Archived: The Town Surgery

Updated 20 January 2017

Town Surgery is located in London Borough of Enfield, North London. The practice has a patient list of approximately 4,100 patients. Twenty five percent of patients are aged under 18 (compared to the national practice average of 21%) and 8% are 65 or older (compared to the national practice average of 17%). Fifty seven percent of patients have a long-standing health condition.

The services provided by the practice include child health care, ante and post natal care, immunisations, sexual health and contraception advice and management of long term conditions.

The practice holds a Personal Medical Services contract with NHS England; a locally agreed alternative to the standard general medical services contract which is used when services are agreed locally with a practice.

The staff team comprises two male partner GPs (providing a combined 13 sessions per week), one non clinical GP partner, two female practice nurses (working a combined 5 sessions per week), a practice manager and administrative/reception staff.

The practice’s opening hours are:

• Monday - Friday: 8am-6:30pm

The practice offers extended hours opening at the following times:

• Monday 6:30pm-8:30pm

Appointments are available at the following times:

• Monday: 9am – 1pm and 4pm – 8:30pm

• Tuesday - Friday: 9am – 1pm and 3:30pm - 6:30pm

Outside of these times, cover is provided by out of hours provider.

The practice is registered to provide the following regulated activities which we inspected:

Diagnostic and screening procedures; Treatment of disease, disorder or injury and Surgical procedures. On the day of the inspection, the practice was hosting a weekly midwifery clinic but we noted that it was not registered to provide maternity and midwifery Services. On 25 November 2016, we received a provider application to add maternity and midwifery services to its registration.

Updated 20 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Town Surgery on 3 November 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.
• 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.
• 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.
• Practice management and governance arrangements facilitated the delivery of high-quality person-centred care.

The areas where the provider should make improvement are:

• Review the current arrangements for the storage of prescription pads in the reception office.

• Review the care outcomes for patients with a learning disability.

• Continue to monitor national GP patient survey results which showed that patient satisfaction on how nurses treated patients with care and concern was below national and local averages.

• Introduce a formal protocol to accommodate gender specific GP consultation requests.

We previously inspected this location in 2014. The inspection was part of a pilot scheme, testing our new methodology for inspecting general practices and consequently, the practice was not rated.

Updated 20 January 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• We noted that the percentage of patients with diabetes in whom the last blood pressure reading was the target 140/80 mmHg or less was 78% (compared to the respective 76% and 78% CCG and national averages).

• 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.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

Updated 20 January 2017

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. Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• 82% of women aged 25-64 had had a cervical screening test performed in the preceding 5 years compared with 82% nationally.

• 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. For example, midwives provided a weekly baby clinic from the practice.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

Updated 20 January 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 offered home visits and urgent appointments for those with enhanced needs.

• A register of older patients was maintained and all patients on the register had a care plan and had been given a direct phone number to a named GP.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.

• We spoke with the manager of a local care home where several patients lived.The manager spoke positively about how requests for home visits were promptly actioned and about the level of clinical support provided.

Updated 20 January 2017

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 offered continuity of care.

• 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.

Updated 20 January 2017

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

• 90% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the 84% national average.

• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015).

• 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.

• 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 20 January 2017

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 those with a learning disability, although there was no evidence of how the practice had worked to improve patient outcomes.
• 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.

• 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.

• During the inspection, patients from this population group spoke positively about the care and treatment they received.