The Mountfield Surgery Also known as Dr Patrick Keane & Dr Ann Robinson

Updated 11 January 2018

The Mountfield Surgery is located in Finchley, London Borough of Barnet, North London. The practice has a patient list of approximately 4,500 patients. Twenty percent of patients are aged under 18 (compared to the national practice average of 21%) and 17% are 65 or older (compared to the national practice average of 17%). Forty two percent of patients have a long-standing health condition and practice records showed that 1% 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 Personal Medical Services contract with NHS England. This is a locally agreed alternative to the standard General Medical Services contract and includes additional services beyond the standard contract.

There are currently two partner GPs and two salaried GPs (3 female and 1male), two female nurses, a business manager and a team of reception/administrative staff.

The practice’s opening hours are:

• Monday to Friday: 7:30am - 6:30pm

The practice offers a walk in service enabling patients to be seen by a GP or nurse between 8am -10.15 am Monday to Friday. Patients are not required to make an appointment or phone in advance.

Outside of the above times, cover is provided by an out of hours provider.

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

Diagnostic and screening procedures; Family planning; Treatment of disease, disorder or injury;

Maternity and midwifery services.

Updated 11 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 13 August 2015– Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced inspection at Mountfield Surgery on 8 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• All staff were actively engaged in activities to monitor and improve quality and outcomes. For example, a

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice provided a Monday to Friday morning non appointment based walk in service. People spoke positively about how this allowed them to access care and treatment in a way and at a time that suited them.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• We saw examples of compassionate, inclusive and effective leadership.

We saw two areas of outstanding practice:

• One of the practice nurses was an experienced, former district nurse. She coordinated care for elderly, housebound and vulnerable patients and had a proactive programme of scheduled home visits which integrated with the local hospital’s admission avoidance team. A monthly vulnerable patients multidisciplinary team meeting fed into this programme and was also used to review safeguarding concerns.

• The practice provided a Monday to Friday morning non appointment based walk in service. Patients spoke positively about how they could access appointments in a way and at a time that suited them.

  Clinicians spoke positively about the impact of both of these initiatives on the practice’s avoidable admissions performance (which was in the lowest quartile for the CCG area). For example, CCG wide average performance on avoidable admissions was 8.12 patients per 1,000 compared with the practice’s performance of 2.73 patients per 1,000 (as of November 2017).

The areas where the provider should make improvements are:

• Introduce a programme of formal clinical audit, so as to drive a more proactive structured and evidence based approach to improving patient outcomes.

• Continue to monitor recent actions taken to widen its patient participation group membership.

• Monitor recently introduced improvements to how learning from significant events is shared.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 24 September 2015

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. The practice was working with the local Clinical Commissioning Group (CCG) to avoid unplanned admissions in these groups. Longer appointments and home visits were available when needed.

Patients had a structured annual review to check that their health and medication needs were being met. The practice reported that 92.8% of patients with diabetes, 96% of those with COPD and 80.4% of those with asthma attended. The practice invited all eligible patients for a review, and sent reminders if patients did not attend.

For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 September 2015

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. The practice maintained a list of children considered to be at risk of abuse. There was a practice lead in child safeguarding and the practice had implemented a policy and training for all staff.

Immunisation rates were good for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 91.7% to 100%, compared to a CCG range of 78.1% to 92.6%. One of the practice nurses took a lead in this area, proactively encouraging uptake of immunisations and sending reminders where necessary.

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.

Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had a walk-in clinic every morning and prioritised young children for urgent appointments. The practice also encouraged young adults to contact them by email, which they felt encouraged communication with this patient group.

Updated 24 September 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes were good for patients with conditions commonly found in older people. Further, the practice was in line with averages on preventative care for this population group, including the number of patients aged 65 and older who had been offered a seasonal flu vaccination. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, for example offering home visits as required. All patients over the age of 75 had a named GP and were advised of this.

Updated 24 September 2015

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 offered extended opening times, providing appointments from 7:30am. The practice was offering online services, including online appointment booking, and allowed patients to contact them by email if necessary. This made it easier for those working during practice opening hours to contact the practice. The practice also offered a full range of health promotion and screening that reflects the needs for this age group.

Updated 24 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had conducted face-to-face reviews of 100% of patients with dementia in the preceding year, compared to a national average of 83.82%. The practice also reported that they saw 90.9% of patients with poor mental health for a health check in the preceding year. The practice was proactive in encouraging patients to attend these health checks, sending reminders as necessary. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The practice was participating in a study led by Imperial College London, looking at dementia prevention.

The practice signposted patients experiencing poor mental health to various support groups and voluntary organisations. Staff had received training on how to care for people with mental health needs and dementia. One of the partners had a range of experience in mental health care and took a lead in this area. This brought further expertise into the practice.

Updated 24 September 2015

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, those with serious mental health problems and patients who were housebound. One of the GPs provided care for patients who had been removed from other practice lists for threatening or aggressive behaviour. The practice offered home visits and longer appointments as necessary for patients. The practice also provided advice and signposting for those who required further assistance, for example with regards to benefits.

The practice offered annual health checks to all patients with a learning disability, sending invites to patients and reminders as necessary.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It signposted patients to various support groups. Training had been provided to all staff, who 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.