East Finchley Medical Centre

Updated 28 June 2017

East Finchley is an area in North London, and East Finchley Medical Centre is one of the 62 member GP practices in NHS Barnet Clinical Commissioning Group (CCG).

The practice is located in the ninth less deprived decile of areas in England. At 83 years, male life expectancy is above the England average of 79 years. At 86 years, female life expectancy is above the England average of 83 years. Compared to the Outer London average, Barnet has a higher proportion of people within the White ethnic group: 58% and 61% respectively.

The practice has approximately 6,500 registered patients. It has more patients in the 25 to 39 years age ranges than the England average, but otherwise has a practice age distribution similar to the England average. Services are provided by East Finchley Medical Centre under a General Medical Services (GMS) contract with NHS England.

The practice is housed in a converted residential property. The premises have been adapted to meet the needs of the practice and its patients. There is level access to the practice, and the waiting area and ground floor treatment room are accessible to wheelchair users. There is a disabled toilet. There are three consulting rooms, one on the ground floor and two on the first floor. There is no lift, however any patient can consult with their doctor in the accessible treatment room where required.

The three GP partners work at the practice, two full time and one part time, and all female. There is a part time practice nurse (0.42 whole time equivalent or WTE); a full time practice nurse trainee (a qualified nurse completing a conversion course so that they can work in primary care instead of hospitals); and a part time healthcare assistant who also is the practice secretary: they work 31 hours a week (0.83WTE) in their combined role. The clinical staff are supported by a team of secretarial, administrative and receptionist staff headed up by full time practice manager and a part time (0.69 WTE) senior receptionist. The practice manager and practice nurse had both started at the practice within the last 12 months.

The practice’s opening times are:

• 8.00am to 6.00pm Monday, Tuesday, Thursday and Friday. The telephones are not answered between 12.30pm and 3.00pm.

• 8.00am to 12.30pm on Wednesday.

• Extended hours appointments were available with the practice nurse and healthcare assistant between 7.00am and 8.00am on Tuesday and Wednesday.

Patients contacting the practice outside its opening times, and between 12.30pm and 3.00pm on Monday, Tuesday, Thursday and Friday are directed to an out of hours GP service.

East Finchley Medical Centre is registered with the Care Quality Commission to carry on the following regulated activities at 39 Baronsmere Road, East Finchley, London N2 9QD: Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures, and Treatment of disease, disorder or injury.

We previously carried out an announced comprehensive inspection at East Finchley Medical Centre on 27 July 2015. The overall rating for the practice was good. Within that overall rating the practice was rated as requires improvement for providing safe services. This was because it was not meeting some legal requirements in relation to infection prevention and control arrangements. The full comprehensive report of the July 2015 can be found at www.cqc.org.uk/location/1-556330457.

Updated 28 June 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at East Finchley Medical Centre on 27 July 2015. The overall rating for the practice was good. Within that overall rating the practice was rated as requires improvement for providing safe services. This was because it was not meeting some legal requirements in relation to infection prevention and control arrangements at the practice. The full comprehensive report of the July 2015 can be found at www.cqc.org.uk/location/1-556330457.

This inspection on 23 May 2017 was an announced comprehensive inspection and was carried out to confirm that the practice completed their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 July 2015. This report covers our findings in relation to those requirements.

Overall the practice is rated as good.

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

• The practice had clearly defined and embedded systems to minimise risks to patient safety, including infection prevention and control.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Patients were less satisfied with the practice’s opening times, compared with local and national averages.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with 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.

• The practice 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 the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Put in place policy and procedures to guide staff in the handling of notifiable safety incidents in accordance with the duty of candour.

• Keep under review the changes the practice is making so that patients’ satisfaction with the practice’s opening hours is improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 June 2017

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

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

• Data from the 2015-16 Quality and Outcomes Framework showed the practice performed below the national average for some diabetes indicators. The practice demonstrated that increased nursing capacity and new ways of working had led to improved outcomes in 2016-17 which were being sustained into 2017-18.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• All these patients had a named GP and there was a system to recall patients for 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 28 June 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 on the child protection register and looked after children.

• The practice had achieved the national expected coverage of childhood vaccinations of 90% in the last two quarters of 2016-17, and was sustaining these rates into 2017-18.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives and health visitors to support this population group, for example, in the provision of ante-natal and post-natal checks, and the six week baby check.

• Young children were automatically given an urgent appointment.

Updated 28 June 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible, for example over 75 health checks and referrals to Barnet Wellbeing Hub, which utilised a social prescribing model to support people to become more involved in community activities and to access a range of community base support services.

• The practice identified patients with enhanced needs as Golden Patients. These patients were flagged on the electronic patient record to alert all staff to their needs, for example to be seen by a particular member of staff or GP, for a double appointment, or to be seen in the downstairs accessible consulting room.

Updated 28 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours on Monday and Tuesday mornings.

• 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. It was trialling the NHS MyGP app with patients to improve access to the service.

Updated 28 June 2017

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

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2015-16, which was comparable to the national average.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example 78% of patients with psychoses had their alcohol consumption recorded in 2015-16 which was comparable to the national average.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• 81% of patients with psychoses had a comprehensive, agreed care plan documented in the record in 2015-16, which was comparable to the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations. An advisor from Dementia Care held a monthly session at the practice.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. They were proactive in recognising changes in patients’ behaviour or circumstances and raising this with the GPs.

Updated 28 June 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.

• The practice identified patients with enhanced needs as Golden Patients. These patients were flagged on the electronic patient record to alert all staff to their needs, for example to be seen by a particular member of staff or GP, or for a double appointment, or to be seen in the downstairs accessible consulting room.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. For example, they 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.