Saturday morning clinic for working patients who could not attend during normal opening hours.
• The practice also provided extra doctor-led influenza vaccine clinics on some Saturdays and Sundays between September and November.

Updated 17 March 2017

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

• 92% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84%.
• Overall performance for QOF mental health related indicators was comparable to the national average: 90% compared to 93%.
• 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. From hospital or A&E letters the practice ensured all patients with episodes of deliberate self-harm or attempted suicide were discussed in clinical multidisciplinary team meetings.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice facilitated telephone access to the local ‘talking therapies’ counselling service.

Updated 17 March 2017

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.
• There was telephone follow up for patients on the unplanned admissions register who have had a hospital admission/A&E attendance.
• 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.