St Albans Surgery

Updated 25 July 2018

St Albans Surgery is a practice based in Dagenham, Essex. The practice has approximately 8062 registered patients. The practice population is diverse and is in an area in London of high deprivation. Compared to an average GP practice in England, there is a higher than average percentage of patients in employment or full-time education and a higher than average percentage of patients under the age of 24.

The practice has a Personal Medical Services contract ((PMS contracts are locally agreed contract between NHS England and the practice) and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include childhood vaccination, extended hours access, dementia diagnosis and support, flu and pneumococcal immunisation, learning disabilities, rotavirus and shingles immunisation, and unplanned admissions.

The practice operates from two locations; the main practice is in Urswick Medical Centre on Urswick Road, with a branch on Maplestead Road. Both locations are purpose built premises and are wheelchair accessible, there are facilities for wheelchair users including accessible toilets.

The practice has installed hearing loops at each location. The main practice at Urswick Medical Centre has access to six consultation rooms and two treatment rooms on the ground floor. The Maplestead Road branch has access to four consultation rooms on the ground floor. We did not visit the branch surgery as part of our focused inspection. Opening hours are between 8.30am and 6.30pm at the main practice and 8am to 8pm at the branch site on weekdays.

The staff team comprises one Principal GP (male), three salaried GPs (2 female, 1 male) and 4 regular locums (three female and one male). The GPs provide around 38 clinical sessions per week. The GPs were supported by one female nurse prescriber, four part-time female practice nurses-one of whom is a specialist diabetic nurse and a female health care assistant (HCA). Non-clinical staff includes a full-time practice manager, two assistant practice managers, a medical secretary and various administrative and reception staff. The practice is a teaching and training practice.

When the practice is closed patients are automatically directed from the practice telephone to the NHS 111 service. This information is also available on their website and in their practice leaflet. Appointments are also offered by the Barking and Dagenham GP Hub Service for patients who are unable to get appointments with the practice. The practice is registered as an individual with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury, maternity and midwifery services and family planning.

Updated 25 July 2018

This practice is rated good for providing responsive service. (Previous rating for responsive 06 2017– requires improvement)

The key question at this inspection is rated as:

Are services responsive? – Good

We carried out an announced comprehensive inspection at St Albans Surgery on 15 June 2017. The overall rating for the practice was good, however responsive key question was rated requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for St Albans Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 June 2018 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified at our previous inspection on 15 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• At the inspection of June 2015, the practice was not proactive in identifying patients with caring responsibilities. This was because they had identified 46 patients as carers which represented less than 1% of the practice’s population. At this inspection, we found this had significantly improved; 126 patients were now identified and recorded as carers and the practice manager maintained the carer’s register which was used to invite patients to attend influenza vaccines and annual health checks.
• We saw evidence the practice had taken steps to improve and monitor patient feedback in relation to how they accessed treatment and care.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Updated 27 July 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 was comparable to the CCG and below national averages. For example the percentage of patients who had well controlled blood sugar was 68% compared to the CCG average of 67% and the national average of 78%.

• 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 27 July 2017

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 relatively high 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 27 July 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. The practice had sent a letter to every patient over the age of 85 to offer an appointment and an information leaflet about a confidential helpline for older people.

Updated 27 July 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, extended opening hours and Saturday appointments.

• 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 27 July 2017

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.

• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review was 79%, which was comparable to the CGG average of 85% and the national average of 84%.

• Performance for some mental health related indicators was below the CCG and national averages. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in their record was 76% compared to the CCG average of 90% and the national average of 93%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• 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 27 July 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.

• 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. It had carried out annual health checks for 28 of the 45 patients on the learning disability register.

• 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.