Bincote Surgery

Updated 28 December 2016

Bincote Surgery is located in the London Borough of Enfield, North London. The practice has a patient list of approximately 6,000 patients. Twenty percent of patients are aged under 18 (equal to the national practice average) and 15% are 65 or older (compared to the national practice average of 17%). Fifty five 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 practice holds a General Medical Services contract with NHS England; which is the commonest form of GP contract for delivering general medical services. The practice is registered to provide the following regulated activities which we inspected: Diagnostic and screening procedures; Maternity and midwifery services; Treatment of disease, disorder or injury; Surgical procedures and Family Planning.

The staff team comprises two partner GPs (one male, one female providing a combined 12 sessions per week), two salaried GPs (one male, one female providing a combined 8 sessions per week), one long female term locum GP (4 sessions), one female practice nurse and one female nurse practitioner (providing a combined 4 sessions per week) a practice manager and a team of administrative/reception staff.

The practice’s opening hours are:

• Monday: 8am-8pm

• Tuesday: 8am-7:30pm

• Wednesday: 8am – 6:30pm

• Thursday: 8am-7:30pm

• Friday: 8am-12pm and 4:30pm–7pm

• Saturday: 9:30am – 11am

Appointments are available at the following times:

• Monday: 8am-12pm and 4:30pm– 8pm

• Tuesday:8am-12pm and 4:30pm–7pm

• Wednesday: 8am-12pm and 4:30pm-6pm

• Thursday: 8am-12pm and 4:30pm–7pm

• Friday: 8am-12pm and 4:30pm–7pm

• Saturday: 9:30am-10:30am

Outside of these times, cover is provided by out of hours provider.

Bincote Surgery is a teaching practice. This means that each year, the practice provides clinical supervision to two or three final year trainee GPs. At the time of our inspection, one trainee GP was on placement at the practice.

Updated 28 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bincote Surgery on 22 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.

• We spoke with 20 members of the practice’s patient participation group (PPG) and reviewed 41 patient Care Quality Commission comment cards. Patients fed back that they were treated with compassion, dignity and respect.

• 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.

• 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.

  We saw an area of outstanding practice:

• The PPG met regularly and submitted proposals for improvements to the practice management team. For example, following PPG feedback, a men’s health initiative presentation had been delivered; offering information and advice on a range of issues affecting men’s health. We were told that more than thirty patients had attended and we noted that the presentation notes were available for download from the practice website.

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

• Ensure that emergency medicines are stored in a location which is readily accessible.

• Consider introducing a standard practice protocol for two week referrals, in cases of suspected cancer (as per national guidelines).

We previously inspected this location in 2014 and at that stage the practice was not rated.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 December 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.

• The percentage of patients with diabetes in whom the last blood pressure reading was the target 140/80 mmHg or less was 75% (compared to the respective 76% and 78% CCG and national averages).

• 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.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

Updated 28 December 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.

• 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.

• 81% of women aged 25-64 had had a cervical screening test performed in the preceding 5 years compared with 82% nationally.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with health visitors.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

Updated 28 December 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.

• A register of older patients was maintained and all patients on the register had a care plan and had been given a direct phone number to a named GP.

• The manager of a local nursing home where several patients resided spoke positively about GPs’ proactive approach to home visits and the clinical support provided to the home’s nursing team.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

Updated 28 December 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.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

Updated 28 December 2016

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

• 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the 84% national average.

• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015).

• 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.

Updated 28 December 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 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.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

• The practice provided an in house weekly substance misuse counselling service.