The Goodinge Group Practice

Updated 16 November 2017

The Goodinge Group Practice provides primary medical services through a General Medical Services (GMS) contract to just under 13,000 patients in the Islington area of London. The practice has an ethnically diverse patient population. There are high rates of deprivation within the CCG area and above CCG and national averages within the practice’s catchment area. There has been a significant rise in the number of patients registering with the practice in the last six years with 2,287 new patients registering in 2014/2015, putting pressure on staffing resources and premises.

The practice is registered to carry on the following regulated activities: Diagnostic and screening procedures; Maternity and midwifery services; and Treatment of disease, disorder or injury.

The practice team is made up of a team nine GP partners (six female and three male). There was also a salaried GP (male) employed at the time of the inspection. The practice employs a practice manager, reception manager, three nurses, one health care assistants, plus reception and administrative staff.

The practice is a training practice and there was a trainee registrar placement at the practice at the time of our inspection.

The surgery is open and appointments are available at the practice from 8:30am to 1:00pm and from 2:00pm to 6.30pm on Monday to Friday. There is also a Saturday morning surgery from 9:00am to 1:00pm and one early morning surgery a week from 7:20am to 8:00 am. Both of these clinics are for pre-bookable appointments only. A duty doctor is in the practice until 6:30pm Monday to Friday.

Out of hours services are provided by a local provider. Access to the service is via the national NHS 111 call line. The NHS 111 team will assess the patient’s condition over the phone and if it is clinically appropriate, will refer the case to the out of hours service.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Goodinge Group Practice on 14 September 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• There was a system to recall patients for ongoing monitoring or annual reviews to check their health and medicines needs were being met. This was coordinated so that patients with multiple long term conditions were reviewed at a single, longer appointment. Non-attenders were followed up.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• Performance for diabetes related indicators was comparable to the CCG and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 70% compared with the CCG average of 76% and the national average of 78%. The practice exception reporting rate, was 6% compared to the CCG average of 17% and the national average of 13%.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.
• There was on-site access to a range of services for patients with long term conditions. This included district nurses, a leg ulcer clinic, an anticoagulation clinic, retinal screening for diabetic patients, and a dietician.

Updated 16 November 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates for all standard childhood immunisations were above the 90% standard, ranging between 94% and 97%.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 16 November 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services such as the out of hours provider and community teams.
• Patients aged 75 years or over had a named GP were offered an annual health check, which could be carried out at home if needed.
• Patients visiting the Age UK day centre next door to the practice were seen by clinical staff on the day if requested by day centre staff.
• Frail patients were seen by the duty doctor on the day if they attended the practice for an urgent appointment.

Updated 16 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, weekday evenings and Saturday morning appointments were available.
• 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.
• Time has been allowed for every doctor to have telephone consultations.
• 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.

Updated 16 November 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than both the CCG average of 83% and the national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. A practice nurse contacts all patients on the mental health register to arrange annual appointments for health promotion and blood tests.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months is 90% which is comparable to both the CCG and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. 

Updated 16 November 2017

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

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability and for patients with complex needs.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.