Archived: The Windmill Medical Practice

Updated 5 May 2016

The Windmill Medical Practice provides NHS primary medical services to around 7200 patients in the Cricklewood and Kilburn areas of North West London, through a General Medical Services contract. The catchment area of the practice crosses three local authorities Brent, Barnet and Camden. The practice provides services from a single surgery.

The current practice staff team comprises four GP partners (male and female), a practice nurse, part-time phlebotomists and health care assistants, a practice manager and a team of receptionists and administrators.

The practice is open between 8.00am-6.30pm on weekdays, closing for lunch between 12:30pm and 1.30pm. Appointments are available morning and afternoon. The practice also offers extended hours opening from 7.00am on Wednesday morning, and until 7.30pm on Monday evening. The GPs undertake home visits for patients who are housebound or are too ill to visit the practice.

When the practice is closed, the practice has arranged for patients to access an out-of-hours primary care service. Patients ringing the practice when it is closed are provided with recorded information on the practice opening hours and instructions to call the “111” telephone line for directions on how to access urgent and out-of-hours primary medical care or, what to do in an emergency. This information is also provided in the practice leaflet and on the website. The practice also includes information on local urgent care centres and the local network ‘hub’ practices which offer appointments in the evening and at weekends.

The practice has a higher than average proportion of adult patients in the 20-44 age range. The proportion of babies and very young children is in line with the English average. The practice has fewer patients over 65compared to the national average 9.8% compared with national average 16.5%.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder and injury.

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Windmill Medical Practice on 4 November 2015. 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. The provider was aware of and complied with the requirements of the Duty of Candour.
• 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 was well equipped to treat patients and meet their needs. However, space within the practice was limited and acted as a constraint on expansion. The practice was aiming to relocate in the long term.
• 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.

There is one area where the provider should make an improvement:

• The practice should develop its failsafe systems to alert the doctors within a set period when prescriptions remain uncollected.

We saw one area of outstanding practice:

• The practice partners had identified good access to primary care as a priority and one of their ‘guiding principles’. One of the GP partners had developed a software programme to monitor patient access. The practice used this to predict changes in patient demand (using a ‘traffic light’ system for easy interpretation) and to plan the clinical staffing accordingly. The practice manager also reviewed the availability of appointments daily. The GPs put on additional clinical sessions when demand was rising to prevent delays from building up. Additional sessions were seen as a shared responsibility and allocated fairly between the partners. As a result, practice patients could obtain routine appointments within two to three days. The practice received excellent patient feedback on the accessibility of the service. For example, the national GP patient survey showed that the practice scored in the top 10% of practices nationally and the top five per cent of London practices for patients describing the experience of making an appointment as good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 May 2016

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

• Patients with long-term conditions had a named GP and a structured annual review to check their health needs were being met.
• The practice carried out care planning with patients with complex needs and at risk of unplanned hospital admission and worked with other health and social services professionals to deliver coordinated care. The practice had designed its own care plan template for diabetes.
• All the doctors had lead roles in chronic disease management being responsible for each of the various QOF areas. The practice nurse had a specialist respiratory disease qualification and had identified patients with previously undiagnosed COPD (chronic obstructive pulmonary disease) and two of the GPs had diabetes diplomas.
• The prevalence of diabetes was high in the local area. Practice performance for diabetes related indicators was similar to the national average. For example, the percentage of patients with diabetes, on the register, whose blood sugar levels were well controlled (ie their last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months) was 75%.
• Longer appointments and home visits were available when needed. The practice had dedicated appointments at the end of each surgery with no time limit for patients with chronic conditions or complex needs.

Updated 5 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, for example, children and young people who had a high number of A&E attendances.

• The practice was consistently achieving higher child immunisation targets.
• The practice offered a weekly walk-in baby clinic.
• The practice had extended the appointments for primary vaccinations since introduction of the Meningitis B vaccination.
• 74% of patients diagnosed with asthma had an asthma review in the last 12 months (national average 75%).
• Access to care was good. Appointments were available outside of school hours. Young children were always seen the same day.
• We saw examples of joint working and timely communication with health visitors.
• The practice had carried out an audit of the quality of its ‘safety netting’ for child consultations.

Updated 5 May 2016

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

• Older patients were allocated a named GP and the practice provided continuity of care.
• Older patients assessed to be at greatest risk, for example housebound patients, had individual care plans. One of the partners had designed a protocol for housebound patients (which included consideration of continence, foot health and social care needs) and designed the care plan template used by the practice. We viewed a number of care plans which had been well completed and were up to date.
• The practice provided a range of vaccinations for older patients such as shingles, pneumococcal and flu vaccination. The practice achieved its over 65 flu vaccination target in 2014/15.
• The practice team held monthly multidisciplinary meetings with district nurses, the local care co-ordinator and palliative care nurse and the local pharmacist.
• The practice engaged with local community services including an 'out of hospital' service to manage sudden deteriorations and prevent unplanned emergency hospital admissions.

Updated 5 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 available outside of working hours. Weekend and evening primary care services were also available through the local ‘hub’ network service.

• The practice offered online appointments, repeat prescriptions and email communication with the doctors. Telephone consultations were easily available to assess whether a face-to-face consultation was required. The practice website included up-to-date information about its services on its website.
• The practice provided a wide range of health promotion, travel advice and screening reflecting the needs for this age group. These services were available during extended hours. The practice did not offer routine screening for HIV for new patients.
• Practice patient uptake for the cervical screening programme was high at 81%. The practice had implemented its own call and recall system to improve uptake further.

Updated 5 May 2016

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

• The practice provided dementia screening with referral to specialist services for patients meeting the criteria.
• 83% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• The practice regularly worked with multi-disciplinary teams and the local dementia nurse in the case management of people experiencing poor mental health, including those with dementia.
• 95% of patients with diagnosed psychosis had a documented care plan in the last 12 months.
• 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.
• The reception team were seen as an integral part of the service for patients with enduring mental health problems. For example, patients were welcomed if they came in to the reception for a chat. We were given examples of how the reception staff had picked up on signs that patients they knew were becoming unwell and had alerted the doctors.
• The practice signposted patients to the IAPT (Improving Access to Psychological Therapies) programme, counselling and online support for mental health issues.

Updated 5 May 2016

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

• The practice offered longer appointments for patients with a learning disability or other complex needs. The practice had a good track record of carrying out annual health reviews with patients with learning disability.
• The practice welcomed patients regardless of their circumstances. The practice registered patients from a local refuge, a probation hostel and children from a local care home. The reception team knew the more vulnerable patients and responded sensitively.
• Vulnerable patients were supported to register at the practice, for example patients at risk of serious harm were able to register without an identifiable address.
• All staff were involved in team meetings to review ongoing safeguarding concerns. The whole staff team demonstrated good awareness of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. We saw recent examples where staff had raised concerns about children and vulnerable adults to ensure they were protected from abuse.
• The practice kept a register of carers and assessed their needs. The practice informed carers how to access support groups and voluntary organisations, for example the local carers association.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.