Quarterly Report CQC Ratings – 29th February 2020

Introduction

This report provides a summary of the CQC rating scores of practices visited in Hounslow, and whose reports have been published as at 29th February 2020.

Each CQC inspection report gives a full account of the assessment of the practice and provides a breakdown on whether the practice is well led and providing a safe, caring, responsive and effective service; each area is rated separately, with an overall rate of the practice performance. All Hounslow practice reports can be found at www.cqc.org.uk

Practices rated as good or outstanding Practices rated as good or outstanding, can expect to be inspected at least every five years. Every year, the CQC will carry out a formal review of the information they hold about a practice.

Practices rated as requires improvement or inadequate If your practice is rated as requires improvement or inadequate, the annual regulatory review process and provider information collection call does not apply. CQC will continue to inspect:

 Within six months for a rating of inadequate  Within 12 months for a rating of requires improvement.

Changes to ratings across the CCG

Since the start of publishing Hounslow CCG practices CQC ratings, for the first time we can report that there is no practice within the CCG rated Inadequate after inspection. In February 2020, three new practices were inspected and received Requires Improvement ratings; Albany Practice, Thornbury Road Practice and HMC Health - Feltham.

Jan- Apr- Dec- Apr- July- Nov– Feb- 18 18 18 19 19 19 20 0 0 0 0 0 0 0 Outstanding 41 41 41 41 43 43 41 Good 4 3 4 2 1 1 3 Requirements improvement 1 1 1 1 1 1 0 Inadequate 2 2 1 2 1 1 2 Awaiting Published Report

Hounslow Primary Care Network overall CQC ratings

Overall Rating Primary Care Networks Brentford & Great Heart of Grand Isleworth Chiswick Feltham West Road Hounslow Total Good 4 8 11 9 9 41 Requires Improvement 2 1 3 Awaiting Published Report 1 1 2 Grand Total 7 8 13 9 9 46

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Hounslow Practices individual overall CQC ratings

Practice Location Latest Overall Practice Name Locality Code Rating E85744 Arygle Health Group - Isleworth Practice Brentford & Isleworth Good E85750 Spring Grove Medical Practice Brentford & Isleworth Awaiting Published Report E85605 Brentford Group Practice Brentford & Isleworth Good E85004 Albany Practice Brentford & Isleworth Requires Improvement E85001 Thornbury Road Centre for Health Brentford & Isleworth Requires Improvement E85735 Brentford Family Practice Brentford & Isleworth Good E85007 St Margaret's Practice Brentford & Isleworth Good E85746 Grove Park Terrace Surgery Chiswick Good E85683 Glebe Street Surgery Chiswick Good E85693 Grove Park Surgery Chiswick Good E85040 WEST4GPs Chiswick Good E85625 Chiswick Family Doctors Practice Chiswick Good E85030 Chiswick Health Practice Chiswick Good E85658 Holly Road Medical Centre Chiswick Good E85692 Wellesley Road Practice Chiswick Good E85699 Grove Village Medical Centre Feltham Good E85071 Clifford House Surgery Feltham Good E85708 Gill Medical Practice Feltham Good E85718 Hatton Medical Practice Feltham Good E85024 Carlton Surgery Feltham Good E85736 Little Park Surgery Feltham Good E85115 Pentelow Practice Feltham Good E85056 St David's Practice Feltham Good E85035 Mount Medical Centre Feltham Good E85734 Queens Park Medical Practice Feltham Good Y02672 HMC Health - Feltham (New Provider) Feltham Requires Improvement E85697 Bedfont Surgery (New Provider) Feltham Awaiting Published Report E85045 Twickenham Park Medical Practice Feltham Good E85739 Living Care at Heston (HMC Health - Caretaker) Great West Road Good E85713 Hounslow Family Practice Great West Road Good E85681 Jersey Practice* Great West Road Good E85018 Dr Sood's Practice Great West Road Good E85114 Crosslands Surgery Great West Road Good E85062 Firstcare Practice Great West Road Good E85696 Clifford Road Surgery Great West Road Good E85707 Skyways Medical Centre Great West Road Good E85052 Cranford Medical Great West Road Good E85126 Green Practice Heart of Hounslow Good E85716 Bath Road Surgery Heart of Hounslow Good E85015 Hounslow Medical Practice Heart of Hounslow Good E85600 Willow Practice Heart of Hounslow Good E85059 Chestnut Practice Heart of Hounslow Good E85113 Redwood Practice Heart of Hounslow Good E85058 Blue Wing Surgery Heart of Hounslow Good E85060 Kingfisher Practice Heart of Hounslow Good Y02671 HMC Health - Hounslow Heart of Hounslow Good

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Requires Improvement rating

 Albany Practice – Joint contract visits continue to take place between the practice, NWL Primary Care Team and Hounslow CCG. As part of the programme of support being offered to the practices, a place on the Resilience Programme will be offered to the practice to help their sustainability

 Thornbury Road – Following their recent Requires Improvement rating a joint contract visits will be arranged with the practice

 HMC Health – Feltham Practice - Following their recent Requires Improvement rating a joint contract visits will be arranged with the practice

Collaborative working with CQC Inspector

Hounslow Primary Care Team continues to hold regular meetings and share soft intelligence with CQC inspectors to help identify possible changes in the quality of primary care services delivered by practices to Hounslow residents.

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Practices Visits

Introduction

As you will be aware over the course of November, December 2019 and January 2020 the Hounslow Primary Care team and Clinical Governing Body members have been conducting visits to all of our practices. The visits were planned in response to the North West London financial position and increasing secondary care activity with the aim at sharing good practices and reducing variation across practices.

There was no mandatory or contractual obligation on practices to engage with visits but practices were reassured that these visits are aimed to be supportive to practices aiming to listen to issues and share good practice across Hounslow. Forty-five of Hounslow’s forty-six practices agreed to a visit.

The core goals of the Reducing Primary Care Variation for Hounslow CCG are to: ▪ Improve the quality of care and increase accountability; ▪ Improve health outcomes; ▪ Reduce operational costs; ▪ Reduce health care inequalities; ▪ Improve accessibility and patient satisfaction; ▪ Improve performance across all primary care providers and networks

Approach

All practices were offered an hour meeting and were given the choice of who attended on behalf of the practice. Visits were split equality between members of the primary care team and the governing body members and primarily lead by the clinical lead. Variation data was provided to practices a week in advance to review before the meeting, with the clinical lead using a list of probing questions to help frame the visit discussion. The team used both ranked practice and PCN data to identify key areas, conversations were targeted with probing questions to understand how systems and processes worked within each individual practice.

In addition to the ranked data profiles, the team also reviewed GP referral data from the Monthly GP Information pack which included;

▪ GP ICRS referrals ▪ Pathology activity ▪ Falls referrals ▪ IAPT ▪ Coordinate My Care records

Overall Feedback

Generally practices who took part in similar exercises stated that the visits were supportive and have enabled them to share learning on practice resilience and quality improvement initiatives.

▪ Visits last longer than an hour in general some as long as two ▪ Practice attendance was from lead partners and practice mangers, some practices provided all partners ▪ Difference of approach from each governing body members normally focussing on their area of interest ▪ Helpful for relationship building and reaffirming between primary care team and practices ▪ Good for clinical leads to see outside of their own practices ▪ Focus was around care planning and access ▪ Practices highlighted difficulties with referrals to ICRS ▪ Practices highlighting difficulties with high intensity users driving their activity ▪ Variety in approaches to care planning, some nurse led some GP lead. ▪ General link between good access and low UCC attendances ▪ Every practice is run completely differently in terms of front and back office function, which seem to impact on access ▪ Practices highlighted a need to have greater involvement with PCN decision making process

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▪ Practices requested support to analysis population health data

Area Feedback ▪ No clear comparisons between High A&E attendances, Non-electives and short length of stays and Ipsos-Mori Patient survey. ▪ Where practices have high turnover of staff and recruitment issues (Nurses, Practice Genera Issues managers) performance decreases ▪ Every practices claims uniqueness in terms of population, demographics drives the secondary care activity ▪ Greater education of patients through appropriate redirection at reception has an impact on demand ▪ Joint PPG working in health centre practices leads to better overall engagement with PPGs and there are examples of health events developed by practices as a result ▪ Clinical team made up of ANP and Pharmacists undertaking triage and acting as first point of first point of contact, allowing GPs to only see long term conditions, “GP as a consultant” type model ▪ Senior Nurses undertaking needs assessment and functional activities then follow up Good Practice with GP ▪ Month of birth process for care planning and long term conditions ▪ Joint clinical and administrative review of appointments to ensure appropriate clinician and type of appointment (Telephone/Face-to-face) ▪ All doctors have reserved recall slots, which are only booked by the doctor seeing you, so can be booked in consultation ▪ All GP appointments are fifteen minutes focused on more complex patients. Those patients seen by the doctors everything else moved to other clinicians. ▪ All practices provide some level of on the day, but this a managed different from practice to practice ▪ Range of 25%-90% of appointments being available online, those practices with high online appointment see reduced demand on receptionist’s desk allowing them to do Access other things. Conversely some practices considering reducing online access due to inappropriate booking. ▪ Waiting times for routine access vary from practice to practice ▪ Concerns that the hubs only serves the practice population that’s running it and a lack of transparency to analysis the usage data of the hub ▪ Some practices have nurse specialist led care planning, specific training undertaken by nurse (GPs on hand for escalation) ▪ Good practice would be that all appointments are thirty minutes, home visits also undertaken for care planning ▪ Variation in sessions GP/ Nurses split sessions half care planning or specialist areas and half seasonal Care Planning ▪ Most practices start care planning starts in April then use opportunistic care planning for last three months ▪ Administrative review of dashboards being undertaken to highlight patients for call and recall, new data analyst employed recently for this purpose ▪ Acknowledgement from several practices that Mental and Learning Disability patients are difficult to get in ▪ Clearer referral guidelines for ICRS ▪ Several high users causing the activity to go up, concerns that practice demographics UCC/A&E and people not calling the practice and just going straight to hospital ▪ Education issues raised with families just taking children in ▪ GP phone-call follow-up within 72 hours following admission, SMS messages follow up Admissions for UCC/NEL attendances

▪ Practices are struggling with out of hours and vulnerable adults/High intensity users

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▪ MDT follow-up for high users alongside GP follow-up of all attendances ▪ Some practices send letters and speak to patients following all attendances ▪ Where workforces is an issues for practices secondary care activity increases ▪ Mixed workforce being used, allied healthcare professional embedded but this isn’t Workforce consistent across all practices. ▪ Recruitment and retention is less of a problem where there is a varied staff workload and they are provided with work in special interest areas. ▪ Guidelines generally being used but some refreshing needed, particularly with locum staff Outpatients ▪ Help lines for Imperial good and ChelWest it depends on the speciality ▪ Ability to download pathology results from ICE

Next Steps

Working collectively by sharing best practise between practices and PCNs is required to support change to transform the delivery of care, reduce variation and improve quality, increase capability and productivity further, and to create capacity within primary care.

The Primary Care Commissioning Committee are requested to approve the following overarching actions to take this work forward from 2020/21

▪ Use the data analysis already undertaken to identify key areas of variation in Primary Care to best prioritise the areas for support and development; - Review of referral guidelines for Outpatients including templates - Easy to use eRS - Increase utilisation of ICRS - Audit of general practices core access provision

▪ Work with practices identified within top 10% cohort to develop plans to address variation ▪ The CCG will provide supportive visits through the year to assess progress and support those who need additional help to ensure their plans are on track. ▪ Apply a benchmarking approach that supports on-going Peer Review – care planning, ▪ Scope and source training programme to support - Signposting at front desk - Clinical correspondence training for administrative teams

▪ Commissioning of external consultancy support to work with nominated practices to increase their sustainability and resilience

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