Archived: Orient Practice

Updated 2 April 2019

The Orient Practice is managed by Living Care Medical Services and is located in a purpose-built building with one other practice and other community services within a residential area of Waltham Forest. The practice is a part of Waltham Forest Clinical Commissioning Group (CCG).

There are approximately 8,200 patients registered with the practice, 3% of which are aged over 60. Eighty percent of the practice population is in paid work or full-time education, which is higher than the CCG average of 69% and the national average of 62%. The practice has a large number of patients of eastern European decent and 38% of patients do not have English as a first language and require an interpreter.

The practice has one clinical GP lead, three male and three female (salaried and long-term locum) GPs. In addition, there is an advanced nurse practitioner, one practice nurse and a healthcare assistant. There is a deputy practice manager and eight reception/administration staff members.

The practice operates under an Alternative Provider Medical Services (APMS) contract (a locally negotiated contract open to both NHS practices and voluntary sector or private providers e.g. many walk-in centres).

The practice is open Monday to Friday between 8am and 8pm and Saturday between 8am to 1pm.

Phone lines are open from 8am, appointments run concurrently throughout each day. The locally agreed out of hours provider covers calls made to the practice whilst it is closed.

The Orient Practice operates regulated activities from one location and is registered with the Care Quality commission to provide maternity and midwifery services, treatment of disease, disorder or injury, diagnostic and screening procedures and surgical procedures.

Updated 2 April 2019

We carried out an announced comprehensive inspection at The Orient Practice on 5 and 7 February 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 2 July 2018.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We rated this practice inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems to keep patients safe.
• Risks were not adequately assessed and monitored.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not have appropriate recruitment processes.
• There was insufficient learning when things went wrong.

We rated the practice as inadequate for providing effective services because:

• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• The practice was unable to demonstrate that patients’ needs were fully assessed.
• No action had been taken to improve the uptake of childhood immunisations.
• Staff learning and development needs were not assessed.

We rated the practice as inadequate for providing well-led services because:

• There had been minimal improvements made since our inspection on 2 July 2018, it had not appropriately addressed the Warning Notice in relation to learning from significant events, safeguarding systems, governance processes and management capacity. At this inspection, we also identified additional concerns that put patients at risk.
• Leaders could not show that they had the capacity and skills to deliver high quality sustainable care.
• While the practice had a vision, this was not supported by a strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance was ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• The practice did not promote an environment where learning and improvement was a priority.

These areas affected all population groups, so we rated all population groups as inadequate.

We rated the practice as requires improvement for providing responsive services because:

• The practice did not mitigate risks of cancelling appointments when they had advanced notice.
• There was insufficient learning from complaints and they were not handled appropriately or in a timely way.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect.
• Patients rated the practice favourably in questions relating to the practice being caring in the national GP patient survey.

Following this inspection on 5 and 7 February 2019, urgent action was taken. The provider was served with a Section 30 conditions of registration and The Orient Practice was removed from Living Care as one of their registered locations. The practice was subsequently placed in the care of a care taking provider.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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

Updated 2 April 2019

Updated 2 April 2019

Updated 2 April 2019

Updated 2 April 2019

Updated 2 April 2019

Updated 2 April 2019