Archived: Carlton House Surgery

Updated 6 June 2016

The practice is based in a residential area of the north London borough of Enfield, at 28 Tenniswood Road, Enfield, EN1 3LL. It is one of 49 GP practices in the NHS Enfield Clinical Commissioning Group (CCG).

• Carlton House Surgery provides GP primary care services to approximately 12,300 people living in Enfield. There is free unrestricted parking on the road outside the practice which is also served by buses and a nearby train station at Enfield Town.

• The practice is situated in the fourth least deprived decile and has an average distribution of patients across all age groups, with life expectancy of 80 years for men and 84 years for women, which is in line with national averages. Of the patients registered with the practice 82% identified themselves as white, 5% Asian, 7% are Black, and 5% are of mixed or other ethnic background.

• The practice has a General Medical Services (GMS) contract with the NHS and is signed up to provide a number of enhanced services (enhanced services require an enhanced level of service provision above what is required under core GMS contracts. These enhanced services include: Childhood Vaccination and Immunisation Scheme; Extended Hours Access; Facilitating Timely Diagnosis and Support for People with Dementia; Influenza and Pneumococcal Immunisations; Learning Disabilities; minor surgery; Remote Care Monitoring; and Rotavirus and Shingles Immunisation.

• The practice is registered with the Care Quality Commission to carry on the regulated activities of Maternity and midwifery services; Family planning; Treatment of disease, disorder or injury; Diagnostic and screening procedures. Following our inspection we noted that the provider is also undertaking minor surgical procedures. The provider is taking action to obtain registration for surgical procedures.

• There are six GP partners (four female and two male) and five salaried GPs (two male and three female), three female nurses, and a non-clinical team comprising of a full-time business manager, full-time admin manager, practice PA and a reception and admin team of twelve. The partners between them work a whole time equivalent (WTE) of 4.25 GPs across the week, whilst the salaried GPs work a WTE of 3.4 GPs throughout the week. The nurses work a whole time equivalent of two full time nurses.

• It is a teaching and training practice with one GP trainee and one F2 doctor (F2 is a grade of medical practitioner undertaking a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training) but no medical students at the time of our visit.

• The practice is open between 8.00am and 7.00pm Monday to Friday. Appointments are from 8.30am to 12.30pm every morning and 2.00pm to 6.00pm every weekday, with 10 minutes for each doctor every weekday for telephone consults after their afternoon surgeries. Extended surgery hours are offered between 6.30pm to 7.15pm Monday to Friday.

• The practice has opted out of providing out-of-hours (OOH) services. When the practice is closed patients are directed to phone 111 (for non-urgent assistance) or its out of hours GP service provider.

• The practice is arranged over two floors, with consultation and treatment rooms on the ground floor and staff offices located on the upper floor. There are disabled toilets that are wheelchair accessible, and baby changing facilities.

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carlton House Surgery on 27 January 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 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 services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a GP and that there was continuity of care, with urgent appointments available the same day.
• Appointments with a named GP were available but were more difficult to obtain. The practice was aware of this, having previously operated system wherein each GP had personal patient lists. The practice had taken action to educate patients about different ways of accessing appointments, this included distributing leaflets explaining how to get the most from their appointments and explaining the new appointment system.
• 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.

The areas where the provider should make improvement are:

• Review the practice website to show information about how to make a complaint and to whom it should be addressed.

• Keep a log of the emergency medicines stored to ensure that anything used is replaced.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 June 2016

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.

• 90% of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months compared to the national average of 88%

• 95% of patients with diabetes, on the register, had an influenza immunisation in the preceding 1 August to 31 March (national average 94%).

• 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.

Updated 6 June 2016

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.

• 72% of patients with asthma, on the register, had had an asthma review in the preceding 12 months that included an assessment of asthma control (national average 75%).

• 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.

• 95% of women aged 25-64 had had a cervical screening test performed in the preceding 5 years compared to the national average of 82%.

• 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, health visitors and school nurses.

Updated 6 June 2016

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.

• Older patients at risk of dementia were offered memory assessments, with an alert set up on the computer system to facilitate ad hoc assessments during consultations.

Updated 6 June 2016

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 6 June 2016

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

• 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, compared to the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 6 June 2016

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 homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.