The Miller Practice

Updated 25 July 2017

The Miller Practice is situated within the NHS Islington Clinical Commissioning Group (CCG). The practice provides services under a General Medical Services (GMS) contract to approximately 11,200 patients and the practice premises are within a two storey Grade 2 listed building.

The practice provides a full range of enhanced services including extended hours, minor surgery, child and travel vaccines, and family planning including coil fitting. It is registered with the Care Quality Commission to carry on the regulated activities of maternity and midwifery services, family planning services, treatment of disease, disorder or injury, surgical procedures, and diagnostic and screening procedures.

The staff team at the practice includes four GP partners, (three female working a total of 21 sessions, and one male working seven sessions per week), two salaried GPs (both female working a total of 14 sessions per week), a part time female Assistant Practitioner (Senior HCA), two part time female practice nurses (working a total of 11 sessions per week), one female health care assistant working 10 sessions week, a full time practice manager, and a team of reception and administrative staff working a mixture of full time and part time hours. All GP partners provide training for trainee GP specialists.

The practices core opening hours are between 8:00am to 6.30pm every weekday. GP appointments are from 8.00am to 6.30pm and include home visits, telephone consultations and online pre-bookable appointments. The doors close between 1.00pm and 2.00pm but emergency lines stay open. Urgent appointments are available for patients who need them. The practice provides an extended hours service from 8.00am to 1.00pm Saturdays and 6.30pm to 7.30pm Mondays. Further (off-site) extended hours are provided through a hub network of local practices Monday to Saturday from 6.30pm to 8.00pm and 8.00am to 8.00pm at weekends. Patients telephoning when the practice is closed are transferred automatically to the local out-of-hours service provider.

The Information published by Public Health England rates the level of deprivation within the practice population group as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The practice area has a relatively low percentage of people over 65 years of age (10% compared to 17% nationally). The average male and female life expectancy for the practice is 79 years for males (compared to 77 years within the Clinical Commissioning Group and 79 years nationally), and 84 years for females (compared to 83 years within the Clinical Commissioning Group and 83 years nationally).

Updated 25 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at The Miller Practice on 14 October 2016. The overall rating for the practice was good. Within that overall rating the practice was rated as requires improvement for providing safe services. This was because it was not meeting legal requirements in relation to some aspects of:

• Learning from significant events and patient safety alerts.

• Legionella, hazardous substances, and fire safety.

• Pre employment checks on staff.

• Emergency medicines.

The full comprehensive report of the October 2016 inspection can be found at www.cqc.org.uk/location/1-542499627.

This inspection on 12 July 2017 was an announced focused inspection and was carried out to confirm that the practice had completed their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 October 2016. This report covers our findings in relation to those requirements.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had put in place systems that provided assurance that action taken in light of a significant event prevented reoccurrence of the event, and that the practice had acted on patient safety alerts.

• The practice was managing risks identified in its legionella and COSHH risk assessments. Legionella is a term for a particular bacterium which can contaminate water systems in buildings. The provider had put in place a fire safety policy.

• The practice had put in place a system to ensure all the information required in respect of persons employed by the practice was maintained for staff recruited since the last inspection. It had also completed DBS checks on all non-clinical staff and had photographic proof of identity on record for all staff.

• The practice had strengthened its system for maintaining the stock of emergency medicines.

The practice had also acted on recommendations we made at our previous inspection and implemented additional improvements:

• The practice had reviewed its systems for complaints documentation, for example it was taking care to include information about the Parliamentary and Health Service Ombudsman in all written responses to complaints.

• A system for staff appraisal had been implemented to formalise arrangements for identifying and meeting staff development needs.

At our previous inspection on 14 October 2016 we rated the practice as requires improvement for providing safe services because actions following significant events and safety alerts were not being evaluated, not all risks to the health and safety of service users were being managed and mitigated, and there were gaps in the information the provider maintained in respect of some of the staff it employed. At this inspection we found these shortfalls had been remedied. Consequently, the practice is rated as good for providing safe services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 July 2017

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

The rating was given following the comprehensive inspection in October 2016. A copy of the full report following the October 2016 inspection is available on our website at www.cqc.org.uk/location/1-542499627.

Updated 25 July 2017

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

The rating was given following the comprehensive inspection in October 2016. A copy of the full report following the October 2016 inspection is available on our website at www.cqc.org.uk/location/1-542499627.

Updated 25 July 2017

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

The rating was given following the comprehensive inspection in October 2016. A copy of the full report following the October 2016 inspection is available on our website at www.cqc.org.uk/location/1-542499627.

Updated 25 July 2017

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

The rating was given following the comprehensive inspection in October 2016. A copy of the full report following the October 2016 inspection is available on our website at www.cqc.org.uk/location/1-542499627.

Updated 25 July 2017

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

The rating was given following the comprehensive inspection in October 2016. A copy of the full report following the October 2016 inspection is available on our website at www.cqc.org.uk/location/1-542499627.

Updated 25 July 2017

The practice is rated as good for the care of p eople whose circumstances may make them vulnerable .

The rating was given following the comprehensive inspection in October 2016. A copy of the full report following the October 2016 inspection is available on our website at www.cqc.org.uk/location/1-542499627.