Queenswood Medical Practice

Updated 2 February 2017

The Queenswood Medical Practice operates at the Hornsey Central Health Centre, 151 Park Road, London N8 8JD. It shares the premises with various other healthcare services provided by the local NHS Trust. NHS Property Services is responsible for facilities management, maintenance and cleaning. The premises are located a short distance from Crouch End Broadway and have good transport connections nearby.

The practice provides NHS services through a General Medical Services (GMS) contract to approximately 19,500 patients. It is part of the NHS Haringey Clinical Commissioning Group (CCG), which is made up of 51 general practices. The Queenswood Medical Practice is registered with the Care Quality Commission to carry out the following regulated activities - Treatment of disease, disorder or injury; Maternity and midwifery services; Surgical procedures;

Diagnostic and screening procedures; Family planning. The patient profile has an above average working age population, between 25 and 49, with fewer than average teenage and older patients. The deprivation score for the practice population is in fifth “less deprived decile”, indicating a lower than average deprivation level among the patient population.

The practice has a clinical team of four partner GPs and 11 salaried GPs. There are 11 female GPs and four male. The partner GPs worked six or seven clinical sessions per week; four of the salaried GPs also work seven sessions; with the remainder working between three and five and a half sessions each. There is a full time advanced nurse practitioner and two practice nurses, who work slightly reduced hours. The clinical team is completed by a full time female health care assistant, a part-time clinical pharmacist, who works at the practice two days a week and a part-time psychotherapist. It is a training practice, with one GP registrar (qualified doctors gaining general practice experience) currently working there.

The administrative team is made up of a practice manager, an operational manager and 17 other staff.

The practice is open from 8.00 am to 8.00 pm, Monday to Friday. The telephone lines are staffed between 8.00 am and 1.00 pm and from 2.30 to 6.30 pm, Monday to Friday and from 3.30 to 6.30 pm on Thursday. Appointments are ten minutes long and available between 8.00 am and 7.30 pm. Emergency appointments can be booked on the day. A GP is on triage duty each morning between 8.00 and 9.30 am and during the afternoon between 2.00 and 3.00 pm, able to speak with patients regarding non-urgent matters. Patients can also book telephone appointments for set times, if attendance in person at the practice is not necessary. The GPs make home visits to patients who are unable to attend the practice for reasons of health or disability. Patients are able to register with the practice to allow them to book appointments and order repeat prescriptions online.

The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. There is information given about the out-of-hours provider and the NHS 111 service on the practice website.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 11 October 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well 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.

However, there were areas of practice where the provider should make improvements:

• Monitor the use by locum nurses of patient group directions (PGDs) to ensure they are completed correctly, in accordance with current guidelines.
• Continue with efforts to identify, record and support patients who are carers.
• Continue with efforts to increase patient participation, particularly among under-represented groups.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 2 February 2017

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

• The practice’s performance relating to patients with long term conditions was above local and national averages.
• The practice maintained a register of 705 patients with diabetes, of whom 67% had received an annual eye check and 84% had received an annual foot check so far this year.
• The practice was engaged in contacting patients identified as being at risk of developing diabetes.
• The practice maintained of register of 85 patients with heart failure, of whom 82 had had an annual medicines review in the preceding 12 months.
• Ninety-nine per cent of patients had evidence of lifestyle advice documented on their records.
• Longer appointments and home visits were available when needed.

Updated 2 February 2017

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

• The practice worked closely with health visitors, 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 and maintained a register of vulnerable children.
• Take up rates for standard childhood immunisations were comparable with local and national averages.
• 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.
• We saw positive examples of joint working with midwives and health visitors and of regular MDT meetings.
• The practice had appointed carers’ leads to improve the identification and recording of patients who were carers.

Updated 2 February 2017

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 longer appointments were available for those with enhanced needs.
• The practice maintained a case management register of patients at high risk of admission to hospital. There were 377 patients currently on the register, 345 of whom had up to date care plans.
• Data showed that 974 patients aged over-65 were prescribed ten or more medicines; of whom 836 (86%) had had an annual structured medication review.
• Two-hundred and nineteen patients identified as being at risk of developing dementia had received a cognition test or memory assessment in the past two years.

Updated 2 February 2017

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

• 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.
• Early morning and evening appointments with both GPs and nurses were available for those patients who could not attend during normal working hours.
• Telephone consultations with GPs could be booked in advance and issues could be discussed with the daily duty GP.
• The practice’s uptake for the cervical screening programme was comparable with the local and national average.
• Data showed that 5,548 patients (74% of those eligible) had had their blood pressure monitored over the last five years.

Updated 2 February 2017

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

• Eighty per cent of the 261 patients experiencing poor mental health had a comprehensive, agreed care plan documented in the record, so far this year.
• Sixty-six patients diagnosed with dementia (81% of those on the register) had had their care reviewed by the time of the inspection.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Continuity of care for patients experiencing poor mental health was prioritised.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had completed online training relating to the Mental Capacity Act.

Updated 2 February 2017

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

• The practice held registers of patients living in vulnerable circumstances, including a register of homeless patients and travellers, who could register at the practice address to receive healthcare-related correspondence.
• It maintained a learning disability register of 66 patients, of whom 22 (33%) had received an annual follow up and had their care plans reviewed so far this year. The practice had an action plan to complete the outstanding reviews.
• 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.