The Pinn Medical Centre

Updated 22 September 2016

The Pinn Medical Centre is situated at 37 Love Lane, Pinner, HA5 3EE. The practice provides NHS primary care services through a Personal Medical Services (PMS) contract to approximately 20,000 patients living in the London Borough of Harrow. The practice is part of the NHS Harrow Clinical Commissioning Group (CCG). The practice is based in a health centre that provides a range of other services.

The practice has a higher than average older population (people over 65; 18.5% vs 14.8% CCG average, people over 75; 8.9% vs 6.8% CCG average). There is also a higher than average number of children. Male life expectancy is 83.4 years and female life expectancy 88.6 years. The predominant ethnicity is Asian (30.4%) with an above average prevalence of diabetes (6.4% vs 6.2% England average) and obesity. The practice area is rated in the least deprived decile of the Index of Multiple Deprivation (IMD). People living in more deprived areas tend to have greater need for health services.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder or injury; maternity & midwifery services; surgical procedures; family planning

The practice team consists of four GP partners, three male and one female (3.5 whole time equivalent (WTE)), 14 salaried GPs (11.5 WTE), eight nurses (6.5 WTE), three healthcare assistants (2.6 WTE), a clinical pharmacist (0.5 WTE), a practice manager (1 WTE), two assistant practice managers (2 WTE) and a large team of reception / administration staff (24.5 WTE).

The practice is open between 8:00am and 8:00pm Monday to Sunday, 52 weeks a year. For registered patients appointments can be booked by phone from 8:15am to 7:30pm, seven days a week. They can also be booked 24 hours a day online or through an automated telephone system. The practice is a designated walk-in centre for both registered and unregistered patients between 8:00am and 8:00pm, seven days a week, 52 weeks a year. For out-of-hours (OOH) care patients are instructed to contact the local OOH services or alternatively the NHS 111 service.

Services provided include cervical screening, family planning, antenatal and postnatal checks, breast cancer screening, six to eight weeks baby checks, childhood immunisations, adult and travel vaccinations, minor surgery, smoking cessation advice, chronic disease clinics including insulin initiation, anticoagulation initiation and monitoring warfarin, phlebotomy, dermatology, intrauterine contraceptive devices and implants, audiology, cardiology and paediatrics services.

In addition to the services provided by the practice the health centre provides X-ray and ultrasound facilities, on-site pharmacy and dental surgery as well as a growing number of consultant led specialist clinics from local hospitals.

The Pinn Medical Centre is an accredited training practice for medical students with two GP registrars in training. Two of the GP partners are approved trainers.

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Pinn Medical Centre on 12 July 2016. Overall the practice is rated as Outstanding.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice carried out 'Virtual Wards' for the multidisciplinary management of patients with long term conditions and to reduce the need for admission to hospital. They also  and accommodated and supported outreach clinics to provide specialist care locally in the community.

• Feedback from patients about their care was consistently positive.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice had introduced a flexible appointment system and diabetes clinics.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had a strong and visible clinical and managerial leadership who sought to ensure services were developed in response to patient and staff feedback. There were effective   and governance arrangements which focussed on delivering good quality care .

We saw several areas of outstanding practice including:

• The practice’s effectiveness in managing patients conditions locally, through delivering a high level of specialist care within the GP setting through the range of specialist interests provided through the GPs, supported by hospital consultants.
• The practice had the capacity to deliver unlimited telephone consultations to support patients with minor ailments.
• The practice had a very engaged PPG which influenced practice development which allowed the practice to set up a volunteer driver service comprising of 25 drivers who supported 60 patients with mobility issues including support with shopping and a befriending service. In collaboration with the PPG, the practice held information talks and organised patient education events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 September 2016

The practice is rated as outstanding 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.
• Quality and Outcomes Framework (QOF) performance in 2014/15 for diabetes related indicators was 94% which was above the CCG average of 87% and the national average of 89%. The practice provided unpublished data for 2015/16 which showed they had achieved 100%.
• 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 ran a weekly ‘virtual ward’ to provide multidisciplinary care management of patients with diabetes this prevented having to refer patients to hospital. This included a weekly virtual review of all diabetic patients due a review three months ahead. The GPs and administrator then planned their care and review.
• There was a strong focus on self management of long-term conditions with all diabetes patients invited to the practice to education programs.
• The practice provided in house spirometry for patients with asthma and chronic obstructive pulmonary disorder (COPD).
• The practice nurses had received additional training to provide leg ulcer and wound management clinics which were of benefit for this population group to avoid unnecessary hospital admissions.

Updated 22 September 2016

The practice is rated as outstanding 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 others 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.
• The practice’s uptake for the cervical screening programme was 77%, which was the same as the CCG average of 77% and comparable to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies including breast feeding facilities.

• One of the GP Partners was a GP with specialist interest in Paediatrics who ran an on-site Paediatric clinic supported by consultant Paediatrician. He supported Practice and neighbourhood GPs in the treatment and care of children reducing unnecessary delays in treatment and hospital visits for unwell children and their parents. The GP also provided an audiology clinic to adult patients at the surgery reducing the need for unnecessary visits for hearing tests and assessment for hearing aids.

• The practice provided a full range of services to cater for this population group. These included family planning and women’s health services including Hormone Replacement Therapy (HRT) and long acting contraceptives such as implants and coils.

• The GPs provided shared antenatal and postnatal care to support mothers through their pregnancy and after birth of their child.
• The in house phlebotomy service could take blood tests from children five years of age upwards.
• Regular patient education evenings were held appropriate to this population group with invited clinicians to promote self care and health awareness. Recent events included embarrassing women's problems and men's health.

Updated 22 September 2016

The practice is rated as outstanding 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 very responsive to the needs of older people. For example:

• Home visits and longer 30 minute appointments were carried out for those with enhanced needs.

• The practice had achieved maximum Quality and Outcomes Framework (QOF) points in disease indicators commonly found in older people including heart failure, osteoporosis, palliative care and rheumatoid arthritis.
• The practice had proactively completed over 600 care plans in the previous 12 months with six month reviews (including the top 2% at risk patients). Outcomes from these included referral to care home providers and review of medication with the support of a practice employed clinical pharmacist. The clinical pharmacist monitored compliance of patients taking several medications to minimise risk and support good clinical care.
• There was an enhanced scope practice nurse dedicated and trained to support the care and management of older housebound patients with an aim to prevent unnecessary hospital admissions.

• The Practice had a GP with a Post Graduate Diploma in Cardiology supported other clinicians in the treatment and care of possible cardiology related conditions reducing unnecessary delays in treatment and hospital visits in liaison with on-site Cardiology services with Consultant cardiologists.

• One of the GP partners led a special interest clinic catering to audiology and hearing aids for this population group within the surgery.

• There was a GP with special interest in case management and care planning for older patients working at the practice and also provided support to this and other practices in the local GP network through multi-disciplinary meetings.

• The practice shared a CCG employed care navigator who collaborated with the administrative team to monitor for older patients including newly registered who were at risk of an emergency hospital admission.

• The practice through its patient participation group actively supported this population group. For example, by providing 25 volunteer drivers who supported 60 frail patients with mobility issues including support with shopping, transport to practice and the local hospital.
• The practice was supported by a GP with an interest in palliative care (Macmillan GP) who specialised in supporting education, training and delivery of end of life care to patients at this stage.

Updated 22 September 2016

The practice is rated as outstanding 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.
• The practice opened between 8:00am and 8:00pm, seven days a week, 52 weeks a year.
• The practice opened 12 hours a day, seven days a week, as a walk in centre for the urgent and acute needs of patients. They provided a flexible appointment system allowing patients to book an appointment over ten hours a day during weekdays, allowing working people to access their GP at times convenient to them.
• There was an automated telephone system for booking appointments that operated 24 hours a day.
• The practice was a designated walk-in centre for both registered and unregistered patients was provided throughout the practice opening hours.
• Early morning phlebotomy appointments (from 8.00am Monday to Friday) were available which was of benefit for working patients.
• The practice provided unlimited telephone consultations to support working age patients with minor ailments who could not attend the practice due to work commitments.

Updated 22 September 2016

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

• 93% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 86% and 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 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.
• The practice nurses had received additional training to provide depot injections of anti-psychotic medicines.

Updated 22 September 2016

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

• The practice held a register of patients living in vulnerable circumstances 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.
• One of the GP partners has a special interest in drug and alcohol dependence problems and supported a small group of patients through their detoxification programme with support from the Westminster drug project.
• 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.
• The practice reviewed all children and adults on the at risk register on a quarterly basis. The meeting was attended by all GPs, senior management, community nurses and health visitors with actions recorded on the register.
• Any patient considered to be vulnerable or at risk due to a change in circumstance or new to the register was discussed at a weekly clinical meeting to share management and awareness in the whole team.
• Any patient attending the practice who had no registered GP or no fixed abode would be registered at the practice.