The Abbey Medical Centre

Updated 28 April 2017

The Abbey Medical Centre is a purpose-built GP practice set over two floors. The building has level access from the street and lift access that enables step-free access to all areas. There are two waiting rooms and a dedicated children’s area. This is a teaching practice and patients may be seen by trainee GPs. The practice is based at 85 Abbey Road, London NW8 0AG.

The Abbey Medical Centre is one of a number of GP practices commissioned by Camden Clinical Commissioning Group (CCG). It has a practice list of 10,402 registered patients. The practice is in the fourth most deprived decile out of 10 on the national deprivation scale. The practice has a higher percentage of unemployed patients (9%) compared to the local average of 7% and national average of 5%.

The practice staff includes three GP partners, five salaried GPs and four trainee doctors (registrars). There are eight female GPs and four male GPs. There is a full time healthcare assistant and a part time locum practice nurse. At the time of our inspection the vacant practice manager post had been filled by a new business manager, who was due to start imminently. A team of receptionists, secretaries and administrators provided non-clinical services.

The practice is open and offers appointments during the following hours:

Monday - 7am to 6.30pm

Tuesday - 8am to 8pm

Wednesday - 8am to 1pm

Thursday - 8am to 6.30pm

Friday – 8am to 6.30pm

A local GP federation provides services seven days a week from 6.30am to 8.30pm Monday to Friday and from 8am to 8pm at weekends. Outside of these hours cover is provided by the NHS 111 service.

We had not previously carried out an inspection at this practice.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Abbey Medical Centre on 19 January 2017. Overall the practice is rated as outstanding.

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

• Staff used an effective system report and investigate significant events and the working culture encouraged openness and honesty to highlight areas for improvement.
• Risks to patients were assessed and well managed, including through medicines management and safeguarding processes.

• 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.
• There was evidence of extensive and consistent multidisciplinary working to meet the complex needs of patients, including vulnerable young people and those who received palliative care.
• A comprehensive programme of audits was in place and staff used this to assess quality of care and establish standards against national best practice guidance. The audit programme had demonstrably led to improvements in practice.
• Patients provided positive feedback about the caring nature of staff and said they took the time to listen to their concerns. We saw staff treated people with compassion, dignity and respect and involved them in care planning 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.
• 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.

We saw areas of outstanding practice:

• GPs had developed a significant range of multidisciplinary services to meet the complex needs of the location population that included young people with brain injuries, patients with needs relating to drug addiction and those under child protection orders. An on-call, responsive and individualised service was provided that included patients who lived in protective or sheltered accommodation.
• Care for patients with safeguarding needs extended beyond the practice’s immediate responsibility. This included proactive working with schools, key workers, social workers and the police. Children at risk, refugees and homeless patients were offered an on-demand service by a team of staff who adapted the electronic patient records system to improve tracking and who undertook regular training with specialist teams to be able to deliver such services safely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as good for providing services to people with long-term conditions.

• Individual GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• A GP contacted patients who attended hospital unexpectedly to support them in managing their condition.
• Performance for diabetes related indicators was better than the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 87% compared to the CCG average of 76% and the national averages of 78%. The percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 87% compared with the CCG average of 82% and national average of 80%. Longer appointments and home visits were available when needed.
• A GP lead was in post for patients with complex care and worked with a wide multidisciplinary team to provide individualised care, including out of hours through a local federation.
• A range of services were offered on-site, including phlebotomy, spirometry and electrocardiograms.

Updated 28 April 2017

The practice is rated as good for providing services to families, children and young people.

• There were systems in place to identify and support children living in disadvantaged circumstances. This included those who were at risk such as children and young people who had a high number of emergency hospital attendances.
• Immunisation rates were relatively high for all standard childhood immunisations and comparable to local and national averages.
• The practice’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average of 72% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies including a dedicated children’s waiting area.
• The practice provided specialised care and support for children with needs relating to autism.
• The practice had established relationships with local schools to provide care, including school visits for health checks, to bridge a gap in care due to a shortage of local school nurses.
• A GP was the dedicated child protection lead and worked closely with health visitors to provide care and support. The GP also worked with alcohol and drug counsellors and mental health specialists to support young people with complex needs.
• The practice offered new born baby checks, antenatal and postnatal care and sexual health screening.

Updated 28 April 2017

The practice is rated as good for providing services to older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• A GP frailty lead was in post and provided targeted care and reviews for patients with a well-coordinated multidisciplinary team.
• A planned care lead was in post who offered extended appointments for patients and worked with a care navigator to support patients over the age of 60.
• Staff worked with community rehabilitation therapists, dietetics, phlebotomy and community nursing teams to provided individualised, coordinated care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice invited all patients over 75 years old to attend an annual health assessment that included a blood test, medicine review and advice regarding diet and lifestyle.
• Staff offered dementia screening and referrals to a memory clinic as well as assessments using a frailty pathway. This helped to ensure patients received care that met their changing needs.
• The practice provided a dedicated service to 140 patients in nearby residential and nursing homes. Each patient had a named GP and the homes had direct mobile telephone access to them. A named receptionist provided single point of contact access to the practice and appointments.

Updated 28 April 2017

The practice is rated as good for providing services to 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 range of health promotion and screening that reflected the needs of this age group, including in relation to alcohol consumption and recreational drug use.
• The practice offered extended hours to support those patients that could not attend appointments during standard working hours and facilitated e-mail communication between GPs and patients.
• The patient participation group was actively promoting recruitment to this age group to improve their representation at practice development meetings.
• GPs offered telephone consultants and email communication and facilitated patient access to an online psychology service.

Updated 28 April 2017

The practice is rated as good for providing services to people experiencing poor mental health (including people with dementia).

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%. The practice had exception reported 4% compared to the national average of 7%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had a designated dementia support lead who was responsible for overseeing the treatment of all diagnosed patients.
• The practice carried out advance care planning for patients with dementia.
• 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 had participated in a pilot scheme to improve access for patients to mental health services in the practice. This had resulted in regular access to drug and alcohol counsellors, a community psychiatrist, mental health nurses and a psychologist.

Updated 28 April 2017

The practice is rated as outstanding for providing services to people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, those over 75 years of age living alone, those with a learning disability and patients with refugee status.
• 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, including those providing services to specific cultural groups.
• 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 demonstrated a proactive approach to engaging other agencies for urgent support.
• Patients who were considered vulnerable were given same day priority appointments.
• The practice maintained registers of patients who were known to suffer domestic violence or had experienced female genital mutilation. These patients were offered access to urgent appointments.
• GPs worked with social workers to provide dedicated support to patients living in emergency or sheltered housing as well as people with refugee status and those who were homeless.