Archived: Bedfont Clinic Also known as Greenbrook Bedfont

Updated 29 November 2016

Bedfont Clinic (Greenbrook Bedfont) is located at Imperial Road, Bedfont, Middlesex, TW14 8AG. The practice provides NHS primary care services to approximately 5,400 patients living in the Feltham area through an Alternative Provider Medical Services (APMS) contract (a locally negotiated contract open to both NHS practices and voluntary sector or private providers e.g. many walk-in centres). Bedfont Clinic is part of Greenbrook Healthcare Ltd which manages four other GP practices in Hounslow.

The practice is part of Hounslow Clinical Commissioning Group (CCG) which consists of 54 GP practices.

The practice operates from a single-level portacabin with access to four consulting rooms. The practice portacabin is situated on the site of NHS community services which includes district nurses, speech therapy and podiatry. The practice facilities are maintained by the landlord.

The practice is registered as an individual with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services; and family planning.

The practice staff comprises one lead female GP and a male and a female salaried GP (totalling 16 sessions per week). The clinical team is supported by practice nurse, phlebotomist, lead receptionist and five receptionists. At the time of our inspection the practice were recruiting for a practice manager, the previous practice manager having left the practice in April 2016. As an interim measure, The Greenbrook Healthcare Business Manager has been providing cover approximately two days per week.

The practice premises are open from 8am to 6.30pm Monday to Friday. Extended hours are provided on Thursday from 6.30pm to 9pm.

The practice provides a range of services including childhood immunisations, chronic disease management, smoking cessation, sexual health, cervical smears and travel advice and immunisations.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111. In addition, patients have access to services on Saturday and Sunday from 10am to 4pm at hub practices within the locality. Bedfont Clinic is one of 14 practices within the CCG which provides this service from its location on a rotational basis. Appointments are booked via 111 or the Urgent Care Centre.

Updated 29 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bedfont Clinic (Greenbrook Bedfont) 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 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 could get urgent appointments when they needed them and had access to telephone consultations. However, some patients told us they could not get an appointment with their preferred GP as easily which was also noted in the national GP patient survey.
• 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:

• Ensure there is an effective system in place to track blank printer prescriptions through the practice in line with national guidance.
• Undertake a Control of Substances Hazardous to Health (COSHH) risk assessment.
• Ensure all staff have undertaken identified mandatory training and review chaperone training to ensure all staff understand their role and responsibility when chaperoning.
• Put a system in place to ensure all medical equipment is included in an annual schedule for medical equipment checks in line with guidance.
• Consider improving communication with patients who have a hearing impairment.
• Advertise the availability of interpreter services and consider providing information in other languages reflective of the patient population.
• Review the staff’s understanding of Gillick competency and Fraser guidelines (used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions) and its impact on a minor accessing care and treatment.
• Continue to review the patient satisfaction and the national GP patient survey to ensure continuous improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 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.
• Performance for diabetes related indicators was similar to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 75% (national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 99% (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.
• The practice participated in the CCG Out of Hospital Services strategy and integrated care model and undertook in-house services such as ambulatory blood pressure monitoring and warfarin (a medicine to stop the blood from clotting) monitoring.

Updated 29 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.
• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months comparable to the national average (practice 79%; national 75%).
• Appointments were available outside of school hours and same day appointments were available for children under the age of five.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the national average of 82%.

Updated 29 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.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice had an alert system on its clinical system for patient at risk of hospital admission.
• The practice utilised the Integrated Community Response Service (ICRS), a rapid community response service for those at high risk of hospital admission for its elderly cohort.

Updated 29 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. The practice operated a text reminder service with the functionality to cancel appointments via text and respond to the Friends and Family Test (FFT) survey.
• The practice provided eConsult (a platform that enabled patients to self-manage and consult online with their own GP through their practice website).
• The practice offered a ‘Commuter’s Clinic’ on Thursday from 6.30pm to 9pm for working patients who could not attend during normal opening hours.
• The practice referred into ‘One You Hounslow’, a one-stop local support service to help people stop smoking, lose weight, eat healthily and exercise more.

Updated 29 November 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 84% (national average 84%). The practice reported a high dementia prevalence. QOF clinical prevalence data (2015/16) for dementia showed the practice were 0.71% above the CCG average and 0.47% above the national average.
• The practice undertook a twice weekly ward round at a nursing home which provided dementia care and closely liaised with the local Community Integrated Dementia Service (CIDS) in the care of its patients.
• The practice carried out advance care planning for patients with dementia.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice achievement for the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record was 100% (national average 88%) but we noted a high exception reporting (practice 50%; national average 13%).
• 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.

Updated 29 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 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 and informed 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.