Archived: Stroud Green Medical Clinic

Updated 26 April 2017

Stroud Green Medical Clinic is an established GP practice situated within the London Borough of Islington and lies within the administrative boundaries of NHS Islington Clinical Commissioning Group (CCG).

The practice provides personal medical services to approximately 6280 patients living within its catchment area. The practice holds a General Medical Services (GMS) contract with NHS England. The practice has its surgery located on Stroud Green Road, N4 3PZ and is served by good transport links by both bus and rail services with Crouch Hill overground rail station within a short walk. Buses W3, W7 and 210 stop nearby with the closest underground station being Finsbury Park. The surgery has no wheelchair or step free access, and no parking facilities. The practice has an accessible toilet and they have access to a hearing loop system for deaf and hearing impaired patients and visitors as required.

The practice population is ethnically diverse, with the highest proportion being from the following groups - white British 44%; white other 15%, black African 7% and black Caribbean 7%. The area has significant deprivation with an Indices of Multiple Deprivation (IMD) score of 3 (third most deprived decile). An area has a higher IMD deprivation score than another one if the proportion of people living there who are classed as deprived is higher. An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas.

The demographic data shows the population groups recorded at the practice were lower than the CCG average across all bandings, with the working age population being significantly higher.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic & screening procedures, treatment of disease disorder or Injury, surgical procedures, family planning and maternity & midwifery services. Some directed enhanced services are provided at this practice which includes facilitating timely diagnosis and support for people with dementia, childhood vaccination and immunisation scheme, influenza and pneumococcal immunisations, extended hours access and minor surgery.

The practice was a partnership until April 2016; however since the resignation of one of the partners, the team now comprises of one male lead GP and two part time regular locum GP’s, (one male and one female). They are supported by one part time locum practice nurse, one part time locum health care assistant, one part time assistant practice manager, one full time reception manager, two full time and one part time receptionist and one part time administrator.

The reception opening hours are Monday to Friday 9am to 1pm, except Wednesdays when the practice closes at 12 noon. Afternoon reception opening is Monday to Friday 2pm to 6pm except Wednesday. Patients also have access to the i-Hub service daily from 8am to 8pm. This allows patients to have an appointment at an Islington GP surgery where the doctor or nurse seeing them has full access to patient’s medical records. This service runs as a pilot under the Prime Ministers Challenge Fund.

Consultation times are Monday to Friday from 9am to 12 noon. Afternoon consultations are from 3pm to 6pm, except Wednesday. The practice opens at 6.30am three times a week in order to provide a commuter clinic, on a Monday, Wednesday and Thursday.

The provider has opted out of providing out of hours services to their own patients between 6.30pm and 8am when the practice directs patients to seek assistance from the locally agreed out of hours provider. Information is provided on the practice telephone line, the website and on the practice notice board.

The practice is contracted to provide a full range of general medical services (GMS) including chronic disease management, minor surgery (not currently provided), and NHS health checks. The practice also provides health promotion services including, cervical screening, childhood immunisations, antenatal and postnatal care, contraception and family planning.

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stroud Green Medical Centre on 23 September 2016. Overall the practice is rated as requires improvement.

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 not always assessed and well managed for example there was no system to monitor uncollected prescriptions.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had not always 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 generally 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 good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management although there were gaps in the clinical governance arrangements regarding safety and monitoring quality and audits were not used to drive improvements. The practice 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 must make improvement are:

• Review induction process to include infection prevention and control and governance.

• Develop the governance structure to support the delivery of good practice and quality care.

The areas where the provider should make improvement are:

• Consider how to record near misses.

• Develop an effective system to monitor prescriptions issued but not redeemed.

• Ensure PSDs are available to support healthcare assistants in their role.

• Ensure recruitment checks are consistent and complete for all staff.

• Develop and formalise the strategy and business plan for the practice to reflect the vision and values and to monitor improvements.

• Continue to develop the PPG to support patient participation and feedback.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 26 April 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The practice was rated as requires improvement for effective, caring and well led, resulting in the practice being rated as requires improvement overall. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• In conjunction with the lead GP, nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 79% of patients last IFCC-HbA1c (a specific blood glucose level test) measured 64 mmol/mol or less (CCG 77%, national 78%).

• 82% of patients last blood pressure reading measured 140/80mmHg or less (CCG 77%, national 78%).

• 88% of patients had a record of a foot examination and risk classification (CCG 89%, national 88%).

• 87% of patients with asthma had an asthma review (CCG 77%, national 75%).

• 92% of patients with chronic obstructive pulmonary disease (COPD) had a review including an assessment of breathlessness (CCG 91%, national 90%).

• 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. 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. The practice nurse visits housebound patients who need a chronic disease review.

• Support for smoking cessation and weight management were available to support people with long term conditions.

Updated 26 April 2017

The practice is rated as requires improvement for the care of families, children and young people. The practice was rated as requires improvement for effective, caring and well led, resulting in the practice being rated as requires improvement overall. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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.

• 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 82%, which was comparable to the CCG average of 79% 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 and health visitors.

• The practice provided postnatal reviews and 6-8 week baby checks.

Updated 26 April 2017

The practice is rated as requires improvement for the care of older people. The practice was rated as requires improvement for effective, caring and well led, resulting in the practice being rated as requires improvement overall. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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 engaged with local services, including local community navigators and voluntary sector organisations to provide further support and signposting.

• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.

• The practice offered health checks to patients aged over 75.

• The practice triaged all home visit requests and worked in conjunction with other multidisciplinary professionals to facilitate earlier intervention.

Updated 26 April 2017

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The practice was rated as requires improvement for effective, caring and well led, resulting in the practice being rated as requires improvement overall. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 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 encouraged its patients to attend national screening programmes for bowel and breast cancer.

• Telephone appointments were available for those who prefer this.

• The practice provided an early morning clinic three times a week from 6.30am to 9am.

• Patients can access the i-Hub service 8am to 8pm daily, this allows them to have an appointment at an Islington GP surgery where the doctor or nurse seeing them will have full access to their medical records.

• The practice provided a self-service POD to enable patients to check and record their own blood pressure and weight which would be automatically transferred to their patient notes and provide additional time during their consultation if necessary.

Updated 26 April 2017

The provider is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice was rated as requires improvement for effective, caring and well led, resulting in the practice being rated as requires improvement overall. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG (85%) and national (84%) average.

• 82% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record (CCG 89%, national 88%).

• 89% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded which was comparable to the CCG (90%) and national (90%) average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 and had an unplanned admissions register.

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

Updated 26 April 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice was rated as requires improvement for effective, caring and well led, resulting in the practice being rated as requires improvement overall. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

• The practice held a register of patients living in vulnerable circumstances including homeless people, those with a learning disability and palliative care.

• The practice offered longer appointments for patients with a learning disability and those with complex needs. They offered patients with a learning disability an annual review.

• 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.