Archived: Aksyr Medical Practice

Updated 11 October 2017

Aksyr Medical Practice provides NHS primary medical services to around 3100 patients in the Stonebridge and Harlesden areas of North West London through a general medical services contract. The practice is part of the Harness network of 24 GP practices in Brent.

The practice partnership provides services from two locations: Aksyr Medical Practice and Preston Hill Surgery which is located around four miles away in Kenton. The local practice populations have markedly different socio-economic and demographic profiles. The Aksyr Medical Centre practice population is multicultural, with a higher proportion of young adults and is characterised by high levels of income deprivation, unemployment and lower average life expectancy.

The practice as a whole is run by three GP partners. The team based at Aksyr Medical Centre comprises one of the GP partners supported by two long term locum GPs, an advanced nurse practitioner, a practice nurse, a health care assistant, a practice manager and a team of administrators and receptionists. The GPs typically provide 13 clinical sessions in total per week. A choice of male or female GPs is available.

The practice is open between 9am and 7pm on Monday, Tuesday, Wednesday and Friday and between 9am and 1pm on Thursday. Extended hours surgeries are offered on Tuesday from 7pm to 7.30pm.

Appointments are typically available from 9.30am to 12.30pm and between 3.30pm and 7.00pm depending on the individual GP. The GPs also undertake home visits for patients who are housebound or are too ill to visit the practice.

The practice provides recorded information on the opening hours and instructions on how to contact the out of hours provider or the NHS 111 service. This information is also provided in the practice leaflet and on the website. The practice informs patients about the local urgent care centre and ‘hub’ practices which offer primary care appointments in the evening and at weekends.

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

This inspection report focuses on the service provided at Aksyr Medical Practice which is registered with the Care Quality Commission as a distinct location.

Updated 11 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Aksyr Medical Practice on 10 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Aksyr Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 10 August 2017. We found that improvements had been made since the previous inspection and the practice was meeting the regulations which it had previously breached. Overall the practice is now rated as good.

Our key findings across all the areas we inspected were as follows:

• The practice had reviewed its approach to safety and had systems in place for reporting and recording significant events. The provider was aware of the requirements of the duty of candour.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. At this inspection we found the practice had reviewed its policies and procedures and made changes where required.
• Staff were aware of current evidence based guidance. Staff had been trained and had the skills and knowledge to deliver effective care and treatment.
• Patient feedback showed that patients were treated with compassion, dignity and respect. The practice tended to score below average for patient involvement in decisions about their treatment however.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was good continuity of care. Urgent appointments were 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 areas where the provider should make improvement are:

• The practice should aim to increase its care planning with patients with mental health problems who could benefit from this approach.
• The practice should review patient feedback on involvement in decision making with the aim of improving in this area.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 11 October 2017

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

• The practice maintained registers of patients with long-term conditions. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The GPs, practice nurses and health care assistant had clearly defined roles in long term disease management.
• The practice followed up on patients with long term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• The practice provided a phlebotomy service so patients did not need to be referred elsewhere. The practice had also introduced spirometry testing since our previous inspection, facilitating more efficient diagnosis of certain respiratory conditions.
• The practice had a high incidence of diabetes. Performance for some diabetes related indicators was below the CCG and national averages. In 2015/16, 66% of diabetic patients had blood sugar levels that were adequately controlled compared to the CCG average of 77%. The practice exception reporting rate was 5% for this indicator which was below the national rate of 13%.
• The practice offered regular diabetic clinics, patients had access to an attached diabetic specialist nurse and the practice offered insulin initiation for eligible patients. The nurse practitioner liaised with the local diabetic team who were running outreach sessions in the community to improve patient understanding and self management.

• For patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. For example, the practice held a monthly meeting with the community nurses and attended locally organised multidisciplinary meetings such as the complex patient management group.

Updated 11 October 2017

The practice is rated as good for the care of families, children and young people.

• The practice provided antenatal and postnatal services and liaised with the local family nurse programme which supported younger mothers.
• Immunisation rates were high for standard childhood immunisations. The practice encouraged pregnant women to have the flu and pertussis vaccinations (whooping cough). The practice also offered appropriate vaccinations to children staying longer term in a local mental health unit. 
• Appointments were available outside of school hours and the premises were suitable for children and babies, for example with baby changing facilities and access to a private space for breastfeeding if required.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• There were systems 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 accident and emergency (A&E) attendances.

Updated 11 October 2017

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

• The practice offered personalised care to meet the needs of the older patients in its population, for example by developing integrated care plans for older patients with more complex needs.
• The practice referred patients with the greatest health care needs to the local Complex Patient Management Group. The group's meetings were held monthly and attended by social care coordinators, social workers, district nurses, local GPs, and secondary care hospital consultants including a psychiatrist.
• The practice was aware of the range of local community services and resources (including urgent mobilisation) available to support older patients at home such as STARRS (the Brent short term assessment, reablement and rehabilitation service).
• The practice was responsive to the needs of older patients, and offered home visits and priority appointments when appropriate.
• The practice followed up older patients discharged from hospital or following an A&E attendance and ensured that their care plans were updated to reflect any extra needs.
• The practice provided preventative advice and services for older patients and carers including influenza and shingles vaccination.
• The practice identified patients in need of palliative care and encouraged early discussion about end of life choices. Palliative care was supported by community nurses,  Macmillan nurses and a local hospice.

• Staff were able to recognise the signs of abuse in vulnerable older patients and knew how to escalate any concerns.

Updated 11 October 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 available outside of working hours.
• The practice offered online services, telephone consultations, email contact and a text messaging reminder service.
• The practice provided a full range of health promotion and screening reflecting the needs for this age group, including the meningitis ACWY vaccination for young people attending university.
• Practice patient uptake for the cervical screening programme was 80% and in line with the national average.

Updated 11 October 2017

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

• In 2015/16, 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the local and national averages.
• The practice liaised with the community dementia nurse specialist and carried out advance care planning for patients with dementia. The practice involved patients and carers in care planning.
• In 2015/16, 66% of patients with a diagnosed psychosis had a comprehensive care plan in their records. This was below the local and national averages.
• The practice told us that some patients were reluctant to engage with formal health services. The practice was able to demonstrate it offered a range of services for these patients, for example referring patients to culturally appropriate counselling support with drug and alcohol misuse.
• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, for example the community mental health team; the home treatment team and child and adolescent mental health services.
• The practice had a system in place to follow up patients who had attended accident and emergency for example for self-harm or who were known to have mental health problems. Patients on the mental health register had priority access to appointments.
• The practice was able to signpost patients experiencing poor mental health to various support groups and voluntary organisations.

Updated 11 October 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 homeless people and those with a learning disability. Vulnerable patients were supported to register at the practice.
• The practice offered longer appointments for patients with a learning disability or other complex needs.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations, for example the local carers associations.
• 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.
• The practice offered a shared care service for patients with substance misuse problems.
• Practice staff had been trained about female genital mutilation and were aware of locally available resources for affected or 'at risk' women and girls.