Honor Oak Group Practice

Updated 25 August 2016

The Honor Oak Group Practice is based in Honor Oak, a suburban area largely within the London Borough of Lewisham. The practice is on a small council estate, which was developed in the 1930s to house families moved from London’s East End. More housing was added in the 1990s.

There are 9227 patients at the practice. These are drawn principally from the Honor Oak estate, and reflect the estate’s population. Compared to the England average, the practice has more young children as patients (age up to nine) and fewer older children (age 10 – 19). There are more patients aged 20 – 49, and many fewer patients aged 50+ than at an average GP practice in England.

The practice has a high proportion of Afro-Caribbean or African patients. As the practice is based in area of significant social housing, many of the patients are classified as vulnerable; such as homeless young families and asylum seekers.

Life expectancy of the patients at the practice is in line with CCG and national averages. The practice population scores highly on national measures of deprivation: being in the fourth most deprived decile, high on measures of income deprivation affecting older people and children. Compared to the English average, more patients are unemployed and have a long-standing health condition.

Honor Oak Group Practice was established with the estate in the 1930s. The surgery moved to new, purpose built health centre in 1998, owned by an NHS community trust. There are 11 consulting rooms, a treatment/minor surgery suite, a counselling suite, showers, and offices and meeting rooms.

The health centre is fully accessible to the disabled, and all the patient areas including waiting room, consulting rooms and toilets have wheelchair access. Designated disabled parking spaces are located nearest to the entrance to the health centre.

Six doctors work at the practice: three male and three female. Five of the doctors are partners and there is one salaried GP (who is male). Some of the GPs work part-time. Full time doctors work 8 sessions per week. The practice has 19 GP sessions per week.

The practice nursing team is made up of an advanced nurse practitioner, two practice nurses and two health care assistants. They are all female and work part-time. Their working hours added together equate to just over 3 full time roles (whole time equivalents).

The practice became a training practice for GPs in 2013. The practice also trains apprentices.

The practice is open from 7.00am to 6.30pm Monday to Friday. Appointments are available from 7.00am to 12pm and 1.30pm to 6.00pm Monday to Friday. When the practice is closed cover is provided by a local out-of-hours care service.

The practice is registered as a partnership with the CQC to provide a range of GP services including treatment of disease, disorder or injury, maternity and midwifery services, surgical procedures and diagnostic and screening procedures.

Honor Oak Group practice was inspected on 9 July 2014 prior to our rating methodology. No areas for improvement were identified.

Updated 25 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Honor Oak Group Practice on 13 April 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Survey data showed that patients were less satisfied than those at other practices with telephone access and with the ease of getting an appointment. The practice had taken action, and were waiting for updated survey data that it hoped would show improvement. Most patients told us that it they could contact the practice by telephone and make convenient appointments, although it could be difficult to get appointments with particular GPs.

• 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 and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The partners at the practice were particularly interested in factors that affect children’s development and wellbeing, so an extra service had been developed to support new parents. In addition to the standard NHS postnatal check at six weeks, the practice invited new parents and their babies to the practice at two weeks after the birth. The aim of this intervention was to provide new parents insight into how to develop of secure attachment with their babies over the first 12 months, and therefore supporting overall social, emotional and educational development. The practice reported high rates of satisfaction with this service and had carried out an evaluation that showed a positive impact on parental understanding and behaviours.

• One of the partners set up a liaison group to work with other organisations to improve services on the housing estate where the practice is based. The practice manager still attended the group to represent the practice. The group had worked particularly on health issues and security concerns that benefitted practice patients and others in the community, which had led for example, to improved street lighting and the installation of a security camera on the footbridge close to the practice.

The provider should:

• Formalise infection control processes and complete the actions identified from the last audit.

• Implement procedures to ensure that practice policy on vaccine fridge monitoring is followed.

• Continue to monitor and act to improve patient satisfaction with telephone access, appointment availability and waiting times.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 August 2016

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.

• Measures of the practice’s care for patients with diabetes were generally in line with other practices. For example, 97% had a flu jab in 2014/15 (compared to a national average of 94%).

• The practice was involved with an initiative to improve patient involvement in planning their care so that patients are more able to manage their own conditions. The practice provided written information in advance of consultations with patients about their diabetes, to make it easier for patients to understand their test results, raise the issues of concern for them and be better engaged with planning how their diabetes would be managed.

• The practice had high prevalence of diabetes in its patient population. In response, the practice created their own information pack on pre-diabetes to give to patients, and provided patients with different options to support weight loss (including referral to an exercise programme, Weight Watchers or a dietician).

• 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 25 August 2016

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 Accident and Emergency (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.
• The practice’s uptake for the cervical screening programme was 71%, which was comparable to the Clinical Commissioning Group (CCG) average of 73% and the national average of 74%.
• 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, health visitors and school nurses.
• The practice set up a custom mechanisms on their computer system to record the accompanying adult every time a child was brought for a consulation, and to deal with queries raised by others in the multidisciplinary team. The practice gave us examples of when this has provided valuable information, which was shared this with others in the multidisciplinary team to keep children safe.
• There was a structured and systematic process of support for patients who had suffered bereavement. This included: informing clinical and non-clinical staff so that they could provide support, sending a bereavement card, contact by telephone or letter from their GP and alerting other services (so that families did not receive further communication addressed to their relative). Written information was provided that explained the legal process of registering a death and details of how to get support. This information was also available on the practice website.
• The partners at the practice were particularly interested in factors that affect children’s development and wellbeing, so an extra service had been developed to support new parents. In addition to the standard NHS postnatal check at six weeks, the practice invited new mothers and their babies to the practice at two weeks after the birth. The practice reported high rates of patient satisfaction with this service.

Updated 25 August 2016

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.

Updated 25 August 2016

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 reflected the needs of this age group.

Updated 25 August 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the national average.
• Performance for mental health related indicators was similar to the national average.
  • 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan (national average 88%).
  • 86% patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded (90%).
• 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.

Updated 25 August 2016

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 carers, travellers and those with a learning disability.
• The practice had identified just over 2.5% of the practice list as being carers, and wrote to those identified as carers with information about support available, and the offer of referral to a local carers' organisation.
• The practice offered longer appointments for patients with a learning disability, and had created materials to help these patients understand and communicate more easily with the clinical team. Patients with learning disabilities were sent an ‘easy-read’ invitation for their annual review and an accessible questionnaire to help them raise any concerns (about their care, mental or physical health) and to support these patients to work with practice staff to plan their care.
• One of the partners set up a liaison group to work with other organisations to improve services on the housing estate where the practice is based. The practice manager still attended the group to represent the practice.
• 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, and had developed bespoke systems to collect particular information to help keep children safe 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.