Archived: AK Rana

Updated 27 July 2017

AK Rana (Merchant Street Practice) is located in a residential area. It provides primary medical services to approximately 5,300 patients. The practice also provides care and treatment for a hostel and a care home for patients with chronic mental health. The practice holds a General Medical Services (GMS) contract and is commissioned by the NHSE London (A GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities). The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services, family planning, surgical procedures and treatment of disease, disorder or injury. Services are provided from the location of Merchant Street Health Centre, 5 Merchant Street, Bow, London E3 4LJ.

The practice is staffed by two GP partners (one male one female) providing nine sessions per week between them. One salaried GP (female) five sessions and one long term locum (male) covering six and half sessions per week. The practice employs one female practice nurses, one male and one female healthcare assistant, six female administrative staff, one practice manager and one deputy practice manager. It is a teaching and training practice supporting medical students and providing training opportunities for doctors seeking to become fully qualified GPs. The practice has two GP registrars.

The practice is open between 8am and 6.30pm Monday, Tuesday, Wednesday and Friday. On Thursday the practice is open between 8am and 1pm. The surgery is closed Monday, Wednesday and Friday between 1pm and 2pm for lunch. Appointments are from 9.30am to 12.30pm every morning and 3.30pm to 6pm daily. There are no afternoon appointments on Thursday. Extended surgery hours are offered on Monday between 6.30pm and 7.30pm and on three Saturdays every month between 10am and 12.30pm. Appointments can be booked over the phone, in person or online. The out of hours services are provided by an alternative provider, Tower Hamlets Out of Hours service and the details of the service is displayed on the practice leaflet and accessed by calling the practice number.

The practice has a higher than average population of patients aged 20 to 39 years when compared to national average. The life expectancy of male patients is 81 years, which is comparable than the national average of 79 years. The female life expectancy at the practice was 83 years, which is the same as the national average. Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.

The practice runs a number of services for its patients including, cervical smears, sexual health clinic, dressings and removal of stiches, phlebotomy, anti-coagulation clinic and new patient health checks.

Updated 27 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at AK Rana on 14 January 2016. The overall rating for the practice was good. The full comprehensive report on the 14 January 2016 inspection can be found by selecting the ‘all reports’ link for AK Rana on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 25 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 January 2016. There were concerns due to the registered person did not do all that was reasonably practicable to assess, monitor, manage and mitigate risks to the health and safety of service users.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice referred patients for social prescribing to improve their overall wellbeing.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the practice referred patients for social prescribing.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example the PPG suggested a PPG notice board to encourage new members and to keep patients informed of developments at the practice.

• The practice had good facilities and was well equipped to treat patients and meet their needs, however, the main entrance was not wheelchair user friendly.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

However there were areas of practice where the provider should make improvements:

• Review their health and safety risk assessment and ensure it is specific to the practice.

• Ensure that there is a system in place to assist wheelchair and pushchair users in gaining access through the main doors.

• Ensure improvements are made to address patient access to appointments and some aspects of care as outlined in the patient survey.

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Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 July 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 percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 89% compared to the CCG average of 85% and the national average of 80%.
• 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.
• 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 27 July 2017

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

• 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.
• Immunisation rates were high for all standard childhood immunisations.
• 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.
• The practice provided support for premature babies and their families following discharge from hospital.

• 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, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 27 July 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 27 July 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 and Saturday appointments.
• 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.
• Repeat prescriptions, online consultations and telephone consultations were also available.
• Patients aged 40–74 had access to appropriate health assessments and checks that were followed up where abnormalities or risk factors were identified.

The practice ran a drop in clinic for blood pressure checks, blood tests and sexual health screening.

Updated 27 July 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.

• 85% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• 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.

• The practice had a separate mental health patient participation group (PPG) to ensure the needs of this group were met.

Updated 27 July 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.
• The practice referred patents to social prescribing where they could get support with issues such as housing, financial and exercise.