Featherstone Road Surgery - Care Quality Commission

Background to this inspection

Updated 23 May 2017

Featherstone Road Surgery provides services to approximately 8300 registered patients in the surrounding areas of Southall. The service is provided through an Alternative Provider Medical Services (APMS) contract.

The practice has a team of three permanent/long term GPs (one of whom is directly employed and two of whom are self-employed), one nurse practitioner (0.80 wte) and two practice nurses (1.24 wte). The practice also employed a healthcare assistant, a practice manager and a team of receptionists and administrators. Patients have access to a male or female GP. One of the practice GPs was acting as the local GP lead at the time of the inspection. The provider was in the process of running a selection process to fill this post on a permanent basis.

The practice is part of a larger company providing primary care and diagnostic services from four locations across London and South East England. Staff at the practice were supported by the provider's centrally based management team.

The practice is located in a primary and community health centre housing a number of community health services as well as the practice. The building is purpose-built with good access for patients with a disability.

The practice is open from 8am to 8pm, seven days a week. Appointments with a health professional are available throughout the day.

Out of hours primary care is contracted to a local out of hours care provider. The practice provides patients with information in the practice leaflet and by answerphone about how to access urgent care when the practice is closed. Patients are advised to ring “111” to access the out of hours primary care service.

The registered practice population is characterised by high proportions of young adults aged under 40 and children under four years of age. Only three per cent of registered patients are aged over 65 compared to the English average of 27%. The registered practice population is around 90% black, Asian and minority ethnic and the practice has a multilingual staff team.

The practice is registered to provide the following regulatory activities: diagnostic and screening procedures; treatment of disease, disorder or injury and family planning.

The practice was previously inspected on 26 May 2016.

Overall inspection

Good

Updated 23 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 26 May 2016 at Featherstone Road Surgery. At that inspection the practice was rated requires improvement overall and requires improvement for providing a responsive service to patients and for being well-led. This was because patients reported difficulties accessing the service in a timely way and the practice had not responded to longstanding patient feedback to address the problems. We also identified some concerns about the practice’s performance in managing diabetes and patient uptake rates for national screening programmes. This resulted in the practice being rated requires improvement for the care provided to people with long term conditions. The practice was rated good for providing safe, effective and caring services. The full report of the 26 May 2016 inspection can be found by selecting the ‘all reports’ link for Featherstone Road Surgery on our website at www.cqc.org.uk.

We carried out a focused follow-up inspection on 26 April 2017. Following this inspection, we revised the practice’s ratings for providing responsive and well-led services and the rating for the care of people with long term conditions. All these aspects of the service were now rated as good. As a result, the overall rating for the practice is good.

Our key findings were as follows:

The practice had taken action to improve patient access. The number of appointments relative to the patient list size had increased from an average of 72 to 77 per thousand patients per week.

The practice had changed its appointment system and patients were now able to pre-book appointments up to four weeks in advance. More online appointments were available and the telephone system had been upgraded.

We noted improvements to the practice’s cervical screening uptake rate since our previous inspection. Practice performance was now in line with the national and clinical commissioning group averages.

The practice had also improved its management of longer term conditions as measured by the Quality and Outcomes Framework. We noted in particular, improvements to the practice’s approach to managing diabetes. The practice had introduced in-house diabetes clinics and screening checks to identify patients at high risk of developing diabetes.

The practice had increased the number of patients it had identified as carers. The practice now had 108 carers, (that is over 1% of the practice list) and provided them with appropriate support.

The practice had revived its patient participation group which was now meeting quarterly and was in the process of running a feedback survey to test whether the changes it had made had improved patient experience.

We saw one area of outstanding practice:

The practice had identified a particularly low uptake rate for cervical screening among its Somali patients. The practice had a relatively high number of patients who had recently arrived in the UK with limited English and very variable understanding of the risk of cancer and cancer screening. Written invitations and reminders were of limited value with this group. The practice nurse (who spoke three Somali languages) had visited women at the local mosque to explain the purpose of the screening test and the procedure. As a result, the practice had successfully persuaded a number of eligible women to attend the surgery for the test and had also encouraged women who were not registered with a GP to register themselves and their families. This approach had contributed to the practice's increase in cervical screening uptake rates which were in line with the local and national averages in 2016/17.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

People with long term conditions

Good

Updated 23 May 2017

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

The practice was able to demonstrate consistent improvement in its performance on managing long term conditions as assessed by the Quality and Outcomes Framework (QOF).

The practice had consistently improved its QOF overall achievement from 85% in 2014/15 to 91% in 2015/16. Pre-validated date for 2016/17 showed the practice's overall performance for 2017/18 was likely to be 98%.
Practice performance on diabetes was improving. In 2015/16, the practice achieved 55.26 of 86 points on the QOF for its management of diabetes. Pre-validated QOF data from 2016/17 showed that the practice was likely to achieve 79.1 of 86 points with exception rate reporting close to the CCG average.
The practice had introduced in-house diabetes clinics, including longer appointments for patients with uncontrolled diabetes and access to a dietitian. The clinical staff had attended further training. The practice had also introduced screening checks to identify and educate patients at high risk of developing diabetes.
The practice had reviewed its management of other long term conditions and had taken action to improve. For example, it had introduced more chronic disease clinics and increased the number of eligible patients who attended for an annual review in 2016/17.