Museum Practice

Updated 28 July 2016

The Museum Practice operates from 58 Great Russell Street, London WC1B 3BA. The practice’s premises are leased from the local authority and are in the basement of a listed block of flats. Access for disabled patients may be problematic, but the listed status and limited space prevents any building alterations. The practice website mentions this and patients who may have difficulty attending the surgery are visited in their homes by the GPs. The premises have good transport links.

The practice provides NHS services through a Personal Medical Services (PMS) contract to approximately 4,200 patients. The patient list size had increased by approximately 800, following the closure of a nearby practice in 2014. It is part of the NHS Camden Clinical Commissioning Group (CCG) which is made up of 36 general practices. The practice is registered with the CQC to carry out the following regulated activities - diagnostic and screening procedures, treatment of disease, disorder or injury, maternity and midwifery services and surgical procedures. The patient profile for the practice has a higher than average working age population group, with lower than average young children, teenage and older patient groups.

The practice has a clinical team of two female partner GPs and a salaried female GP. The partners work full-time (six or seven clinical sessions per week) and the salaried GP works the equivalent of one and a half days (three sessions) a week. The practice uses three regular locum female GPs. It is a teaching practice, with three GP registrars (qualified doctors gaining general practice experience) working there at the time of the inspection. The practice also teaches students from The Royal Free and University College Hospital. The practice has a senior receptionist and three receptionists who work various weekly hours to an agreed rota.

The practice’s opening hours are 8.45 am to 7.45 pm on Monday; 8.45 am to 6.30 pm Tuesday to Friday. Phones are answered from 8.15 am each morning. The lunch break is between 1.00 pm and 2.00 pm. The practice is closed at weekends, but there is provision for patients to be seen at the nearby South Camden Centre for Health on Saturday mornings. The practice has opted out of providing out-of-hours services; patients calling the practice when it is closed are referred to the local out-of-hours provider. Details of the service, together with information about a nearby walk-in centre operating at weekends, was available.

Appointments with the GPs are available each weekday morning between 9.00 and 11.30 and during the afternoon between 4.00 and 6.00; the practice operates extended hours on Monday evening, with pre-booked appointments with GPs available up to 7.30. In addition, each weekday morning between 9.00 and 11.00 one of the GPs provides a walk-in clinic, for which no appointment is needed. Between 11.30 am and 4.00 pm, the GPs make home visits and are available to provide telephone advice to patients who are not able to attend the surgery. Appointments can be booked online by patients who have previously registered to use the system, and there is a 24-hour automated telephone booking system.

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 26 May 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 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.
• A daily walk-in clinic was available, without the need for patients to make an appointment.
• 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 noted an aspect of outstanding practice:

• GPs had visited a nearby hostel to opportunistically target residents who were registered as homeless, to encourage the uptake of annual health checks. The practice had a total of 109 patients on its homeless register. It had carried out health checks on 86 patients (79%), offering flu vaccinations and screening for blood-borne viruses.

However, there was an area of practice where the provider should make improvement:

• It should continue to monitor the gender mix of locums, as appropriate, to allow male patients some choice in seeing a male GP.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 July 2016

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

• 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.
• Data showed that the practice was performing above local and national averages in relation to diabetes care. It maintained a register of 151 patients with diabetes and had carried out annual foot checks on 144 (95%) of the patients and retinal checks on 120 (76%).
• The practice maintained of register of 29 patients with heart failure, all of whom had had an annual medicines review.
• The percentage of patients on the practice’s asthma register, who have had a review in the preceding 12 months, was above the local and national average.

Updated 28 July 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 and maintained a register of vulnerable children.
• Immunisation rates for all standard childhood immunisations were comparable with the local average.
• 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.
• We saw positive examples of joint working with health visitors.

Updated 28 July 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.
• The practice maintained an Avoiding Unplanned Admissions register of 72 patients, all of whom had up-to-date care plans.
• All nine patients who had been discharged from hospital had had a follow up consultation.
• The practice had a register of 238 patients prescribed more than four medicines and records showed that reviews had been carried out in respect of 233 (98%).
• Flu vaccination rates for patients aged over-65 were above the local average.

Updated 28 July 2016

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.
• The practice’s uptake for the cervical screening programme in 2014/15 was 78%, which was 6% above the local average.
• Data showed that 1300 patients (91% of those eligible) had undergone blood pressure checks.

Updated 28 July 2016

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

• Data showed that all 14 patients on the dementia register had had their care reviewed in a face-to-face review in the preceding 12 months, above both local and national averages.
• 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.
• Continuity of care for patients experiencing poor mental health was prioritised.
• Data showed that 56 patients (89% of those on the serious mental health register) had received a physical health checks and 60 (95%) had had their alcohol status recorded.
• 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 July 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 homeless people (109 patients) and those with a learning disability (five patients). It had carried out health checks on 86 (79%) of the homeless patients and all of those with a learning disability.
• The practice had opportunistically targeted residents at a nearby hostel to encourage the uptake of annual health checks.
• The practice offered longer appointments for patients with a learning disability. All five of the registered patients had received annual follow ups and care plan reviews in relation to their care.
• 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.