Archived: Chestnuts Park Medical Practice

Updated 10 September 2015

Chestnuts Park Medical Practice operates from The Laurels Healthy Living Centre, 256a St Ann’s Road London N15 5AZ, premises it shares with various other healthcare providers, including another general practice and a pharmacy.

The practice provides NHS primary medical services through a Personal Medical Services (PMS) contract to approximately 4,900 patients in Haringey, north London. The practice is part of the NHS Haringey Clinical Commissioning Group (CCG) which is made up of 51 general practices.

The practice has been run by the Hurley Clinic Partnership since July 2013. Hurley operates 22 locations across London. The practice is registered with the CQC to provide the regulated activities Diagnostic and screening procedures, Family planning, Maternity and midwifery services, and the Treatment of disease, disorder or injury.

The clinical staff at the practice was made up of three GPs, all female. The practice’s one nurse had recently left and the nursing duties were being covered temporarily by Hurley’s corporate nurse team. In addition, there was a practice manager and an administrative team of five. The practice manager had started very recently and additional management and administrative support was being provided by the Hurley Clinical Partnership corporate team.

The practice opening hours were 8.00am to 6.30pm Mondays and Fridays; 8.00am to 7.00pm on Tuesdays, Wednesdays and Thursdays. The phones were answered from 8.00am to 6.30pm Monday to Friday. The practice had opted out of providing out-of-hours (OOH) services and had a contract in place with the local OOH provider. When the practice was closed, callers were referred to NHS 111, which triaged the calls and passed them to the OOH provider as appropriate.

Updated 10 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chestnuts Park Medical Practice on the 28 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led service.

It was also good for providing services to the six population groups - older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

The practice has been run by the Hurley Clinic Partnership. Hurley took over the service in 2013. Prior to that, following action by service commissioners over concerns with performance and patients outcomes, three other providers had operated the service in the preceding three years. A number of the non-clinical staff at the practice had worked for the previous providers, later being transferred to the succeeding providers and eventually to Hurley. Hurley had recognised that staff morale was low as a consequence and had carried out various successful teambuilding exercises. Patients told us that the service had improved since Hurley took over the service and the practice was continuing to work with commissioners to further develop and improve performance.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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.

• There was a clear leadership structure, vision and strategy.

• The practice proactively sought feedback from staff and patients, which it acted on.

However there were areas of practice where the provider needs to make improvements.

The practice should

• Put into place an effective system to ensure that an accurate record is maintained regarding the use of medicine fridges and temperature monitoring.
• Review and update the infection control policy, identifying the lead staff member responsible. 

• Introduce a system for carrying out regular clinical audit cycles to monitor performance and identify where improvements may be made to the service and patient outcomes.

• Consider opportunities for employing more male GPs to improve outcomes for male patients, who may be unwilling to see female doctors.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 10 September 2015

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

The practice kept a register to monitor the health of patients with known long-term health conditions. Patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 September 2015

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

All new mothers were invited in for post-natal screening. 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, children who had frequently missed appointments and those with identified health conditions such as asthma. There were monthly meeting with the health visitor to discuss issues of concern.

Patients told us 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.

Updated 10 September 2015

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. It offered a range of services including palliative and end of life care, to improve outcomes for patients. It was responsive to the needs of older people. Care was taken to allocate older patients to their usual GP, or locums with whom they are familiar. It offered home visits for those patients who were not able to attend the surgery, liaising appropriately with any carers involved. The practice had monthly meetings with the district nursing team and community matron to discuss patients’ needs. All patients aged over 75 had named GPs.

Updated 10 September 2015

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 to offer continuity of care. For example telephone consultations were available and extended hours offered a wider choice of appointment times. Patients could book their appointments and order repeat prescriptions on line.

Updated 10 September 2015

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

The practice ensured that regular reviews and appropriate blood tests are carried out to monitor patients’ medication. The practice liaised with relatives and carers appropriately. The practice regularly worked with multi-disciplinary teams in the case management of people in this population group. The electronic record system would flag up if vulnerable patients were attending for an appointment so that staff members were aware of any relevant issues.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 10 September 2015

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

The practice maintained registers of patients living in vulnerable circumstances, such as those with learning disabilities, and a register of carers so that patients’ healthcare needs could be monitored and reviewed.

There was a system to highlight vulnerable patients on the practice’s electronic records. This included information to inform staff of any relevant issues when patients attended appointments, for example patients with limited capacity.

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 regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.