Archived: Fryent Medical Centre

Updated 5 March 2015

Fryent Medical Centre provides primary medical services to around 2,100 patients in the Kingsbury area of North West London. It is run by Willow Tree Family Doctors, a larger practice nearby. Plans are underway to merge the two practices and move to larger newly built premises around a mile away. The patient population includes a cross-section of socio-economic and ethnic groups. The practice serves a young population group with above national average numbers of patients in the 25-39 and 50-54 years age ranges.

Four partner GPs from Willow Tree Family Doctors work in rotation at the practice each day. An associate GP also works at the practice every Wednesday and Thursday. A timetable of their surgeries is on display at the reception desk for the calendar month. The practice does not employ locum doctors. A nurse works at the practice on Tuesday and Thursday each week and a health care assistant provides a phlebotomy service two days a week. The administrative team comprises a practice manager and assistant practice manager who divide their time between Willow Tree Family Doctors and Fryent Medical Centre. They are supported by five receptionists who work on rotation at the practice.

Appointments are available from 9.00am – 12.00 noon and 3.30pm – 6.30pm Monday, Tuesday, Wednesday and Friday and 9.00am – 12.00 noon on Thursday. The practice operates extended hours on Monday 6.30pm – 7.15pm and Friday 6.30pm – 7.00pm. Appointments can be booked up to three weeks in advance in person, by phone or online. Patients are encouraged to see the same doctor each time but can request any doctor or nurse working at the practice. Home visits are available to patients who are housebound or too unwell to attend the surgery.

The CQC intelligent monitoring placed the practice in band six. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

There are out-of-hours (OOH) arrangements in place with an external provider. Patients are advised that they can also call the 111 service for healthcare advice.

Updated 5 March 2015

Letter from the Chief Inspector of General Practice

Fryent Medical Centre provides primary medical services to around 2,100 patients in the Kingsbury area of Brent in North West London. It is run by Willow Tree Family Doctors which also operates a larger practice nearby.

We visited the practice on 23 October 2014 and carried out a comprehensive inspection of the services provided.

We found the practice to be good for providing effective, caring, responsive and well-led services. It was also good for providing services to the six population groups we looked at: older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); and people experiencing poor mental health (including people with dementia); and people whose circumstances may make them vulnerable.

We found the practice requires Improvement for providing safe services.

Our key findings were as follows:

• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
• The practice promoted good health and prevention and provided patients with suitable advice and guidance.
• The practice provided a caring service. Patients indicated that staff were caring and treated them with dignity and respect. Patients were involved in decisions about their care.
• The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
• The practice understood the needs of its patients and was responsive to these. It recognised the needs of different groups in the planning of its services.
• The practice learned from patient experiences, concerns and complaints to improve the quality of care.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Arrange a programme of regular infection control audit of the practice, and ensure all staff have received up to date infection control training in line with national guidance. In addition, the practice should carry out and document an assessment of the risk of Legionella in line with national guidance.
• Complete a health and safety and fire risk assessment of the building and environment to help ensure patients, staff and visitors are sufficiently protected from the risks associated with unsafe or unsuitable premises.

In addition the provider should:

• Arrange for all staff to complete formal training in safeguarding of vulnerable adults.
• Complete a documented risk assessment stating the rationale for the decision not to carry out a criminal records check for non-clinical staff.
• Communicate the practice’s chaperone policy more clearly to patients.
• Arrange for non-clinical staff who occasionally act as chaperones to undergo a criminal records check.
• Ensure the monthly check of medicine expiry dates is recorded.
• Ensure regular checks carried out on medical emergencies equipment are recorded. In addition, staff trained to deal with medical emergencies should receive update training to fully meet UK Resuscitation Council guidelines.
• Record weekly fire alarm system checks and implement a planned schedule of fire evacuation drills.
• Ensure following clinical audits the practice reviews whether care has improved by repeating clinical audits and thereby completing the full audit cycle.

• Document regular clinical governance meetings and administrative staff meetings to help track agreed actions and review progress at subsequent meetings. Record in the minutes evidence of the communication throughout the year of lessons learned from complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 March 2015

The practice is rated good for the care of people with long term conditions. The practice provided services for patients with diabetes, asthma, hypertension and chronic obstructive pulmonary disease (COPD). Annual reviews were carried out on all patients with long-term conditions in line with best practice guidance Care plans had been put in place for patients at risk of hospital admission and bypass telephone numbers allocated to enable them to receive same-day telephone consultations or follow-up arrangements when required. The practice held regular meetings with district nurses, care-coordinators, palliative care and health visitors to help establish best care for patients with long term conditions. Increased patient autonomy and self-care was encouraged by providing patients with information on self-care, and sign-posting to self-help groups. The practice was involved in the North West London ‘Whole Systems Integrated Care’ programme to ensure better co-ordinated care for patients with complex conditions. Flu and pneumococcal vaccinations were offered to patients in at risk groups, including patients with long term conditions.

Updated 5 March 2015

The practice is rated as good for the care of families, children and young people. The practice provided contraception and sexual health services including contraception advice and emergency contraception, smear testing and chlamydia screening. The practice’s performance for cervical screening uptake was 83% in 2012/13 which was better than the average for the CCG area. The practice offered a full range of immunisations for children. Flu vaccination was offered to pregnant women. Most child health checks were provided by health visitors at the clinic immediately next door to the practice with whom the GPs and practice nurse worked closely. Easy access was available for parents/children and patients could phone the practice for advice and be provided with same day appointments. There were procedures in place to safeguard children and young people from abuse. All clinical and all but one non-clinical member of staff had received child protection training in line with national guidance. The practice was also part of the Brent multi-agency safeguarding hub (MASH). This provided a secure email address for sending safeguarding information to social services and enabled the practice to highlight any concerns about family members.

Updated 5 March 2015

The practice is rated as good for the care of older people. Care and treatment was planned with appropriate reviews to meet the identified needs of patients over the age of 75. There were effective risk assessment processes in place to identify patients over age 75 at risk of hospital admission. The practice had established a case management register and care plans for at risk patients. Patients on the register were allocated a named GP and care co-ordinator. Home visits were carried out for older patients who were not well enough to attend the surgery. The practice worked closely with district nurses to support the care and treatment of elderly, housebound patients. There were also arrangements in place for engagement with other health and social care providers. Patients at risk of dementia were referred to a memory clinic, followed up by a 6 month follow-up assessment for patients with a confirmed dementia diagnosis on discharge from the clinic. There were appropriate and effective end of life care arrangements in place.

Updated 5 March 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).The practice was accessible to working people. For example, the practice operated extended hours on Monday and Friday. In addition, the practice offered telephone consultations and online booking for this group. The practice offered a full range of health promotion and screening which reflected the needs for this age group. All patients in the 45-74 age group were offered a health check. All newly registering patients were invited to a new registration consultation with the practice nurse to help identify and plan their medical needs. The practice provided ‘well person’ checks, carried out by appointment with the practice nurse. Health and exercise advice was given at routine appointments. For patients approaching retirement the practice discussed opportunistically their plans and encouraged them to adopt a structured life-style, exercise, good diet and identified the potential risk of depression and relationship stresses due to their changing role. Flu vaccination was offered to patients over the age of 65.

Updated 5 March 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice facilitated patients’ access to the local ‘Improving Access to Psychological Therapies’ (IAPT) programme which provided self-help courses for patients with common mental health difficulties such as stress, worry and low esteem. An IAPT counsellor was available on site to provide counselling and psychology services and patients were referred by their GP or could ask for a referral. The practice participated in a CCG commissioned direct enhanced service (DES) to profile patients who may be at risk of dementia. Patients identified as at risk were referred to a memory clinic and follow up assessments were carried out on their discharge from the memory clinic. Regular reviews and medication management plans and recall protocols were in place for patients on high risk medicines, including medicines for patients with mental health conditions.

Updated 5 March 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice had an open policy regarding registrations. For example, there were two homeless persons on the practice’s register and travellers from a visiting fun fair had been temporarily registered. Quick access appointments were available for vulnerable patients, for example if they turned up without a booked appointment. Patients with learning disabilities were reviewed annually and received a physical health check, medicines review and blood and other screening tests. The practice had access to an interpreter service and could book a trained interpreter on behalf of patients or they could phone for assistance themselves. The premises and services had been adapted to the needs of patients with a disability. The practice had a policy for the safeguarding of vulnerable adults and staff we spoke knew how to recognise signs of abuse and the process to follow and who to contact if they suspected abuse However, the majority of staff had not completed formal training in safeguarding of vulnerable adults.