GP at hand

Updated 21 May 2019

GP at Hand is located at 139 Lillie Road, Fulham, London, SW6 7SX. The practice is situated within the Hammersmith and Fulham Clinical Commissioning Group (CCG) and provides services to approximately 43,000 patients under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community. The practice’s list of patients has grown significantly and rapidly due to the practice’s use of the ability to register patients from out of their practice area. This was done in agreement with Hammersmith and Fulham CCG.

The practice provides a digital-first service whereby patients’ first contact is via an online GP consultation using a mobile phone application or website. Following an online GP consultation, depending on the outcome, patients are advised to book through the practice’s support centre, a face to face consultation with a GP or other healthcare professional either at the main Lillie Road site or at a choice of four other locations across London.

The digital service is provided through a subcontract with Babylon Healthcare Limited, 60 Sloane Avenue, Chelsea, London, SW3 3DD. The mobile application provided by the subcontractor also includes a symptom checker. The symptom checker does not triage patients, it is an optional tool that provides health information, rather than a prerequisite for accessing online GP consultations. The symptom checker software is regulated as a class one medical device and registered with the Medicines and Healthcare Regulatory Agency (MHRA).

Since November 2017, when the practice developed from a traditional GP practice to a digital-first service, a rapid increase in new patient registrations has taken place under the NHS England patient choice scheme (the patient choice scheme allows GP practices to register new patients who live outside the practice area, without any obligation to provide home visits or out of hours services when the patient is unable to attend their registered practice).

To be eligible to register with the practice, a person must live or work in London zones 1-3 (within 40 minutes of one of the five London locations). To complete registration a person must de-register from their current GP practice. For legacy patients (existing patients who prefer to continue with a traditional GP service), a subcontract is in place with a local GP practice called Dr Jefferies and Partners located at 292 Munster Road, Fulham, London, SW6 6BQ. There are approximately 4,000 legacy patients managed by the subcontract.

The practice has three male GP partners and a female business partner. There are five GPs directly employed by the practice who provide face to face consultations at the main location at Lillie Road and approximately 140 GPs provided through the Babylon subcontract who carry out online consultations remotely. The subcontracted GPs also provide face to face consultations from the locations in London. Face to face GP, nurse, healthcare assistant and phlebotomy appointments are booked directly through a central support team that can be accessed 8am to 10pm seven days a week. Additional staff including GPs, pharmacists, nurses, healthcare assistants, pharmacists, phlebotomists are provided through the subcontracts. The senior management and governance teams are provided by the Babylon subcontract and report directly to the GP at Hand partnership.

There is an additional subcontract in place with a home visiting service for patients living in London. The home visiting service is available seven days a week to 11pm.

The practice’s list of patient groups shows that 98.5% of registered patients are of working age (20-64 age group), 10.6% are people with long-term conditions, 0.7% are older people, 0.2% are people whose circumstances may make them vulnerable, 0.7% are people experiencing poor mental health and 1.3% are families, children and young people. The practice has a low prevalence of chronic disease compared to the England average except for mental health (0.8% compared to 1%). The patient population is of mixed ethnicity with 31% of British origin.

The practice opening hours of the main location at Lillie Road are Monday to Friday 8am to 6.30pm. The opening hours of the four other London locations providing face to face appointments varies with two of the locations providing extended hours to 8pm and three of the locations providing weekend opening. Online consultations are available 24/7, 365 days a year. For out of hours services patients are signposted to local out of hours services.

Services provided include cervical smear tests, childhood immunisations, travel vaccinations, electrocardiogram (ECG), 24-hour ambulatory blood pressure monitoring, NHS health checks, long-term condition management, blood tests, ear syringing and wound care.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, family planning, maternity & midwifery services, surgical procedures, treatment of disease, disorder or injury, and transport services, triage and medical advice provided remotely.

Updated 21 May 2019

We carried out an announced comprehensive inspection at GP at Hand on 30 and 31 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall, with a rating of requires improvement for providing effective services.

We rated the practice as good for providing safe care because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen.
• When incidents did happen, the practice evidenced that they had learned from them and improved their processes.

We rated the practice as requires improvement for providing effective care because:

• Performance for childhood immunisations was significantly below the World Health Organisation (WHO) minimum target of 90%.
• Uptake of the practice’s cervical screening programme was significantly below the target 80% coverage and bowel and breast cancer screening rates were below local and national averages.
• Quality improvement activities demonstrating improvements in the quality of care patients received was limited.

We rated the practice as good for providing caring services because:

• Patients reported that they were treated with kindness, respect and compassion.
• The practice respected patients’ privacy and dignity.

We rated the practice as good for providing responsive services because:

• Patients found the appointment system for booking online consultations easy to use and reported that they were able to access care when they needed it. Although, some patients reported delays with face to face appointments and getting through to the support centre by phone.
• Patients told us they did not always receive their referrals and test results in a timely way. However, there was clear evidence that the practice had taken action to improve workflow processes in relation to these.
• The practice had appropriate facilities and was equipped to treat patients and meet their needs.
• Complaints were handled in a timely way.

We rated the practice as good for providing well-led services because:

• The practice had strengthened leadership and governance with the implementation of a subcontracted senior management team. There was strong and visible clinical and managerial leadership and governance arrangements.
• There was evidence of a strong focus on continuous learning and improvement at all levels of the organisation.

Whilst we found no breaches in regulations, the provider should:

• Strengthen links with health visitors and other agencies to ensure vulnerable children are helped, supported and protected.
• Review two week wait referral processes to ensure patients are being followed up.
• Improve the quality of clinical assessment record keeping for face to face consultations.
• Implement a system to ensure individual patients who may have particularly worrying symptoms are followed up to ensure further tests or investigations are done.
• Develop quality improvement activities to improve outcomes in the quality of care patients receive.
• Review staffing numbers to meet the increasing demand for travel vaccinations, long-term condition management, out-of-hospital services, cervical screening and childhood immunisations.
• Identify and support more patients who have carer responsibilities.
• Review the whistleblowing policy to ensure it includes sufficient information on reporting concerns to external organisations.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 21 May 2019

Updated 21 May 2019

Updated 21 May 2019

Updated 21 May 2019

Updated 21 May 2019

Updated 21 May 2019