Mitchison Road Surgery

Updated 21 February 2017

The Mitchison Road Surgery operates at 2 Mitchison Road, London N1 3NG. The premises are off Essex Road in Islington and have good transport connections nearby. The service is provided by AT Medics, which operates 33 other general practices across London. AT Medics took over the practice at very short notice in August 2015. It was originally given an eight month contract by the Islington CCG, which was then extended by a further four months. It has now been given a five year contract to operate the service.

The practice provides NHS services through a General Medical Services (GMS) contract to approximately 4,500 patients. It is part of the NHS Islington Clinical Commissioning Group (CCG), which is made up of 38 general practices. The Mitchison Road Surgery is registered with the Care Quality Commission to carry out the following regulated activities - Treatment of disease, disorder or injury; Family Planning; Maternity and midwifery services; Surgical procedures; and Diagnostic and screening procedures. The patient profile has an above average working age population, between 25 and 49, with fewer than average young children, teenage and older patients. The deprivation score for the practice population is in second “more deprived decile”, indicating a higher than average deprivation level among the patient population.

The practice has a clinical team of three salaried GPs - two male and one female. There is a female practice nurse and a female healthcare assistant. There is an attached pharmacist, who works at the practice and its sister practice in Kings Cross. One of the GPs works three and a half days a week; another two and a half and the third two days a week. AT Medics’ GP Director attends one day a week. The practice nurse works two days a week, with cover on other days from the provider’s bank staff, and the healthcare assistant, two days. There is a senior manager and an administrative team of seven administrators / receptionists.

The practice is open from 8.00 am to 6.30 pm, Monday to Friday, and from 9.00 am to 1.00 pm on Saturday. It is closed on Sunday. Appointments can be booked up to four weeks in advance. Routine appointments are ten minutes long and available throughout the day. Double appointments can be booked if patients have more than one issue to discuss. There are 36 daily appointment slots, with seven or eight same-day appointments available daily. Telephone consultations with GPs are available between 9.00 am and 12 noon, Monday to Friday, which patients can book if attendance in person at the practice is not necessary. The GPs make home visits to patients who are unable to attend the practice for reasons of health or disability. Patients are able to register with the practice to allow them to book appointments and order repeat prescriptions online. Patients can also arrange “E-Consultations” allowing them to correspond securely with GPs by email on routine healthcare issues. Prior registration for this service is not required.

The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. There is information given about the out-of-hours provider and the NHS 111 service on the practice website. In addition, the CCG provides the “IHub” service, operating until 8.00 pm on weekdays and between 8.00 am and 8.00 pm at weekends at three sites across the borough. Appointments can be booked by patients contacting their own general practice. There is also a walk in service available to all patients at three sites.

Updated 21 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 20 October 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 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.

However, there were areas of practice where the provider should make improvements:

• Continue to monitor patients’ satisfaction over access to the service, including continuity of care, and take remedial action where any need for improvement is identified.
• Review current arrangements and consider obtaining an induction loop to assist patients with a hearing impairment.

Professor Steve Field

CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 21 February 2017

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

• The practice’s performance relating to patients with long term conditions was generally above local and national averages.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 85.94%, compared with the national average of 77.58%.
• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 RCP questions (01/04/2015 to 31/03/2016) was 73.86%, compared with the national average of 75.55%
• The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (01/04/2015 to 31/03/2016) was 93.02%, compared with the national average of 89.59%
• Longer appointments and home visits were available when needed.

Updated 21 February 2017

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

• The practice worked closely with health visitors, 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.
• Take up rates for standard childhood immunisations were above or comparable with local and national averages.
• 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 and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors and of regular MDT meetings.

Updated 21 February 2017

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 longer appointments were available for those with enhanced needs.
• The practice maintained a case management register of patients at high risk of admission to hospital. There were 92 patients currently on the register, all of whom had up to date care plans.
• Eleven patients (85%) of those discharged from hospital had received a follow up consultation.
• Data showed that 2,381 patients aged over-65 were prescribed ten or more medicines; of whom 1,667 (70%) had had an annual structured medication review in the half year since April 2016.
• One hundred and seventy patients identified as being at risk of developing dementia had received a cognition test or memory assessment in the past two years.

Updated 21 February 2017

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.
• Early morning and evening appointments were available throughout the week and Saturday mornings for patients unable to attend during normal working hours.
• Telephone consultations with GPs could be booked in advance and issues could be discussed with the daily duty GP.
• Patients could correspond securely with GPs on routine healthcare issues.
• The practice’s uptake for the cervical screening programme was comparable with the local and national average.

Updated 21 February 2017

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

• 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 (01/04/2015 to 31/03/2016) was 92.98%, compared with the national average of 88.77%.
• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016) was 80%, compared with the national average of 83.77%.
• 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had completed online training relating to the Mental Capacity Act.

Updated 21 February 2017

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

• The practice held registers of patients living in vulnerable circumstances, including a register of homeless patients and travellers, who could register at the practice address to receive healthcare-related correspondence.
• It maintained a learning disability register of 32 patients, of whom 16 (50%) had received an annual follow up and had their care plans reviewed in the half year since April 2016. The practice had an action plan to complete the outstanding reviews.
• 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.