The Streatfield Medical Centre

Updated 9 January 2017

The Streatfield Medical Centre is located at 177 Streatfield Road, Harrow, HA3 9BL and operates from a converted semi-detached property with access to three consulting rooms on the ground floor and one consulting room on the first floor. The first floor is accessed by stairs. The practice provides NHS primary care services to approximately 6,600 patients through a General Medical Services (GMS) contract (a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice is part of Harrow Clinical Commissioning Group (CCG) which consists of 35 GP practices.

The practice has a diverse, multi-cultural population with a much larger than average proportion of working age adults within the age ranges 20-24, 25-29 and 30-34 and children aged 0-4 years.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury and maternity and midwifery services.

The practice staff comprises two male GP partners (18 clinical sessions per week) and two female locum GPs (totalling 3 clinical sessions per week). The clinical team is supported by two permanent practice nurses (totalling 27 hours), one regular locum practice nurse, a full-time practice manager, a secretary and six receptionists.

The practice premises are open from 8.30am to 6.30pm Monday to Friday. Extended hours are provided on Monday, Tuesday, Wednesday and Friday from 6.30pm to 7pm. Both doctor and nurse appointments are available at the extended hours clinics.

The practice provides a range of services including childhood immunisations, chronic disease management, smoking cessation, sexual health, cervical smears and travel advice and immunisations.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111.

Updated 9 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Streatfield Medical Centre on 27 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. Data from the National GP Patient Survey was above the CCG and national averages for several aspects of care.
• 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 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.

The areas where the provider should make improvement are:

• Ensure the guidelines for the correct segregation and disposal of sharps waste is followed in line legislation.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 9 January 2017

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.
• Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 84% (national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 96% (national average 94%).
• 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 community diabetes nurse specialist ran an in-house clinic to manage complex and poorly controlled diabetes patients.

Updated 9 January 2017

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 comparable to national averages for standard childhood immunisations.
• The practice coordinated the post-natal check and the eight-week baby check and initial immunisation schedule on the same day to reduce the number of attendances for new mothers.
• The practice website included information on pregnancy care planning and advice on the arrival of a new baby.
• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was above the national average (practice 83%, national 75%).
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to 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.

Updated 9 January 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 and all patients over 75 had a named GP.
• The practice was responsive to the needs of older people and those identified as at risk, and offered urgent telephone access, home visits and urgent appointments. In addition, the practice utilised the local Rapid Response Team to manage complex patients at home.
• The practice worked with the community ‘virtual ward’ (a team of healthcare professionals providing support in the community to people with the most complex medical and social needs) in the management of its patients.

Updated 9 January 2017

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 reflected the needs for this age group.
• The practice offered a ‘Commuter’s Clinic’ for working patients who could not attend during normal opening hours on Monday, Tuesday, Wednesday and Friday from 6.30pm to 7pm. Both doctor and nurse appointments were available at these clinics.

Updated 9 January 2017

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

• Performance for mental health related indicators was above the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95% (national average 88%).
• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 100% (nine patients) compared to the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice hosted an in-house clinic provided by the mental health team.
• 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.

Updated 9 January 2017

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 and arranged home visits to undertake health checks if necessary.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and patients were informed 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.