Archived: The Practice Beacon

Updated 3 April 2019

The Practice Beacon provides primary medical services through a Personal Medical Services (PMS) contract.

The services are provided from a single location to around 2190 patients. The practice is part of a chain of surgeries operated in England by the provider Chilvers and McCrea Limited, also known as The Practice Group.

The practice is located in the borough of Kensington and Chelsea. The patient population includes a higher proportion of working age people between 20 and 49 year olds than the national average and is ethnically diverse.

The practice is staffed by the lead GP (male) and a long-term locum GP (female) who work at the practice part-time. Between them they provide 10 GP sessions per week. The practice also employs an advanced nurse practitioner who works at the practice two days a week, a part-time locum practice nurse, a part-time healthcare assistant, a practice manager, a trainee assistant manager and three reception staff. The provider has recently recruited a pharmacist who will also work at the practice part-time. The local practice staff are supported by a centralised management team with the provider’s regional lead nurse and regional manager attending the practice regularly.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am and 3pm to 5.40pm. Patients are informed about the out-of-hours and local extended hours primary care services.

The practice is registered with the Care Quality Commission to carry on the following regulated activities:

• Diagnostic and screening procedures
• Maternity and midwifery services
• Surgical procedures
• Treatment of disease, disorder or injury

Updated 3 April 2019

We carried out an announced focused inspection at The Practice Beacon on 5 February 2019. The inspection was triggered by concerns received by the Care Quality Commission. The concerns suggested that the practice was not appropriately prepared for medical emergencies and that staff did not have access to sufficient training opportunities.

We previously published a comprehensive inspection of The Practice Beacon on March 2017. At that time the service was rated as good overall, for all key questions, and all population groups.

We focused our inspection on 5 February 2019 on the concerns raised; areas we had identified for improvement at the last inspection and areas where the practice’s published performance had changed since our previous inspection. We have rated the key questions we focused on as follows:

Are services safe? – Good

Are services effective? – Good

The practice remains rated as good overall. It remains rated as outstanding for providing responsive care and good for providing safe, effective, caring and well-led care. It remains rated as good for all population groups.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider and other organisations.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of General Practice

Updated 17 March 2017

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

• Patients at risk of hospital admission were identified as a priority.
• QOF performance for diabetes related indicators was above the CCG and national average for 2015/16. Each year the practice looked at ways to improve diabetes control and was down to only a few patients with stubbornly high blood sugars. These patients were referred to a local clinical trial for diabetes and obesity in a local NHS acute hospital trust. The Lead GP had also undertaken a merit course in diabetes during the year.
• Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice viewed cancer as a long term condition and helped patients to live with and beyond cancer in association with a national charity. It had designed templates to improve quality of end of life care which were being adopted by all practices within the CCG. The practice recognised the importance of cancer screening and had identified, following an audit, that it needed to improve performance in bowel screening. It had contacted various organisations to look at ways to work together with them to improve this with the aim of improving care for its patients.

Updated 17 March 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 and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations for age 2 and below but generally below CCG and National averages for age 5.
• The practice’s uptake for the cervical screening programme was 84%, which was comparable to the CCG average of 75% and 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.
• One of the GPs regularly attended a ‘paediatric hub’. The hub allowed the GP to meet with paediatricians and other GPs to discuss cases. After the hub meeting, a clinic was held, where GPs could see young patients. Hubs were held monthly/6 weekly in multidisciplinary team meetings, followed by a joint paediatrician and GP clinic.
• Within the surgery the reception staff ran a book swap, where patients were encouraged to take a book for their child and in return drop an old book off.

Updated 17 March 2017

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 urgent appointments for those with enhanced needs.
• The practice carried out routine proactive rather than reactive home visits for house bound patients.
• For older patients the practice offered the local whole systems care package, ‘My Care My Way’. Patients over 65 were tiered into levels of frailty. The most frail were reviewed in a specialist hub, providing extended appointments, usually lasting any hour. This was operated within a multidisciplinary approach with social care, pharmacy, and an old age consultant present.
• There was an in-house case manager and health and social care assistant for all patients but in particular the most frail and vulnerable.
• There was a focus on advance care planning and individual care plans were provided.
• A rapid response team was utilised to see patients who needed an urgent review, thus reducing unnecessary admissions.
• The practice also undertook work with old age medicine consultants to look at ways to reduce frequent elderly attenders to A&E.

Updated 17 March 2017

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.
• Following feedback from patients the practice looked at ways to accommodate its working population. The principal changed his clinic starting time from 9am to 8.30am so people could see him before work, and the nurse started at 8.30am.
• The GP also worked 1-2 times a month on a Saturday in the local extended hours hub, which was for planned appointments where he could see the practice’s patients. Patients could also book appointments into the hub on evenings and at weekends via the surgery.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice was active in helping people to get back to work.

Updated 17 March 2017

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

• The practice had 55 patients with mental health illness on its register which was above average (2.6% compared to 0.8% nationally). These patients were monitored closely and provided with continuity of care, which the practice considered as key for this population group.
• Fourteen (100%) of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is above the national average.
• Overall performance for QOF mental health related indicators and performance in six of the seven individual indicators was above the CCG and national average.
• 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. The practice worked closely with secondary care providers in mental health, for example, undertaking joint consultations with psychiatry consultants when required.
• The practice worked with local charities, viewing the social side of the care of patients in this group as important as the medical care. For example, the practice had engaged with a new pilot project under the ‘Community Working Well’ initiative locally to help people with a range of mental health issues to find work or retain their job when they became unwell. The practice had referred eight patients to the project since July 2016, all of whom met the eligibility criteria which had enabled employment advisers to work well with them.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances including homeless people, those who were housebound, vulnerable children, vulnerable elderly and vulnerable adults and those with a learning disability. The practice also put palliative care patients in this section as often their needs were so great and the practice had a particular interest in this area.
• Patients on these registers were reviewed and monitored regularly in a systematic way with recognition of the importance of health checks in these groups.
• 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.