Archived: Porters Avenue Doctors Surgery

Updated 1 May 2018

Porters Avenue Doctors Surgery provides primary medical services in Dagenham to approximately 8646 patients and is a member of the NHS Barking and Dagenham Clinical Commissioning Group (CCG).

The practice population is in the second most deprived decile in England. It has greater than CCG and national average representation of income deprived children and older people. Thirty-three percent of children live in income deprived households compared to a CCG average of 32% and a national average of 20%. Thirty percent of older people live in income deprived households compared to a CCG average of 28% and a national average of 16%. The practice population has a greater than average percentage of children and young people aged up to 18, with a less than average population in all age groups above age 65. The practice had surveyed the ethnicity of the practice population and had determined that 50% of patients described themselves as white, 10% Asian, 17% black and 13% as having mixed or other ethnicity.

The practice operates from a purpose built property with all patient facilities on the ground floor that is wheelchair accessible. There are offices for administrative and management staff on the ground floor.

The practice operates under an Alternative Provider Medical Services (APMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract). The enhanced services it provides are: facilitating timely diagnosis and support for people with dementia; improving patient online access; influenza and pneumococcal immunisations; minor surgery; patient participation; risk profiling and case management; rotavirus and shingles immunisation; and unplanned admissions.

The practice team at the surgery is made up of four male GPs working, between them, a whole time equivalent of three GPs. The nursing team consists of three female practice nurses. Porters Avenue Doctors Surgery also employs one male part-time health care assistant.

There are nine administrative, reception and clerical staff, including one apprentice, and a part-time business manager and a full-time assistant practice manager.

The practice is open between 8am and 8pm Monday to Friday, and from 9am to 12pm on Saturdays. Appointments are from 8am to 8pm daily. The practice has opted out of providing out of hours (OOH) services to their own patients when closed and directs patients to the OOH provider for NHS Barking and Dagenham CCG.

Porters Avenue Doctors Surgery is one of seven GP practices forming Concordia Health Limited and is registered with the Care Quality Commission to provide the regulated activities of treatment of disease, disorder or injury; diagnostic and screening procedures; surgical procedures.

This practice was previously inspected by CQC in October 2016. At that time the practice was rated good overall and requires improvement for providing caring services.

Updated 1 May 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Porters Avenue Doctors Surgery on 5 October 2016. The overall rating for the practice was good, the practice was rated requires improvement for providing caring services. The full comprehensive report on the 5 October 2016 inspection can be found by selecting the ‘all reports’ link for Porters Avenue Doctors Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 28 March 2018 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 5 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is still rated as Good.

Our key findings were as follows:

• Results from the 2017 national GP patient survey did not show an improvement, however the practice had carried out their own more recent survey with the same questions as the national survey which did show an improvement.
• Patients surveyed were satisfied with the surgery`s opening hours.
• The practice had increased the number of carers identified from 1% to 2% of its practice population.
• The practice has improved its communications with patients who may have caring responsibilities by displaying posters detailing the support that is available to them.
• The surgery has partnered with the local carers team, who attended the practice twice a month to provide face to face guidance and support to patients with caring responsibilities.
• The practice also sent letters to the patients who had caring responsibilities to inform them about the local carer’s organisation.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes had improved and were in line with national average. (QOF is a system intended to improve the quality of general practice and reward good practice).
• The practice had also reduced its exception reporting in some areas including patients with diabetes, atrial fibrillation, coronary heart disease, stroke and transient ischaemic attack, depression, heart failure and rheumatoid arthritis. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate).

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However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Continue to ensure that it addresses issues highlighted in the national GP survey in order to improve on the low levels of patient satisfaction.

At our previous inspection on 5 October 2016, we rated the practice as requires improvement for providing caring services as the practice had identified less than 1% of patients as carer’s, patient satisfaction scores were lower than local and national averages. At this inspection we found that the number of carers identified was 2% of the practices list, however the patient satisfaction survey scores were still lower than local and national averages. Consequently, the practice is still rated as requires improvement for providing caring services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 March 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.

• 80% of patients with diabetes had a last blood pressure reading of 140/80 mmHg or less which was comparable to the national average of 78%.

• Longer appointments and home visits were available when needed.

• 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 13 March 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.

• 84% of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years compared to a CCG average of 80% and a 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 13 March 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.

• If families suffered bereavement, their usual GP contacted them or sent them a sympathy card. This was either followed by a patient consultation at a flexible time and location to meet the family’s needs or by giving them advice on how to find a support service.

Updated 13 March 2017

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 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.

• 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.

• The practice undertook NHS health checks for patients aged 40–74.

Updated 13 March 2017

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

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had had their alcohol consumption recorded in the preceding 12 which was above the national average of 90%.

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan, in the preceding 12 months, which was comparable to 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 13 March 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.