The Lea Surgery

Updated 12 April 2017

The Lea Surgery is located in the London Borough of Hackney within the NHS Hackney Clinical Commissioning Group. The practice holds a Personal Medical Services contract (an agreement between NHS England and general practices for delivering primary care services to local communities ). The practice provides a full range of enhanced services including childhood immunisation and vaccination, meningitis immunisation, dementia support, learning disabilities support, influenza and pneumococcal immunisations, rotavirus and shingles immunisation, unplanned admissions avoidance and minor surgery.

The practice is registered with the Care Quality Commission to carry on the regulated activities of family planning, maternity and midwifery services, treatment of disease, disorder or injury, diagnostic and screening procedures and surgical procedures.

The practice has a patient list size of 10,782. The practice has a similar proportion of people with a long standing health condition than the local average (47% compared to the CCG average of 45% and the national average of 54%). The practice serves a diverse community with approximately 41% White, 34% Black, 12% Asian and 13% non-white ethnic groups. At 78 years, male life expectancy is in line with the CCG average of 78 years and the England average of 79 years. At 82 years, female life expectancy is in line with the CCG average of 82 years and the England average of 83 years.

The practice has fewer patients aged 60 years of age and older compared to an average GP practice in England. The percentage of patients between the ages of 25 and 39 is higher than the average GP practice in England. The surgery is based in an area with a deprivation score of one out of ten (one being the most deprived). Children and older people registered with the practice have a higher level of income deprivation compared to the local and national averages. Patients at this practice have a higher rate of unemployment than the national average.

The clinical team at the practice included one principal male GP, eight sessional male GPs, two female advanced nurse practitioners, one female practice nurse, one male pharmacist and one female phlebotomist. The non-clinical team at the practice included one practice manager and 10 administrative staff. There were 49 GP sessions available per week.

The practice is open and appointments are available from 8am to 7.30pm Monday to Friday; on Saturday between 9am to 1pm and 2pm to 5pm; and on Sunday between 10am to 1pm and 2pm to 5pm.

Extended hours access is available seven days a week with appointments between 6.30pm to 7.30pm Monday to Friday. Extended hours appointments are available every Saturday from 9am to 1pm and 2pm to 5pm and on Sunday from 10am to 1pm and 2pm to 5pm.

Urgent appointments are available each day and GPs also provide telephone consultations for patients. An out of hour’s service is provided for patients when the practice is closed. Information about the out of hour’s service is provided to patients through posters in the waiting area, on the practice website and the practice leaflet.

Updated 12 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lea Surgery on 6 December, 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an extensive range of extended hour’s appointments available to patients seven days a week.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording 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 had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The practice provided patients with seven day access to the service, including a phlebotomy clinic every Saturday. Extended hours appointments were available seven days a week and the practice was open every Saturday and Sunday for routine and emergency appointments. Patient satisfaction around access to the service was significantly higher than the local and national average. For example, the percentage of respondents to the GP patient survey who were 'very satisfied' or 'fairly satisfied' with their GP practice opening hours was 92% compared to the local average of 81% and the national average of 79%. A total of 97% of patients said the last appointment they got was convenient compared to the local average of 91% and the national average of 92%.

• The practice have put a system in place to ensure continuityof care for patients discharged from secondary care services by employing a full time pharmacist at the practice. The pharmacist takes the initial lead in relation to patients being discharged from secondary care. The pharmacist phones the patient upon receiving the discharge summary to ensure that the patient understands any medication changes, has had services implemented and just as importantly ensures that the relevant pharmacy is notified of key changes so that blister packs can be amended appropriately. The pharmacist discusses any important discharge summaries with the duty doctor daily so that a plan of action can be formulated.

The areas where the provider should make improvement are:

• Review audit systems in relation to the monitoring of prescription pads in accordance with national NHS guidelines.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 12 April 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months was 83% compared to the CCG average of 79% and the national average of 76%. The IFCC-HbA1c measures a patient’s blood sugar levels.

• All these patients had a named GP and 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 12 April 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.

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

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 83% compared to the CCG average of 81% 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 and health visitors.

Updated 12 April 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 home visits and urgent appointments for those with enhanced needs.

• All elderly housebound patients were visited on a quarterly basis to ensure preventive care and treatment for this patient cohort.

• There was a full-time onsite pharmacist to ensure continuity of care following discharge from secondary care.

Updated 12 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• Extended hours appointments were available seven days a week.

• 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.

• Telephone and electronic consultations available for patients who are unable to attend the practice.

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

Updated 12 April 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, was 85% compared to the CCG average of 85% and the national average of 88%.

• 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.

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

Updated 12 April 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.

• 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.