Archived: Highgrove Surgery

Updated 27 February 2017

Highgrove Surgery is located within Barking Community Hospital, which also accommodates other community services such as outpatient phlebotomy, cardiology and sexual health clinics. The building is managed by NHS Properties and they were responsible for the building risk assessments and security. There is suitable patient access to the premises and patient parking, including disabled parking. At the time of our inspection, the providers were in the process of registering their new location with the CQC and it was at this location the inspection was carried out.

On the day of inspection there were approximately 7,257 patients registered with the practice.

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; diagnostic and screening procedures; family planning services; and

maternity and midwifery services at this location.

The practice has two male GP partners. The practice employs two female and one male salaried GPs. The GPs undertake a combined total of 25 sessions between Monday to Friday and one session on Saturday morning. The practice employs one full time nurse and one full time healthcare assistant. Non-clinical staff, included finance, IT and information governance, two administrators, six reception staff, one practice manager and one deputy practice manager.

The practice was open between 8.30am to 6.30pm Monday to Friday. Appointments were from 8.30am to 1.30pm every morning and 3pm to 6.30pm daily. Extended hours appointments were offered between 6.30am to 8.30am and 6.30pm to 7pm Monday to Friday weekdays and every Saturday between 7am and 10.30am. The practice phone lines were open between 8am and 6.30pm Monday to Friday. The out of hours service was provided by the local HUB which was available from 6.30pm to 8am weekdays and 8am to 10pm weekends. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for people that needed them.

The practice has a higher than national average population of people aged 25 years to 55 years and a higher population of children aged new born to 15 years. Life expectancy for males in the practice is 78 years, which is higher than the CCG average of 77 years and lower than the national average of 79 years. The life expectancy for females in the practice is 82 years, which is higher than the CCG average of 81 years and lower than the national average of 83 years.

Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Highgrove Surgery on 24 November 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.
• Patients 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure blank prescriptions pads are handled in accordance with national guidance and that there are systems in place to account for blank prescription stock levels.
• Ensure improvements identified in risk assessments are actioned and recorded within the set period to improve services.
• Continue to review systems to identify carers in the practice to ensure they receive appropriate care and support. Consider ways to support patients who are hard of hearing.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 February 2017

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.
• Unverified data showed that performance for diabetes related indicators was similar to the national average and better than the CCG average. For example, 80% of people with diabetes on the register who had a blood glucose level of 64mmol/mol or less in the preceding 12 months, compared to the CCG average of 67% and national average of 78%.
• 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.
• Patients could see a member of the nursing team for smoking cessation advice.

Updated 27 February 2017

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 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, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 79% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Same day consultations were given to children.

Updated 27 February 2017

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.
• High risk patients discharged from hospital were followed up to avoid further admissions. Medication and social needs were reviewed and discussed at multi-disciplinary team meetings if necessary.
• End of life care plans were discussed where appropriate and multi-disciplinary care plans were recorded in the clinical system.

Updated 27 February 2017

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 reflects the needs for this age group.
• Appointments were available from 6.30am to 7pm between Monday and Friday. Pre-booked appointments were available every Saturday with a GP between 7am and 10.30am.

Updated 27 February 2017

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

• Performance for mental health related indicators was similar to the national average. For example, 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in their records, in the preceding 12 months compared to 90% for CCG average and 89% for national average.
• Performance for dementia related indicators was lower than the national average. For example, 23 out of 30 patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, compared to 85% for CCG average and 84% for national averages. Staff told us that this may have been low due to the practice not having a permanent practice nurse for six months. Staff also told us that it could have been due to computer systems and errors in coding correctly and they would be reviewing their computer systems.
• 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.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 February 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.
• 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 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. 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.