The Village Practice

Updated 19 October 2016

The Village Practice is located in Islington, North London. The practice has a patient list of approximately 6980. Thirty six percent of patients are aged under 18 (compared to the national practice average of 15%) and 9% are 65 or older (compared to the national practice average of 17%). Forty seven percent of patients have a long-standing health condition.

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 staff team comprises two male GP partners who both work six sessions a week, four female contracted GP’s working between four and eight sessions each per week, a female salaried GP working six sessions per week. The practice offers a total of 36 clinical sessions per week. The practice also includes two female practice nurses (one working full time, the other working two days per week), two full time female healthcare assistants a practice manager, practice support manager and administrative staff. The Village Practice holds a General Medical Service (GMS) contract with NHS England.

The practice’s opening hours are:

• Monday –Friday 8:30am-6:30pm
• Tuesday-Thursday 7:30am-8:30am (extended hours)

6:30pm-7:30pm (extended hours)

• Saturday (by appointment only) 9am-12:30pm

Appointments are available at the following times:

• GP daily clinics :8:30am-12:30pm and 2pm -6pm
• Nurse daily clinics: 8:30am-6pm
• Daily quick access clinic 08:30am - 1pm

In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments are also available for people that needed them.

Outside of these times, cover is provided by an out of hour’s provider.

The practice is registered to provide the following regulated activities which we inspected: family planning, treatment of disease, disorder or injury; diagnostic and screening procedures, surgical procedures and maternity and midwifery services.

This practice has not previously been inspected.

Updated 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Village Practice on 8 September 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.
• The practice had not undertaken an infection control audit and we noted that the need to conduct regular audits was not mentioned in its infection control protocol. Shortly after our inspection, we were sent confirming evidence that an infection control audit had taken place and that the protocol had been amended to include reference to the need to undertake regular annual infection control audits.
• 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 facilities that were 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

• Ensure prescription pad numbers are logged to ensure that security is maintained and that there is an audit trail.

• Ensure all Patient Group Directions (PGDs) which allow practice nurses to legally administer medicines are personalised with the practice information.

• Undertake staff appraisals.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 19 October 2016

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.

• Performance for diabetes related indicators was comparable to the CCG and national average. For example:
  • The percentage of patients in whom the last IFCC-HbA1c was 64 mmol/mol or less was 84% compared to the CCG average of 76% and the national average of 77%.
  • The percentage of patients in whom the last blood pressure reading measured 140/80 or less was 80% compared to the CCG average of 76% and the national average of 78%.
  • The percentage of patients with a record of a foot examination and risk classification was 97% compared to the CCG average of 88% and the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. This was organised by patients being called in for review in the month of their birth so that no patient was missed.

• 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 19 October 2016

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.

• The practice operated a watch list for children that they had concerns about.

• The practice had implemented a monthly children’s multidisciplinary meeting with a social worker, health visitor and community children’s nurse to discuss children on the safeguarding register and the practice’s watch list.

• The practice ran a specialist clinic to undertake checks and support in regard to female genital mutilation (FGM).

• The children’s community nurse ran a special clinic for children with asthma and eczema.

• 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.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 78% and the 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, health visitors and school nurses.

Updated 19 October 2016

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.

• The practice provided a full service to a local care home which included a weekly ward round.

• The practice was active in the “Coordinate My Care” initiative, which included multidisciplinary meetings and social prescribing.

• At the time of our inspection, the practice was undertaking a weekly clinic for all those patients over the age of 65 who had not been seen by a GP at the practice within the last two years.

Updated 19 October 2016

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 ran a daily quick access clinic each morning for patients who needed to be seen quickly.

• The practice ran a Saturday morning clinic for minor surgery and NHS health checks.

Updated 19 October 2016

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 CCG and the national average. For example:

    • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record was 93% compared to the CCG average of 89% and the national average of 88%.

    • The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review was 100% compared to the CCG average of 84% and the national average of 84%.

• 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.

• A quiet area was set aside for patients who found the main waiting area a challenge due to their mental health concerns.

• The practice provided an integrated mental health service which included a psychiatrist.

Updated 19 October 2016

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.