Harrow Road GP Practice, Triangle House Health Centre

Updated 4 August 2017

Harrow Road GP Practice, also known as Triangle House Health Centre, provides GP primary care services to approximately 9,000 people living in Leytonstone, London Borough of Waltham Forest. The practice has a Personal Medical Services (PMS) contract for providing general practice services to the local population. Personal Medical Services agreements are locally agreed contracts between NHS England and a GP practice.

The practice is located in a former warehouse building which was fully renovated and refurbished to be a modern medical centre. The building benefits from a lift and all treatment and consulting rooms are fully accessible. On-site patient parking is available including several dedicated disabled parking bays.

There are currently two GP partners, one female and one male. There are five salaried GPs, three female and two male. The practice provides a total of 39 GP sessions per week. The clinical team is completed by a part time practice nurse and a part-time mental health nurse who also undertakes the role of a part-time healthcare assistant. There is also a practice manager, a business manager and eleven administrative and reception staff.

The practice opening hours are 8:00am to 8.00pm from Monday to Friday. Telephones are answered between 8:00am and 6:30pm daily. The practice is a member of a collaborative network of GP practices which offers appointments at a hub location between 9:00am and 5:00pm on Saturday and Sunday.

Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to two weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

The out of hours services (OOH) are provided by the Partnership of East London Co-operatives (PELC). The details of the OOH service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website.

The practice provides a wide range of services including clinics for diabetes, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

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

Updated 4 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harrow Road GP Practice on 5 May 2016. The practice was rated as requires improvement for providing safe, effective and well-led services, good for providing caring and responsive services and an overall rating of requires improvement. The full comprehensive report of the 5 May 2016 inspection can be found by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.

This inspection was carried out to check that action had been taken to comply with legal requirements, ensure improvements had been made and to review the practice's ratings. Overall the practice is now rated as good.

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

• The practice had taken action to improve how it identified, reported and investigated serious incidents. There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had addressed concerns around the management of risks to patient safety and had clearly defined and embedded systems to minimise risks to patient safety.
• There were up to date policies to support and guide staff in the provision of regulated activities including those for medicines management and repeat prescribing.
• 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.
• Staff had received appropriate training in basic life support, fire safety awareness, information governance and infection prevention and control and had had a recent annual appraisal.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• 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.

The areas where the provider should make improvement are:

• Continue to review how eligible patients are encouraged to participate in the health screening programmes with a view to reducing exception reporting rates.
• Continue to review how childhood immunisations are delivered to bring about improvements in uptake rates.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 4 August 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.
• Performance for diabetes related indicators were comparable to CCG and national averages. For instance, 79% of patients had well controlled blood sugar levels (CCG average of 75%, national average 78%). The exception reporting rate for this indicator was 17% (CCG average 16%, national average 13%).
• 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 4 August 2017

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

• 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.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group, for example, in the provision of ante-natal and post-natal checks, and the six week baby check.
• Young children were automatically given an urgent appointment.

Updated 4 August 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 4 August 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, the practice was open between 8am and 8pm every weekday.
• 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 4 August 2017

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

• The practice had employed a mental health nurse to provide additional support to patients experiencing poor mental health. The mental health nurse undertook annual health reviews, helped patients to manage their medicines, and helped patients experiencing poor mental health to access various support groups and voluntary organisations.
• 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice mental health nurse would undertake home visits to support patients who were unable to visit the surgery, including patients who found the experience of visiting the surgery particularly distressing.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan. The exception reporting rate for this indicator was 2% compared to the national average of 13%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• 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 4 August 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 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.