The Nightingale Practice

Updated 23 November 2016

The Nightingale Practice provides primary medical services in the London Borough of Hackney to approximately 10,800 patients and is one of 44 member practices in the NHS City & Hackney Clinical Commissioning Group (CCG).

The practice population is in the second most deprived decile in England. There is with greater than CCG and national average representation of income deprived children (35% of children of the practice were subject to income deprivation, compared to a CCG average of 32% and a national average of 20%) and older people (income deprivation affected 45% of older patients compared to a local average of 41% and a national average of 16%). The practice had surveyed the ethnicity of the practice population and had determined that 37% of patients identified as having white ethnicity, 16% Asian, 20% black and 27% as having mixed or other ethnicity.

The practice operates from a purpose built property with patient facilities on the ground and first floors that are wheelchair accessible. There are offices for administrative and management staff on the ground and first floors. Both floors are accessed via a lift and stairs.

The practice operates under a Personal Medical Services (PMS) contract (a contract between NHS England and general practices for delivering personal medical services. This contract allows the flexibility to offer local services within the contract) and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).The enhanced services it provides are: 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; risk profiling and case management; rotavirus and shingles immunisation; and unplanned admissions.

The practice team at the surgery is made up of four part-time female GP partners along with five female and one male salaried GPs. The GPs work between them a whole time equivalent (WTE) of just under ten GPs. The Nightingale Practice is a teaching and training practice, for undergraduate medical students and GP trainees with one part-time female post-graduate doctor working at the practice at the time of our visit.

The nursing team consists of two part-time female practice nurses, one part-time female assistant practitioner and one part-time female health care assistant. Between them the nursing team work a whole time equivalent of 4.

There are eight administrative and reception staff including a full-time practice manager.

The practice is open between 7.00am and 6.30pm Monday, Tuesday and Friday, from 8.00am to 6.30pm on Wednesday and from 7.00am to 7.30pm on Thursdays. It is also open on two Saturday mornings per month from 9.30am, to 12.30pm. GPs carry out phone triage to decide on which patients need appointments from 8.30am, with appointments available from 9.30am to 1.00pm. Afternoon appointments are from 4.00pm to 6.30pm. Extended hours appointments are from 7.00am to 8.30am on Monday to Wednesday and Friday, with Saturday morning GP and nurse appointments from 9.30am to 12.30pm on two Saturdays a month. Nurse appointments are from 9.00am to 12.45pm and 2.00pm to 4.30pm four days a week and until 7.30pm on Thursday.

The practice has opted out of providing out of hours (OOH) services and directs patients to the OOH provider for NHS City & Hackney CCG.

The Nightingale Practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of: diagnostic and screening procedures; surgical procedures; family planning; treatment of disease, disorder or injury; maternity and midwifery services.

The practice was previously inspected by CQC in January 2014, at which time it was found to be compliant with our previous inspection methodology.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Nightingale Practice on 12 July 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.
• Not all personnel files contained evidence that all staff had undergone all induction training.
• 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 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 GP and there was continuity of care, with urgent appointments available the same day.
• 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:

• To provide information governance and health and safety training to all staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 23 November 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.

• 82% of patients with diabetes, on the register, had well-controlled blood sugars compared to a local average of 79% and a national average of 78%.

• 86% of patients with diabetes, on the register, had well controlled blood pressure (CCG 85% National 78%)

• 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 23 November 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.

• 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.

• 80% of women aged 25-64 whose notes record had had a cervical screening test performed in the preceding 5 years (CCG average 81% national average 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 23 November 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.

• Following a bereavement a GP would offer the family an appointment to discuss their loss and to provide them with details of support available for people experiencing bereavements.

Updated 23 November 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.

• There were appointments from 7.00am to 8.30am on Monday to Wednesday and Friday, with Saturday morning GP and nurse appointment from 9.30am to 12.30pm on two Saturdays a month for the benefit of patients who could not attend during working hours.

Updated 23 November 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 had their alcohol consumption recorded in the preceding 12 months, compared to a CCG average of 92% and a national average of 90%.

• 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 23 November 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 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.