Archived: Jai Medical Centre - Hendon Also known as Hendon Branch

Updated 18 August 2017

Jai Medical Centre –Hendon is located in the London Borough of Barnet, North London. The practice has a patient list of approximately 5100 patients. Eighteen percent of patients are aged under 18 (compared to the national practice average of 21%) and 14% are 65 or older (compared to the national practice average of 17%). Fifty five percent of patients have a long-standing health condition and practice records showed that 4% of its practice list had been identified as carers.

The services provided by the practice include child health care, ante and post natal care, immunisations, sexual health and contraception advice and management of long term conditions.

The practice holds a General Medical Services contract with NHS England. This is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The contract defines Jai Medical Centre Edgware and Jai Medical Centre Hendon as main and branch locations, sharing a single practice list.

The staff team across the two locations comprises five GPs (Hendon only: two male, three female providing a combined 24 sessions per week), two female practice nurses (6 sessions), two female health care assistants (18 sessions), reception manager, care home coordinator and administrative/reception staff. Management support is provided by a principal GP and a general manager.

The practice’s opening hours are:

• Monday to Friday: 8:00am- 6:30pm

Appointments are available at the following times:

• Monday - Friday: 9:00am – 12.30pm and 4:00pm – 6:00pm

Outside of these times, cover is provided by out of hours provider: Barndoc Healthcare Limited.

The practice is part of a network of local practices and is therefore also able to offer early morning, late evening and weekend appointments.

The practice is registered to provide the following regulated activities which we inspected:

Diagnostic and screening procedures; Maternity and midwifery services; and Treatment of disease, disorder or injury; and Surgical procedures.

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jai Medical Centre – Hendon on 28 April 2016. During the inspection we identified a range of concerns including an absence of systems in place to keep patients safe and missed opportunities to use the learning from significant events to support improvement. (The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Jai Medical Centre – Hendon on our website at www.cqc.org.uk).The overall rating for the practice was requires improvement.

An announced comprehensive inspection was undertaken on 22 June 2017. Overall the practice is now rated as good.

We noted that although Jai Medical Centre Hendon and Jai Medical Centre Edgware held separate CQC registrations, their NHS contract defined them as a main location and branch location with a single patient list. Consequently, national GP patient survey results and QOF results relate to both practices. We also noted that an application had been submitted to CQC to amend its practice registration and seek alignment with its NHS contract.

Our key findings of our inspection of Jai Medical Centre Hendon were as follows:

• Action had been taken to improve the monitoring of patient outcomes in that this information was now available at the practice level.

• Action had been taken to improve complaints management in that filing systems were now well organised and there was a clear system in place to ensure that learning from complaints was documented and shared with staff.

• Action had been taken to ensure that governance arrangements in areas such as quality improvement and risk management facilitated the delivery of high-quality person-centred care.

• We noted that due to the nature of the NHS contract, national GP patient survey related to Jai Medical Centre Hendon and Jai Medical Centre Edgware. However, we saw evidence of how Jai Medical Centre Hendon had acted on patient feedback from other sources such as complaints and significant events.

• Clinical audit was being used to drive quality improvement.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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.
• 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.
• 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:

• Continue to monitor and take action as necessary to improve cervical screening and child immunisation uptake rates.

• Continue with efforts to improve patient satisfaction regarding its phone system.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 18 August 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• 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.

• Unverified practice data showed that as of 22 June 2017, 90% of patients with diabetes had a blood sugar level which was within the required range.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured 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 August 2017

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

• The practice had achieved the 90% national target for most standard childhood immunisations for two year olds but had not achieved the target for 5 year olds. We were told that one of the reasons for underachievement was because children had moved away but had not been removed from the practice list. This subsequently adversely impacted on child immunisation data published by the Department of Health. We were also advised that although parents’ refusal to consent to immunisation was documented on the child’s medical records, there was no facility to document this on the Department of Health monitoring system used by the practice. This meant that the practice was required to leave the immunisation dates blank which also adversely affected the immunisation count.

• From the sample of documented examples we reviewed we found 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.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal and post-natal clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 18 August 2017

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

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• The practice was part of a CCG led network of local practices which undertook patient centred assessments for older people. The practice’s GP’s spoke positively about how the network supported care for older people through, for example, proactive falls management (which advised people on their home environment rather than intervening after a fall).

• Care home staff based at two local care homes where patients resided, spoke positively about the senior GP’s routine weekly visits and her responsiveness in making emergency home visits and in providing clinical advice to the nursing team. Staff also spoke positively about the care and compassion shown towards patients.

Updated 18 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• 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.

Updated 18 August 2017

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

• The practice carried out advance care planning for patients living with dementia.

• Unverified practice data showed that as of 22 June 2017, 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the latest available national average data.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

Updated 18 August 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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.