The York Medical Practice

Updated 18 April 2017

The York Medical Practice, also known as St Johns Health Centre, provides primary medical services in the London Borough of Richmond to approximately 11,775 patients. The practice operates under a General Medical Services (GMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

The practice operates from two sites; GP services were provided from St Johns Health Centre, Oak Lane, Twickenham, Middlesex, TW1 3PA and a student walk-in health centre operated from at St Marys University, Waldegrave Road, Twickenham, Middlesex, TW1 4SX. The surgery is located in a purpose built building owned, leased and maintained by NHS properties England (NHSPE). The property is set over two floors; however, the practice is located on the ground floor. The practice has 13 consulting rooms. All practice facilities are located on the ground floor; the second floor is let and manged by a private company.

The practice clinical team is made up of 5 GP partners (male and female), 2 salaried GP’s (both female), one practice nurse, two nurse prescribers, one Health Care Assistant (HCA) and other non-clinical staff. The practice is also supported by two GP registrars’.

The practice is a training practice with three GP registrars, they also provide mentoring for nurse prescribers and all nursing staff at the practice have had mentor training. The practice have also two student nurses on university placement.

The practise’s senior nurse is a Community Education Providers Network (CEPN) director and is involved in staff training and development within the practice.

The practice provided a training placement for a post-registration family planning nurse.

One of the nurse practitioners is a diabetic specialist and teaches regularly at the DESMOND clinics.

The practice offers 52 GP sessions per week.

The practice opens between 8.00am and 6.00pm Monday to Friday.

Appointments are available between 8:30am – 6:00pm Monday to Friday.

Extended hours are available on from 6:00pm to 8:00pm on Tuesday.

When the practice is closed the phone system is set to divert to the local out of hours service.

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

Updated 18 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The York Medical Practice, also known as St Johns Health Centre on 29 November 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.
• 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 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review arrangements in place to ensure that patients with caring responsibilities are identified, so their needs are identified and can be met.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 18 April 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.
• 85% of patients diagnosed with asthma had an asthma review in the last 12 months; this was comparable to the local average of 74% and national average of 75%.
• Performance for diabetes related indicators was comparable to the local and national average:
• 84% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 78%, national average of 78%).
• 84% of patients with diabetes on the register had their cholesterol measured as well controlled (local 78%, national average 81%).
• 99% of patients with diabetes on the register had a recorded foot examination and risk classification (local average 91%, national average 88%).
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and were offered an 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.

Updated 18 April 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 relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 88% of women aged 25-64 had it recorded on their notes that a cervical screening test has been performed in the preceding five years; this was comparable to the local average of 83% and national average of 82%.

• 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.

Updated 18 April 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• These patients had a named GP and were offered an 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.

Updated 18 April 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 extended opening hours on Tuesday evenings.

Updated 18 April 2017

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

• Performance for mental health related indicators was comparable to the local and national average:

• 91% of patients diagnosed with dementia had a recorded review in a face to face meeting in the last 12 months (local average 85%, national average 84%).

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 91%, national average 89%).

• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months (local average 93%, national average 88%).

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 18 April 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, travellers and 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.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.