abbey road medical practice newapproachcomprehensive ... · •...

This report describes our judgement of the quality of care at this service. It is based on a combination of what we foundwhen we inspected, information from our ongoing monitoring of data about services and information given to us fromthe provider, patients, the public and other organisations.

Ratings

Overall rating for this service Good –––

Are services safe? Good –––

Are services effective? Good –––

Are services caring? Good –––

Are services responsive to people’s needs? Good –––

Are services well-led? Good –––

AbbeAbbeyy RRooadad MedicMedicalal PrPracticacticeeQuality Report

Abbey Road Medical Practice28a Abbey RoadStratfordLondonE15 3LTTel: 020 8534 2515Website: www.nhs.uk/abbeyroadmedicalpractice

Date of inspection visit: 17 August 2016Date of publication: 27/03/2017

1 Abbey Road Medical Practice Quality Report 27/03/2017

Contents

PageSummary of this inspectionOverall summary 2

The five questions we ask and what we found 3

The six population groups and what we found 6

What people who use the service say 10

Detailed findings from this inspectionOur inspection team 11

Background to Abbey Road Medical Practice 11

Why we carried out this inspection 11

How we carried out this inspection 11

Detailed findings 13

Overall summaryLetter from the Chief Inspector of GeneralPractice

We carried out an announced comprehensive inspectionat Abbey Road Medical practice on 17 August 2016.Overall the practice is rated as good.

Our key findings across all the areas we inspected were asfollows:

• There was an open and transparent approach to safetyand an effective system in place for reporting andrecording 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 hadbeen trained to provide them with the skills,knowledge and experience to deliver effective careand treatment.

• Patients said they were treated with compassion,dignity and respect and they were involved in theircare and decisions about their treatment.

• Information about services and how to complain wasavailable and easy to understand, however, thepractice did not have its own website.

• Improvements were made to the quality of care as aresult of complaints and concerns.

• Patients said they found it easy to make anappointment with a named GP and there wascontinuity of care, with urgent appointments availablethe same day.

• The practice had good facilities and was well equippedto treat patients and meet their needs.

• There was a clear leadership structure and staff feltsupported by management. The practice proactivelysought feedback from staff and patients, which it actedon.

• The provider was aware of and complied with therequirements of the duty of candour.

The areas where the provider should make improvementare:

• Develop a practice website to signpost their services.

• Review how carers are identified and recorded onthe patient record system to ensure information,advice and support is made available to all.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Summary of findings


The five questions we ask and what we foundWe always ask the following five questions of services.

Are services safe?The practice is rated as good for providing safe services.

• There was an effective system in place for reporting andrecording significant events

• Lessons were shared to make sure action was taken to improvesafety in the practice.

• When things went wrong patients received reasonable support,truthful information, and a written apology. They were toldabout any actions to improve processes to prevent the samething happening again.

• The practice had clearly defined and embedded systems,processes and practices in place to keep patients safe andsafeguarded from abuse.

• Risks to patients were assessed and well managed.

Good –––

Are services effective?The practice is rated as good for providing effective services.

• Data from the Quality and Outcomes Framework (QOF) showedpatient outcomes were generally comparable to the CCG andnational average.

• Staff assessed needs and delivered care in line with currentevidence based guidance.

• There were detailed personalised care plans.• Clinical audits demonstrated quality improvement.• Staff had the skills, knowledge and experience to deliver

effective care and treatment.• There was evidence of appraisals and personal development

plans for all staff.• Staff worked with other health care professionals to understand

and meet the range and complexity of patients’ needs.• The practice had registers to identify vulnerable patients, child

protection, learning disability, female genital mutilation (FGM),palliative care and housebound patients.

Good –––

Are services caring?The practice is rated as good for providing caring services.

• Data from the national GP patient survey showed patients ratedthe practice higher than others for several aspects of care.

• Patients said they were treated with compassion, dignity andrespect and they were involved in decisions about their careand treatment.

Good –––

Summary of findings


• Information for patients about the services available was easyto understand and accessible.

• We saw staff treated patients with kindness and respect, andmaintained patient and information confidentiality.

Are services responsive to people’s needs?The practice is rated as good for providing responsive services.

• Practice staff reviewed the needs of its local population andengaged with the NHS England Area Team and ClinicalCommissioning Group to secure improvements to serviceswhere these were identified. For example, the practicedeveloped a cancer diagnosis protocol which was implementedacross the CCG to improve cancer diagnosis and recording.

• Patients said they generally found it easy to make anappointment with a named GP and there was continuity ofcare, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treatpatients and meet their needs.

• The practice implemented suggestions for improvements andmade changes to the way it delivered services as aconsequence of feedback from patients and from the patientparticipation group (PPG.)

• Information about how to complain was available and easy tounderstand and evidence showed the practice respondedquickly to issues raised. Learning from complaints was sharedwith staff and other stakeholders.

Good –––

Are services well-led?The practice is rated as good for being well-led.

• The practice had a clear vision and strategy to deliver highquality care and promote good outcomes for patients. Staffwere clear about the vision and their responsibilities in relationto it.

• There was a clear leadership structure and staff felt supportedby management. The practice had a number of policies andprocedures to govern activity and held regular governancemeetings.

• There was an overarching governance framework whichsupported the delivery of the strategy and good quality care.This included arrangements to monitor and improve qualityand identify risk.

Good –––

Summary of findings


• The provider was aware of and complied with the requirementsof the duty of candour. The partners encouraged a culture ofopenness and honesty. The practice had systems in place fornotifiable safety incidents and ensured this information wasshared with staff to ensure appropriate action was taken

• The practice proactively sought feedback from staff andpatients, which it acted on. The patient participation group wasactive.

• There was a strong focus on continuous learning andimprovement at all levels.

Summary of findings


The six population groups and what we foundWe always inspect the quality of care for these six population groups.

Older peopleThe practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet theneeds of the older people in its population. We saw that thepractice had detailed and personalised care plans andrecorded problems/issues, progress made against the plan andany outstanding health concerns which required furtherintervention.

• The practice offered proactive, personalised care to meet theneeds of the older people in its population.

• The practice was responsive to the needs of older people, andoffered home visits and urgent appointments for those withenhanced needs.

• The practice offered health checks for patients aged over 75and provided a named GP.

• The practice contacted all patients after their discharge fromhospital to address any concerns and to assess if the patientrequired any GP involvement at that time.

• The practice referred older people to other services in order tomore effectively meet their needs, for example the fallsprevention service.

• The practice had a “housebound list” with named GP’s. Thesepatients were reviewed every 6-12 months by nurse, healthcareassistant or GP as necessary and more frequently based onclinical need.

Good –––

People with long term conditionsThe practice is rated as good for the care of people with long-termconditions.

• Nursing staff had lead roles in chronic disease managementand patients at risk of hospital admission were identified as apriority.

• The practice used the information in the Quality and OutcomesFramework (QOF) to monitor outcomes for patients (QOF is asystem intended to improve the quality of general practice andreward good practice). Data from 2014/2015 showed thatperformance for diabetes related indicators was 84% which wascomparable to the CCG and national average of 84%.

• Longer appointments and home visits were available whenneeded.

Good –––

Summary of findings


• All these patients had a named GP and a structured annualreview to check their health and medicines needs were beingmet. For those patients with the most complex needs, thenamed GP worked with relevant health and care professionalsto deliver a multidisciplinary package of care.

• Diabetic patients are signposted to appropriate supportservices, to support them with diet and lifestyle informationand required changes.

• Smoking cessation, weight management advice and referral forexercise programmes were available to support people withlong term conditions.

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

• There were systems in place to identify and follow up childrenliving in disadvantaged circumstances and who were at risk, forexample, children and young people who had a high number ofA&E attendances. Immunisation rates were relatively high for allstandard childhood immunisations.

• Patients told us that children and young people were treated inan age-appropriate way and were recognised as individuals,and we saw evidence to confirm this.

• The practice provided six week check-ups for mums and babies.• The practice’s uptake for the cervical screening programme was

81%, which was comparable to the CCG average of 81% and thenational average of 82%. The practice had a policy to offertelephone reminders for patients who did not attend for theircervical screening tests.

• Appointments were available outside of school hours and thepremises were suitable for children and babies, and babychange facilities were available.

• They provided advice on family planning, contraceptivemedication and contraceptive coil fitting. Blood pressurechecks were provided after six months for patients on regularcontraception medication.

• We saw positive examples of joint working with midwives,health visitors and school nurses. The practice held a fortnightlymidwife clinic on site.

• The practice had monthly safeguarding meetings whichincluded the midwife and health visitor.

• We saw that the practice offered chlamydia screening forpatients and the promotion of sexual health when relevant.

Good –––

Summary of findings


Working age people (including those recently retired andstudents)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 retiredand students had been identified and the practice had adjustedthe services it offered to ensure these were accessible, flexibleand offered continuity of care.

• The practice was proactive in offering online services as well asa full range of health promotion and screening that reflects theneeds for this age group.

• They encouraged patients to attend national screeningprogrammes for bowel and breast cancer screening. Thepractice uptake for patients aged 60-69, screened for bowelcancer in the last 30 months was 41%; this was comparable tothe CCG average of 41% but below the national average of 58%.The practice uptake for female patients aged 50-70 screened forbreast cancer in the last 36 months was 51%, which was lessthan the CCG average of 60% and the national average of 72%.

• They provided telephone consultations and NHS health checks.• They provided extended hours clinics with evening

appointments three times a week.

Good –––

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

• The practice held a register of patients living in vulnerablecircumstances including homeless people, travellers and thosewith a learning disability.

• They provided annual health checks for those patients with alearning disability and also offered longer, flexibleappointments to meet their needs.

• They offered longer appointments for patients with complexneeds.

• They regularly worked with other health care professionals inthe case management of vulnerable patients.

• They informed vulnerable patients about how to access varioussupport groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adultsand children. Staff were aware of their responsibilities regardinginformation sharing, documentation of safeguarding concernsand how to contact relevant agencies in normal working hoursand out of hours.

Good –––

Summary of findings


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

• 78% of patients diagnosed with dementia had their carereviewed in a face to face meeting in the last 12 months, whichwas below the CCG average of 87% and national average of84%.

• The practice regularly worked with multi-disciplinary teams inthe case management of patients experiencing poor mentalhealth, including those with dementia.

• Staff had a good understanding of how to support patients withmental health needs and dementia. Practice staff were‘dementia friends’ trained to provide extra support andpersonalised care.

• 88% of patients with schizophrenia, bipolar affective disorderand other psychoses had a comprehensive, agreed care plandocumented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) which was comparable to the CCG averageof 84% and national average of 88%.

• There was a GP run monthly clinic with a nurse from thecommunity mental health team.

• A counsellor from Newham Talking Therapy holds a weeklyclinic at the practice.

• The practice had told patients experiencing poor mental healthabout how to access various support groups and voluntaryorganisations.

• The practice had a system in place to follow up patients whohad attended accident and emergency where they may havebeen experiencing poor mental health.

• The practice conducted medication monitoring with theprovision of weekly prescriptions as necessary.

Good –––

Summary of findings


What people who use the service sayThe national GP patient survey results were published on7 July 2016. The results showed the practice wasperforming generally in line with local and nationalaverages. Three hundred and sixty six survey forms weredistributed and 72 were returned. This represented a 20%completion rate and approximately 1% of the practice’spatient list.

• 68% of patients found it easy to get through to thispractice by phone compared to the CCG average of60% and national average of 73%.

• 82% of patients were able to get an appointment tosee or speak to someone the last time they triedcompared to the CCG average of 76% and nationalaverage of 85%.

• 78% of patients described the overall experience ofthis GP practice as good compared to the CCGaverage of 75% and national average of 85%.

• 69% of patients said they would recommend this GPpractice to someone who has just moved to the localarea compared to the CCG average of 66% andnational average of 78%.

As part of our inspection we also asked for CQC commentcards to be completed by patients prior to our inspection.We received 40 comment cards all of which were positiveabout the service experienced, although four alsocommented that sometimes it was difficult to get throughto the practice to arrange an appointment. Patients saidthey felt the practice offered an excellent service and staffwere friendly, helpful, kind, caring and treated them withdignity and respect.

We also spoke with four members of the patientparticipation group (PPG). They also told us they werevery satisfied with the care provided by the practice andsaid their dignity and privacy was respected.

We spoke with five patients during the inspection. All fivepatients said they were satisfied with the care theyreceived and thought staff were approachable,committed, friendly, understanding and caring.

Summary of findings


Our inspection teamOur inspection team was led by:

A CQC Lead Inspector. The team included a GPspecialist adviser and practice manager specialistadviser.

Background to Abbey RoadMedical PracticeAbbey Road Medical Practice is an established GP practicesituated within the London Borough of Newham. Thepractice lies within the administrative boundaries of NHSNewham Clinical Commissioning Group (CCG).

The practice provides general medical services toapproximately 7600 patients living within its catchmentarea in Stratford, London. The practice holds a GeneralMedical Services (GMS) Contract. The practice is located at28a Abbey Road, Stratford, London, E15 3LT and is servedwith relatively good transport links. The nearest stationsare Abbey Road and Stratford High Street on the DLR orStratford International (Underground and SoutheasternRail.) The building is purpose built and provides step freeaccess, automatic doors enabling wheelchair and generalaccess to the entrance, reception and waiting area. Aninduction loop system is available for deaf and hearingimpaired people who use the service. Language lineservices are available for those who do not have English asa first language, together with the provision of aconfidential/isolation area in reception and theopportunity to use a ground floor quiet room. There isparking on site offering general and disabled parking. Thepractice shares the building with a dental practice whichoperates on the first floor of the building.

The practice population is ethnically diverse, with asignificant African, Asian and White European community.The area has significant deprivation with an Indices ofMultiple Deprivation (IMD) score of 2 (2nd most depriveddecile). The lower the IMD decile the more deprived an areais. An area itself is not deprived; it is the circumstances andlifestyles of the people living there that affect itsdeprivation score.

The demographics show a fairly even gender split with Male(52%) and Female (48%). There is a younger than averagepopulation with significantly less people aged over 65, incomparison to the England average. The percentage ofpatients with a long standing health condition appears 20%lower than the England average and 10% lower than theCCG average.

The practice is registered with the Care Quality Commission(CQC) to provide the regulated activities of diagnostic &screening procedures, treatment of disease, disorder orInjury, family planning, surgical procedures and maternity& midwifery services. Some directed enhanced services areprovided at this practice which includes, contraceptive coilfitting, facilitating timely diagnosis and support for peoplewith dementia, and influenza, pneumococcal and shinglesimmunisations.

The practice team comprises of two male partner GP’s(each cover 8 clinical sessions), one full time salariedfemale GP (covers 8 clinical sessions), and one part timefemale GP (covers 2 clinical sessions.) They are supportedby a full time practice nurse, one part time healthcareassistant, one full time practice manager, one full timeadministrator, one part time reception manager and twelveadditional reception/administrative staff, including twopart time trainee receptionists.

The opening hours are Monday, Tuesday and Wednesday8.30am to 8pm, Thursday from 8.30am to 12.30pm andFriday 8.30am to 6.30pm. Appointments are from 9am to

AbbeAbbeyy RRooadad MedicMedicalal PrPracticacticeeDetailed findings


12.30pm daily and from 3pm to 6pm daily except Thursday.There is the opportunity for emergency appointmentsMonday to Friday on a first come first serve basis between8.30am and 9.30am available by telephone or walk in.Extended hours appointments are available Monday toWednesday evenings from 6.30pm to 8pm. Saturdayappointments are available at another nearby “buddy”practice.

Out-of-hours services are communicated by calling theNewham GP Cooperative out of hours service on adedicated telephone line when the practice is closed. Callsto the surgery number are signposted to the out of hoursservice or by calling NHS Direct on111. Information isprovided on the practice telephone line and on the practicenotice board.

The practice provides a full range of general medicalservices including chronic disease management, and NHShealth checks. The practice also provides health promotionservices including, cervical screening, childhoodimmunisations, contraception including IUD (coil) fittingand family planning. The practice is a training practicewhich supports the training of student doctors and nurses,although at the time of our inspection were not providingplacements for doctors.

Why we carried out thisinspectionWe carried out a comprehensive inspection of this serviceunder Section 60 of the Health and Social Care Act 2008 aspart of our regulatory functions. The inspection wasplanned to check whether the provider is meeting the legalrequirements and regulations associated with the Healthand Social Care Act 2008, to look at the overall quality ofthe service, and to provide a rating for the service under theCare Act 2014.

This is the first time the CQC has inspected the practice.

How we carried out thisinspectionBefore visiting, we reviewed a range of information we holdabout the practice and asked other organisations to sharewhat they knew. We carried out an announced visit on 17August 2016. During our visit we:

• Spoke with a range of staff (GP’s, practice manager,nurse, administrative and reception staff); spoke withfive patients who used the service and four members ofthe patient participation group (PPG).

• Observed how patients were being cared for and talkedwith carers and family members.

• Reviewed an anonymised sample of the personal careor treatment records of patients.

• Reviewed comment cards where patients and membersof the public shared their views and experiences of theservice.

To get to the heart of patients’ experiences of care andtreatment, we always ask the following five questions:

• Is it safe?• Is it effective?• Is it caring?• Is it responsive to people’s needs?• Is it well-led?

We also looked at how well services were provided forspecific groups of people and what good care looked likefor them. The population groups are:

• Older people• People with long-term conditions• Families, children and young people• Working age people (including those recently retired

and students)• People whose circumstances may make them

vulnerable• People experiencing poor mental health (including

people with dementia).

Please note that when referring to information throughoutthis report, for example any reference to the Quality andOutcomes Framework data, this relates to the most recentinformation available to the CQC at that time.

Detailed findings


Our findingsSafe track record and learning

There was an effective system in place for reporting andrecording significant events.

• Staff told us they would inform the practice manager ofany incidents and there was a recording form availableon the practice’s computer system. The incidentrecording form supported the recording of notifiableincidents under the duty of candour. (The duty ofcandour is a set of specific legal requirements thatproviders of services must follow when things go wrongwith care and treatment).

• We saw evidence that when things went wrong with careand treatment, patients were informed of the incident,received reasonable support, truthful information, awritten apology and were told about any actions toimprove processes to prevent the same thing happeningagain.

• The practice carried out a thorough analysis ofsignificant events and carried out a formal annualreview of incidents and accidents.

We reviewed safety records, incident reports, patient safetyalerts and minutes of meetings where these werediscussed. We saw evidence that lessons were shared andaction was taken to improve safety in the practice. Forexample, the building recently had sliding doors fittedwhich had resulted in staff and patients accidentallybumping into the door. This was discussed and a generalrisk assessment was conducted which resulted in thefrosted strips with the practice name being applied to theside of the door to make it more visible.

Overview of safety systems and processes

The practice had clearly defined and embedded systems,processes and practices in place to keep patients safe andsafeguarded from abuse, which included:

• Arrangements were in place to safeguard children andvulnerable adults from abuse. These arrangementsreflected relevant legislation and local requirements.Policies were accessible to all staff. The policies clearlyoutlined who to contact for further guidance if staff hadconcerns about a patient’s welfare. There was a leadmember of staff for safeguarding. The practice hadmonthly safeguarding meetings which included the

midwife and health visitor. The GPs attendedsafeguarding meetings when possible and alwaysprovided reports where necessary for other agencies.Staff demonstrated they understood theirresponsibilities and all had received training onsafeguarding children and vulnerable adults relevant totheir role. GPs and nurses were trained to childsafeguarding level 3, healthcare assistant, reception andadministrative staff were trained to Level 1 or 2.

• A notice in the waiting and clinical rooms advisedpatients that chaperones were available if required. Allstaff who acted as chaperones were trained for the roleand had received a Disclosure and Barring Service (DBS)check. (DBS checks identify whether a person has acriminal record or is on an official list of people barredfrom working in roles where they may have contact withchildren or adults who may be vulnerable).

• The practice maintained appropriate standards ofcleanliness and hygiene. We observed the premises tobe clean and tidy. The practice nurse was the infectioncontrol clinical lead who liaised with peers and the localinfection prevention teams to keep up to date with bestpractice. There was an infection control protocol inplace and staff had received up to date training. Annualinfection control audits were undertaken and we sawevidence that action was taken to address anyimprovements identified as a result.

• The arrangements for managing medicines, includingemergency medicines and vaccines, in the practice keptpatients safe (including obtaining, prescribing,recording, handling, storing, security and disposal).Processes were in place for handling repeatprescriptions which included the review of high riskmedicines. The practice carried out regular medicinesaudits, with the support of the local CCG pharmacyteams, to ensure prescribing was in line with bestpractice guidelines for safe prescribing. Blankprescription forms and pads were securely stored andthere were systems in place to monitor their use. PatientGroup Directions (PGDs) had been adopted by thepractice to allow nurses to administer medicines in linewith legislation. (PGDs are written instructions for thesupply or administration of medicines to groups ofpatients who may not be individually identified beforepresentation for treatment). Health Care Assistants weretrained to administer vaccines and medicines against aPatient Specific Direction (PSD) from a prescriber. (PSDs

Are services safe?

Good –––


are written instructions from a qualified and registeredprescriber for a medicine including the dose, route andfrequency or appliance to be supplied or administeredto a named patient after the prescriber has assessed thepatient on an individual basis).

• We reviewed personnel files and found appropriaterecruitment checks had been undertaken prior toemployment. For example, proof of identification,references, qualifications, registration with theappropriate professional body and the appropriatechecks through the Disclosure and Barring Service.

Monitoring risks to patients

Risks to patients were assessed and well managed.

• There were procedures in place for monitoring andmanaging risks to patient and staff safety. There was ahealth and safety policy available with a poster ondisplay which identified local health and safetyrepresentatives. The practice had up to date fire riskassessments and carried out regular fire drills. Allelectrical equipment was checked to ensure theequipment was safe to use and clinical equipment waschecked to ensure it was working properly. The practicehad a variety of other risk assessments in place tomonitor safety of the premises such as control ofsubstances hazardous to health and infection controland legionella (Legionella is a term for a particularbacterium which can contaminate water systems inbuildings).

• Arrangements were in place for planning andmonitoring the number of staff and mix of staff neededto meet patients’ needs. There was a rota system inplace for all the different staffing groups to ensureenough staff were on duty

Arrangements to deal with emergencies and majorincidents

The practice had adequate arrangements in place torespond to emergencies and major incidents.

• There was an instant messaging system on thecomputers in all the consultation and treatment roomswhich alerted staff to any emergency.

• All staff received annual basic life support training andthere were emergency medicines available in thetreatment room.

• The practice had a defibrillator available on thepremises and oxygen with adult and children’s masks. Afirst aid kit and accident book was available.

• Emergency medicines were easily accessible to staff in asecure area of the practice and all staff knew of theirlocation. All the medicines we checked were in date andstored securely.

• The practice had a comprehensive business continuityplan in place for major incidents such as power failureor building damage. The plan included emergencycontact numbers for staff. This had recently beenreviewed and updated following an incident in Junewhich resulted in a partial power loss over two days.

Are services safe?

Good –––


Our findingsEffective needs assessment

The practice assessed needs and delivered care in line withrelevant and current evidence based guidance andstandards, including National Institute for Health and CareExcellence (NICE) best practice guidelines.

• The practice had systems in place to keep all clinicalstaff up to date. Staff had access to guidelines from NICEand used this information to deliver care and treatmentthat met patients’ needs.

• The practice monitored that these guidelines werefollowed through risk assessments, audits and randomsample checks of patient records.

Management, monitoring and improving outcomes forpeople

The practice used the information collected for the Qualityand Outcomes Framework (QOF) and performance againstnational screening programmes to monitor outcomes forpatients. (QOF is a system intended to improve the qualityof general practice and reward good practice). The mostrecent published results at the time of the inspection were94.8% of the total number of points available.

This practice was not an outlier for any QOF (or othernational) clinical targets. Data from 2014/15 showed:

• Performance for diabetes related indicators was in linewith the local and national averages.

• 76% of patients with diabetes, had their HbA1c (bloodsugar over time) last measured at 64 mmol/mol or less,compared to the local average of 73% and the nationalaverage of 78%.

• 75% of patients with diabetes had well controlled bloodpressure, compared to the local average of 83% and thenational average of 78%.

• 98% of patients with diabetes had an influenzaimmunisation, compared to the local average of 94%and the national average of 94%.

• 74% of patients with diabetes had well controlled totalcholesterol, compared to the local average of 81% andthe national average of 81%.

• 95% of patients with diabetes had a foot examinationand risk classification, compared to the local average of89% and the national average of 88%.

• Performance for mental health related indicators wassimilar to the national average.

• 88% of patients with schizophrenia, bipolar affectivedisorder and other psychoses had a comprehensive,agreed care plan, compared to the local average of 84%and the national average of 88%.

• 96% of patients with schizophrenia, bipolar affectivedisorder and other psychoses had their alcoholconsumption recorded, compared to the local averageof 92% and the national average of 90%.

• 78% of patients diagnosed with dementia had aface-to-face review of their care, compared to the localaverage of 87% and the national average of 84%.

• 98% of patients with physical and/or mental healthconditions had their smoking status recorded,compared to the local average of 96% and the nationalaverage of 94%.

Rates of exception reporting were in line with average.(Exception reporting is the removal of patients from QOFcalculations where, for example, the patients are unable toattend a review meeting or certain medicines cannot beprescribed because of side effects).

There was evidence of quality improvement includingclinical audit.

• There had been six clinical audits completed in the lasttwo years, three of these were completed audits wherethe improvements made were implemented andmonitored.

• The practice participated in local audits, nationalbenchmarking, accreditation, peer review and research.

• Findings were used by the practice to improve services.For example, an audit was conducted to improvepatient outcomes through the prevention, earlydetection and treatment of undernutrition. Initially thepractice identified that they did not have a structuredsystem in place to review patients who were receivingoral nutritional supplements. They reviewed theirprocesses and agreed the malnutrition universalscreening tool should be used consistently to improveprescribing and patient outcomes. Through subsequent

Are services effective?(for example, treatment is effective)

Good –––


reviews it was noted that the use of this tool increasedfrom 40% to 99% in an eighteen month period whichresulted in more appropriate prescribing andmonitoring.

Effective staffing

Staff had the skills, knowledge and experience to delivereffective care and treatment.

• The practice had an induction programme for all newlyappointed staff. This covered such topics assafeguarding, infection prevention and control, firesafety, health and safety and confidentiality.

• The practice could demonstrate how they ensuredrole-specific training and updating for relevant staff. Forexample, for those reviewing patients with long-termconditions, one of the practice nurses was doing anadvanced nurse practitioner course at City University tofurther improve their skills and knowledge.

• Staff administering vaccines and taking samples for thecervical screening programme had received specifictraining which had included an assessment ofcompetence. Staff who administered vaccines coulddemonstrate how they stayed up to date with changesto the immunisation programmes, for example byaccess to on line resources and discussion at practicemeetings.

• The learning needs of staff were identified through asystem of appraisals, meetings and reviews of practicedevelopment needs. Staff had access to appropriatetraining to meet their learning needs and to cover thescope of their work. This included ongoing support,one-to-one meetings, coaching and mentoring, clinicalsupervision and facilitation and support for revalidatingGPs. All staff had received an appraisal within the last 12months.

• Staff received training that included: safeguarding, firesafety awareness, basic life support and informationgovernance. Staff had access to and made use ofe-learning training modules, in-house and externaltraining.

Coordinating patient care and information sharing

The information needed to plan and deliver care andtreatment was available to relevant staff in a timely andaccessible way through the practice’s patient record systemand their intranet system.

• This included care and risk assessments, care plans,medical records and investigation and test results.

• The practice shared relevant information with otherservices in a timely way, for example when referringpatients to other services, such as Newham TalkingTherapy for those with emotional, affective and anxietyrelated problems.

Staff worked together and with other health and social careprofessionals to understand and meet the range andcomplexity of patients’ needs and to assess and planongoing care and treatment. This included when patientsmoved between services, including when they werereferred to, or after they were discharged from hospital.Meetings took place with other health care professionals ona regular basis when care plans were routinely reviewedand updated for patients with complex needs.

Consent to care and treatment

Staff sought patients’ consent to care and treatment in linewith legislation and guidance.

• Staff understood the relevant consent anddecision-making requirements of legislation andguidance, including the Mental Capacity Act 2005.

• When providing care and treatment for children andyoung people, staff carried out assessments of capacityto consent in line with relevant guidance.

• Where a patient’s mental capacity to consent to care ortreatment was unclear the GP or practice nurseassessed the patient’s capacity and, recorded theoutcome of the assessment.

• The process for seeking consent was monitored throughpatient records audits.

Supporting patients to live healthier lives

The practice identified patients who may be in need ofextra support. For example:

• Patients receiving end of life care, carers, those at risk ofdeveloping a long-term condition, and those identifiedas vulnerable were signposted to the relevant service.

• The practice nurse provided dietary advice and supportand signposting in relation to smoking cessation.

The practice’s uptake for the cervical screening programmewas 81%, which was comparable to the CCG average of81% and the national average of 82%. There was a policy tooffer telephone reminders for patients who did not attendfor their cervical screening test. The practice demonstrated


Good –––


how they encouraged uptake of the screening programmeby using information in different languages and for thosewith a learning disability and they ensured a female sampletaker was available. The practice also encouraged itspatients to attend national screening programmes forbowel and breast cancer screening. There were failsafesystems in place to ensure results were received for allsamples sent for the cervical screening programme and thepractice followed up women who were referred as a resultof abnormal results.

Childhood immunisation rates for the vaccinations givenwere comparable to the CCG and national averages. Forexample, childhood immunisation rates for thevaccinations given to five year olds from 81% to 96%.

Patients had access to appropriate health assessments andchecks. These included health checks for new patients andNHS health checks for patients aged 40–74 and those 75and over. Appropriate follow-ups for the outcomes ofhealth assessments and checks were made, whereabnormalities or risk factors were identified.


Good –––


Our findingsKindness, dignity, respect and compassion

We observed members of staff were courteous and veryhelpful to patients and treated them with dignity andrespect.

• Curtains were provided in consulting rooms to maintainpatients’ privacy and dignity during examinations,investigations and treatments.

• We noted that consultation and treatment room doorswere closed during consultations; conversations takingplace in these rooms could not be overheard.

• Reception staff knew when patients wanted to discusssensitive issues or appeared distressed they could offerthem a private room to discuss their needs.

All of the 40 patient Care Quality Commission commentcards we received were positive about the serviceexperienced, although four also commented thatsometimes it was difficult to get through to the practice toarrange an appointment. Patients said they felt the practiceoffered an excellent service and staff were friendly, helpful,kind, caring and treated them with dignity and respect.

We spoke with four members of the patient participationgroup (PPG). They also told us they were very satisfied withthe care provided by the practice and said their dignity andprivacy was respected. Comment cards highlighted thatstaff responded compassionately when they needed helpand provided support when required.

Results from the national GP patient survey showedpatients felt they were treated with compassion, dignityand respect. The practice was comparable with the CCGand national average for its satisfaction scores onconsultations with GPs and nurses. For example:

• 89% of patients said the GP was good at listening tothem compared to the clinical commissioning group(CCG) average of 82% and the national average of 89%.

• 84% of patients said the GP gave them enough timecompared to the CCG average of 78% and the nationalaverage of 87%.

• 92% of patients said they had confidence and trust inthe last GP they saw compared to the CCG average of91% and the national average of 95%.

• 81% of patients said the last GP they spoke to was goodat treating them with care and concern compared to theCCG average of 77% and national average of 85%.

• 86% of patients said the last nurse they spoke to wasgood at treating them with care and concern comparedto the CCG average of 81% and national average of 91%.

• 81% of patients said they found the receptionists at thepractice helpful compared to the CCG average of 81%and the national average of 87%.

Care planning and involvement in decisions aboutcare and treatment

Patients told us they felt involved in decision making aboutthe care and treatment they received. They also told usthey felt listened to and supported by staff and hadsufficient time during consultations to make an informeddecision about the choice of treatment available to them.Patient feedback from the comment cards we received wasalso positive and aligned with these views. We also sawthat care plans were detailed and personalised.

Results from the national GP patient survey showedpatients responded positively to questions about theirinvolvement in planning and making decisions about theircare and treatment. Results were in line with local andnational averages. For example:

• 82% of patients said the last GP they saw was good atexplaining tests and treatments compared to the CCGaverage of 80% and the national average of 86%.

• 82% of patients said the last GP they saw was good atinvolving them in decisions about their care comparedto the CCG average of 75% and national average of 82%.

• 77% of patients said the last nurse they saw was good atinvolving them in decisions about their care comparedto the CCG average of 77% and national average of 85%.

The practice provided facilities to help patients be involvedin decisions about their care:

• Staff told us that translation services were available forpatients who did not have English as a first language.We saw notices in the reception areas informingpatients this service was available.

• Information leaflets were available in easy read format.• We saw advice on healthy living, how to access to health

records and how to become involved in the PPGdisplayed within the practice.

Are services caring?

Good –––


Patient and carer support to cope emotionally withcare and treatment

Patient information leaflets and notices were available inthe patient waiting area which told patients how to accessa number of support groups and organisations.

The practice’s computer system alerted GPs if a patient wasalso a carer. The practice had identified 28 patients ascarers which was less than 0.4% of the practice list. Thepractice used the list to offer support, signpost and refer to

other agencies where appropriate. Carers were also invitedto take part in the annual influenza vaccinationsprogramme. Written information was available to directcarers to the various avenues of support available to them.

Staff told us that if families had suffered bereavement, theirusual GP contacted them. This call was followed by apatient consultation at a flexible time and location to meetthe family’s needs. The practice sent sympathy cardstogether with a letter and information sheet produced bythe local bereavement drop in centre.

Are services caring?

Good –––


Our findingsResponding to and meeting people’s needs

The practice reviewed the needs of its local population andengaged with the NHS England Area Team and CCG tosecure improvements to services where these wereidentified. For example the practice developed a cancerdiagnosis protocol which was implemented across the CCGto improve cancer diagnosis and recording.

• The practice offered an extended evening clinic on aMonday, Tuesday and Wednesday evening from 6.30pmto 8pm for working patients who could not attendduring normal opening hours.

• There were longer appointments available for patientswith a learning disability and complex needs.

• Home visits were available for older patients andpatients who had clinical needs which resulted indifficulty attending the practice.

• Same day appointments were available for children andthose patients with medical problems that require sameday consultation.

• Patients were able to receive travel vaccinationsavailable on the NHS as well as those only availableprivately.

• There were disabled facilities, a hearing loop andtranslation services available.

• Other reasonable adjustments were made and actionwas taken to remove barriers when patients find it hardto use or access services.

Access to the service

The practice was open between 8.30am and 6.30pmMonday to Friday, except Thursday when the practiceclosed at 12.30pm. Appointments were from 9am to12.30pm every morning and 3pm 6pm daily. Extendedhours appointments were offered at the following times;6.30pm to 8pm Monday to Wednesday. In addition topre-bookable appointments, that could be booked up tofour weeks in advance, urgent appointments were alsoavailable for people that needed them. Saturdayappointments were available at another nearby “buddy”practice.

Out of hours services are communicated by calling theNewham out of hours service on a dedicated telephoneline when the practice is closed. Calls to the surgery

number are signposted to the Newham cooperative out ofhours service or by calling NHS Direct on111. Information isprovided on the practice telephone line and on the practicenotice board.

Results from the national GP patient survey showed thatpatient’s satisfaction with how they could access care andtreatment was comparable to local and national averages.

• 69% of patients were satisfied with the practice’sopening hours compared to the CCG average of 74%and national average of 76%.

• 68% of patients said they could get through easily to thepractice by phone compared to the CCG average of 60%and national average of 73%.

People told us on the day of the inspection that they wereable to get appointments when they needed them.

The practice had a system in place to assess:

• whether a home visit was clinically necessary; and• the urgency of the need for medical attention.

The duty doctor would telephone the patient or carer inadvance to gather information to allow for an informeddecision to be made on prioritisation according to clinicalneed. In cases where the urgency of need was so great thatit would be inappropriate for the patient to wait for a GPhome visit, alternative emergency care arrangements weremade. Clinical and non-clinical staff were aware of theirresponsibilities when managing requests for home visits.

Listening and learning from concerns and complaints

The practice had an effective system in place for handlingcomplaints and concerns.

• Its complaints policy and procedures were in line withrecognised guidance and contractual obligations forGPs in England.

• There was a designated responsible person whohandled all complaints in the practice.

• We saw that information was available to help patientsunderstand the complaints system e.g. notices weredisplayed and a summary leaflet was available.

We looked at 6 complaints received in the last 12 monthsand found these were satisfactorily handled, dealt with in atimely way and the practice were open and transparentwith dealing with the complaint. The practice conducted aformal annual review of complaints and discussed theoutcomes in a whole practice meeting. Lessons were learnt

Are services responsive to people’s needs?(for example, to feedback?)

Good –––


from individual concerns and complaints and also fromanalysis of trends and action was taken to as a result toimprove the quality of care. For example, patients hadcomplained and were unhappy that when they arrived latefor an appointment they were unable to be seen and wouldhave to book another appointment. This was discussed at

a practice meeting and this policy was reviewed. It wassubsequently agreed that patients would now be seen onthe day of their appointment but may need to wait until theend of surgery to be seen, rather than being advised torebook.

Are services responsive to people’s needs?(for example, to feedback?)

Good –––


Our findingsVision and strategy

The practice had a clear vision to deliver high quality careand promote good outcomes for patients.

• The practice had a mission statement which wasdisplayed in the waiting areas and staff knew andunderstood the values.

• The practice had a strategy and supporting businessplans which reflected the vision and values and wereregularly monitored.

Governance arrangements

The practice had an overarching governance frameworkwhich supported the delivery of the strategy and goodquality care. This outlined the structures and procedures inplace and ensured that:

• There was a clear staffing structure and that staff wereaware of their own roles and responsibilities.

• Practice specific policies were implemented and wereavailable to all staff.

• A comprehensive understanding of the performance ofthe practice was maintained

• A programme of continuous clinical and internal auditwas used to monitor quality and to makeimprovements.

• There were arrangements for identifying, recording andmanaging risks, issues and implementing mitigatingactions.

Leadership and culture

On the day of inspection the partners in the practicedemonstrated they had the experience, capacity andcapability to run the practice and ensure high quality care.They told us they prioritised safe, high quality andcompassionate care. Staff told us the partners wereapproachable and always took the time to listen to allmembers of staff.

The provider was aware of and had systems in place toensure compliance with the requirements of the duty ofcandour. (The duty of candour is a set of specific legalrequirements that providers of services must follow whenthings go wrong with care and treatment).This includedsupport training for all staff on communicating with

patients about notifiable safety incidents. The partnersencouraged a culture of openness and honesty. Thepractice had systems in place to ensure that when thingswent wrong with care and treatment:

• They gave affected people reasonable support, truthfulinformation and a verbal and written apology.

• They kept written records of verbal interactions as wellas written correspondence.

• They learned from complaints, incidents and accidentsand conducted a formal annual review which wasshared and discussed with all staff.

There was a clear leadership structure in place and staff feltsupported by management.

• Staff told us the practice held regular team meetings.• Staff told us there was an open culture within the

practice and they had the opportunity to raise anyissues at team meetings and felt confident andsupported in doing so.

• Staff said they felt respected, valued and supported,particularly by the partners in the practice. All staff wereinvolved in discussions about how to run and developthe practice, and the partners encouraged all membersof staff to identify opportunities to improve the servicedelivered by the practice.

Seeking and acting on feedback from patients, thepublic and staff

The practice encouraged and valued feedback frompatients, the public and staff. It proactively sought patients’feedback and engaged patients in the delivery of theservice.

• The practice had gathered feedback from patientsthrough the patient participation group (PPG) andthrough surveys and complaints received. The PPG metregularly, carried out patient surveys and submittedproposals for improvements to the practicemanagement team. For example, the practiceimplemented changes recommended by the PPG toimprove the telephone system.

• The practice had gathered feedback from staff generallythrough staff meetings, appraisals and discussion. Stafftold us they would not hesitate to give feedback and

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


discuss any concerns or issues with colleagues andmanagement. Staff told us their views were valued andfelt involved and engaged to improve how the practicewas run.

Continuous improvement

There was a focus on continuous learning andimprovement at all levels within the practice. The practiceteam was forward thinking and part of local pilot schemesto improve outcomes for patients in the area. For example,the practice developed a cancer diagnosis protocol whichwere implemented across the CCG to improve cancerdiagnosis and recording.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


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