Heathway Medical Centre

Updated 18 October 2019

Heathway Medical Centre is based in a purpose built building, shared with another GP practice, located in a residential area in Dagenham. The building is managed by NHS Properties. There is suitable patient access to the premises and patient parking, including disabled parking. At the time of our inspection there were approximately 4,000 patients registered with the practice. They also take care of 60 residents from a care home. These patients are elderly and require specialist care in dementia, Alzheimer’s and Parkinson’s disease.

Primary medical care is provided under a General Medical Services (GMS) contract within NHS Barking and Dagenham Clinical Commissioning Group (CCG). The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; surgical procedures; diagnostic and screening procedures; family planning services; and maternity and midwifery services at one location.

Updated 18 October 2019

This practice is rated as Good for providing safe services. (Previous rating for Safe 07 2017 – Requires improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced comprehensive inspection at Heathway Medical Centre on 26 May 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety, receiving and acting on complaints and fit and proper persons employed. We undertook an announced comprehensive inspection at Heathway Medical Centre on 3 July 2017. The overall rating for the practice was good, however safe key question was rated requires improvement. The full comprehensive reports on the May 2016 and July 2017 inspections can be found by selecting the ‘all reports’ link for Heathway Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 2 July 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in Regulation 12 that we identified at our previous inspection on 3 July 2017. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

At this inspection we found:

• The practice had an effective process in place for managing un-collected prescriptions.
• We saw examples of where the practice has formalised how they shared learning from significant events with locum GPs.
• The practice was now monitoring the usage and movement of printer generated prescriptions.
• The practice nurse undertaking cervical cytology now had access to 2017/18 Sample Handling Guidelines.
• The practice had reviewed how patients with caring responsibilities were identified, this included how they were coded on the clinical system.
• Patients now had access to a wealth of information through the practice’s dedicated website.
• Steps had been taken to improve the practice’s performance in cervical cytology. Practice data reviewed suggested there has been year on year improvements.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 30 August 2017

The provider 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 was above CCG and national averages. For example, the percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who was treated with an ACE-I (or ARBs) was 100% which was above the CCG average of 88% and national average of 81%. This was achieved without exception reporting any patients.

• 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.

• Appointments were prioritised for patients with long term conditions.

• 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 social care professionals to deliver a multidisciplinary package of care.

• Regular audits were undertaken, for example, the practice reviewed and referred all patients with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) and who did not have a record of chest x-rays documented. X-ray results found stage two lung cancer in some patients; this early diagnosis meant patients could receive optimal treatment thus potentially improving survival rates.

Updated 30 August 2017

The provider is rated as requires improvement 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 comparable to CCG averages, but below national expected coverage for some standard childhood immunisations.

• At 70% the practice’s uptake rate for the cervical screening programme was below the CCG average of 79% and the national average of 81%.

• 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, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and safeguarding concerns.

• The practice had emergency processes for acutely ill children and young people.

Updated 30 August 2017

The provider is rated as 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.

Updated 18 October 2019

Updated 30 August 2017

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

• The practice carried out advance care planning for patients living with dementia; this information was recorded on the register.

• The practice maintained a dementia register which was monitored and updated monthly by the healthcare assistant (HCA) who alerted the principal GP to those who were due a review.

• Performance for dementia related indicators was above the CCG and national averages. For example, 98% of patients with a diagnosis of dementia had a care plan and was reviewed face-to-face in the preceding 12 months and the practice did not exception reported any patients.

• Performance for mental health related indicators was markedly above CCG and national averages. For example, 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their record compared to the CCG average of 85% and national average of 76%. This was achieved without exception reporting any patients.

• The practice provided care and treatment to a 60 bed care home for older people with dementia, Alzheimer’s and Parkinson’s disease. Patients were reviewed weekly by the GP and referred to the psychiatrist if deemed necessary.

• 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 had received training and attended conferences on how to support patients with mental health needs including dementia.

Updated 30 August 2017

The provider 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 those affected by homelessness.

• End of life care was personalised and delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered annual health checks and longer appointments for patients with a learning disability. There were 20 patients on the register, 18 of those had received an annual health check.

• 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.