The Surgery - Barretts Grove

Updated 18 July 2017

The Surgery – Barretts Grove is located in a converted house in a residential street in East London and is a part of City and Hackney CCG. The practice is served by good transport links and there are disabled parking bays close to the premises.

There are 3500 patients registered with the practice 16% of whom are under the age of 18 years, which is lower than the CCG average of 22% and the national average of 21%, there is also a large number of patients who do not have English as a first language. The practice has a deprivation score of 40, which is significantly higher (more deprived) than the national average of 22.

The practice has one male and one female GP partner and two regular locums who complete a total of 13 sessions per week. There are two practice nurses who carry out 11 sessions per week; a diabetes specialist nurse holds a session at the practice fortnightly and a practice pharmacist. The practice also has a practice manager and five reception/administration staff members.

The practice operates under a General Medical Services (GMS) contract (a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice is open on Monday to Friday between 9am to 6:30pm except for Thursday when it closes at 1pm. Phone lines are answered from 9am and appointment times are as follows:

• Monday 9:30am to 1:45pm and 3:30pm to 5:40pm
• Tuesday 9:30am to 12:10pm and 4:30pm to 7:15pm
• Wednesday 9:30am to 12:15pm and 3pm to 5:10pm
• Thursday 9:30am to 12:15pm
• Friday 9:30am to 12:15pm and 3:30pm to 5:40pm

The locally agreed out of hour provider covers calls made to the practice whilst the practice is closed.

The Surgery – Barretts Grove operates regulated activities from one location and is registered with the Care Quality Commission to provide diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury.

Updated 18 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery – Barretts Grove on 11 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report published in December 2016 can be found by selecting the ‘all reports’ link for The Surgery – Barretts Grove on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 13 June 2017, carried out to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 11 November 2016. There were breaches in health and safety, risk management and recruitment processes. There were also concerns with policies and procedures, staff training and the business continuity plan. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The practice had a full complement of emergency medicines, all of these were stored correctly including vaccines, were in date and included a supply of oxygen.
• The practice had completed a number of risk assessments, which included fire, legionella and infection control.
• All electrical equipment was tested to make sure it was in good working order and clinical equipment was calibrated.
• There was a comprehensive business plan and we saw an example of when it had been effectively used.
• All policies and protocols were accessible to all staff members and had recently been reviewed and version controlled.
• The practice had a new recruitment process, we saw that this was followed for all newly appointed staff members and included an induction.
• All staff had completed mandatory training such as basic life support and fire safety and all clinical staff had attended training updates.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients rated the practice in-line with the CCG and national averages for several aspects of care.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there was also an area of practice where the provider needs to make improvements.

The provider should:

• Continue to work to improve coding issues for patients with mental health as identified by QOF.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 18 July 2017

The provider had resolved all the concerns for safety, effectiveness, and being well-led identified at our inspection on 11 November 2016, this applied to everyone using this practice including this population group. The population group ratings have been updated to reflect this.

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.
• 88% of patients on the diabetes register had a HbA1c blood test result of 64mmol/mol or less in the preceding 12 months which was the same as the CCG average and above the national average of 78%. There was an exception reporting rate of 3%, which was lower than the CCG average of 8% and the national average of 13%.
• The practice as a part of the locally enhanced service called ‘time to talk’, which provided extended appointments (30 minutes) with a GP to patients with cancer or who had two or more long term conditions where they were able to talk about any aspect of their health.
• 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 18 July 2017

The provider had resolved all the concerns for safety, effectiveness, and being well-led identified at our inspection on 11 November 2016, this applied to everyone using this practice including this population group. The population group ratings have been updated to reflect this.

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 above the CCG and national averages 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 18 July 2017

The provider had resolved all the concerns for safety, effectiveness, and being well-led identified at our inspection on 11 November 2016, this applied to everyone using this practice including this population group. The population group ratings have been updated to reflect this.

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.
• The practice had identified 1% of its patient list as a carer, and offered them an annual review and directed them to support services as required.

Updated 18 July 2017

The provider had resolved all the concerns for safety, effectiveness, and being well-led identified at our inspection on 11 November 2016, this applied to everyone using this practice including this population group. The population group ratings have been updated to reflect this.

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 one evening a week.
• Telephone consultations were available each day at different times during the day for patients who were unable to attend the practice.
• The practice was a part of a local HUB, which provided GP and nurse appointments to patients on weekday evenings and on weekends when the practice was closed.
• 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.
• Health promotion advice was offered and there was health promotional material available in other languages.

Updated 18 July 2017

The provider had resolved all the concerns for safety, effectiveness, and being well-led identified at our inspection on 11 November 2016, this applied to everyone using this practice including this population group. The population group ratings have been updated to reflect this.

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.
• 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 90% and the national average of 84%. Exception reporting was 12% which was above the CCG average of 4% and the national of 7%. However this was just two out of 16 patients.
• There were longer appointments for these patients.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 72% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan documented in their record in the preceding 12 months compared to the CCG average 88% and the national average of 89%. There was an exception reporting rate of 2%, which was below the CCG average of 9% and the national average of 10%.
• The practice was signed up to ‘extended primary care’ which gave joint extended appointments to mental health patients with their GP and community services such as a psychiatrist and link worker.
• 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.

Updated 18 July 2017

The provider had resolved all the concerns for safety, effectiveness, and being well-led identified at our inspection on 11 November 2016, this applied to everyone using this practice including this population group. The population group ratings have been updated to reflect this.

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 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 to these patients.
• 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.