Archived: Connaught Surgery

Updated 22 September 2017

Connaught Surgery is located in the London Borough of Enfield, North London. The practice has a patient list of approximately 5000 patients. Twenty two percent of patients are aged under 18 (compared to the national practice average of 21%) and 16% are 65 or older (compared to the national practice average of 17%). Forty four 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 General Medical Services contract with NHS England. This is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The practice team at the surgery is made up of one part-time female and one full-time male GP partners (combined total of 16 clinical sessions per week), one female part time salaried GP (6 sessions per week) one part time female practice nurse, a practice manager and administrative/reception staff.

Appointments are available:

• Monday 9.00am to 1.30pm and 4.00pm to 6.00pm

• Tuesday 9.00am to 11.40am and 4.00pm to 8.20pm

• Wednesday 9.30am to 1.45pm and 2.30pm to 5.30pm

• Thursday 9.15am to 1.00pm and 2.00pm to 5.00pm

• Friday 9.00am to 11.40am and 4.00pm to 6.00pm

Extended hours appointments are available

• Tuesday 6.30pm to 8.30pm

The practice offers extra appointments after 6.30pm on Mondays and Thursdays on an ad hoc basis depending on patient need. The practice has also recently joined a local HUB network which enables patients to access late evening, early morning, Saturday and Sunday appointments.

Outside of these times, cover is provided by out of hours provider: Barndoc Healthcare Limited.

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

Surgical procedures; Treatment of disease, disorder or injury; Maternity and midwifery services;

Diagnostic and screening procedures.

Updated 22 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Connaught Surgery on 21 December 2016. During the inspection we identified a range of concerns including an absence of staff pre-employment checks and systems in place to ensure the safe storage of vaccines. (The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Connaught Surgery on our website at www.cqc.org.uk).The overall rating for the practice was requires improvement.

An announced comprehensive inspection was undertaken on 13 July 2017. Overall the practice is now rated as good.

Our key findings of our inspection of Connaught Surgery were as follows:

• Action had been taken to address failings regarding the safe storage of medicines in that the provider had replaced a domestic fridge which was being used to store vaccines with a new validated medicines fridge.

• Action had been taken to address failings with the practice’s system of undertaking pre-employment checks. Staff personnel records we reviewed contained the necessary pre-employment checks in accordance with the practice’s recently revised recruitment policy.

• Action had been taken to improve governance arrangements in areas such as quality improvement and risk management, such that the arrangements now facilitated the delivery of high quality person-centred care.

• Clinical audit was being used to drive quality improvement.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Data from the national GP patient survey showed that the practice performed well in several aspects of care. For example, all of the 114 patients interviewed as part of the GP national patient survey said they had confidence and trust in the last nurse they saw.

• 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.
• 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:

• Continue to monitor arrangements for managing blood test results, so as to ensure that the system is robust, effective and safe.

• Ensure that water temperature monitoring takes place to control the risk from legionella (a term for a particular bacterium which can contaminate water systems in buildings).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 22 September 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.

• 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.

• Unverified practice data showed that as of 13 July 2017, 74% of patients with diabetes had a blood sugar level which was within the required range.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• 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 22 September 2017

The practice is rated as good for the care of families, children and young people.

• The practice had achieved the 90% national target for most standard childhood immunisations for two and five year olds.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal and post-natal clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 22 September 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• 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.

Updated 22 September 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.

• 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 22 September 2017

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

• The practice carried out advance care planning for patients living with dementia.

• Unverified practice data showed that as of 22 June 2017, 88

• 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.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 September 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 homeless people, travellers and those with a learning disability.

• 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. 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.