Greengate Medical Centre

Updated 9 November 2017

Greengate Medical Centre is situated within NHS Newham Clinical Commissioning Group (CCG). The practice provides services to approximately 7,567 patients under a Personal Medical Services (PMS) contract. The practice provides a full range of enhanced services including, child and travel vaccines and extended hours. It is registered with the Care Quality Commission to carry on the regulated activities of maternity and midwifery services, family planning services, treatment of disease, disorder or injury, surgical procedures and diagnostic and screening procedures.

The staff team at the practice includes the two lead (male) GPs collectively working ten sessions per week, five salaried GPs (four female and one male) collectively working 16 sessions per week, one long term locum female GP working eight sessions per week, a female practice nurse working six sessions per week, a female healthcare assistant working six sessions per week, a practice manager working 36 hours per week, and a deputy manager and team of reception and administrative staff working a mixture of full and part time hours.

The practices' opening hours are between 8.30am and 7pm Monday to Friday.

Appointments are available from 8.30am to 12pm and 4pm to 6.30pm every weekday except Thursday when appointment times are the same in the morning, and afternoon appointments were from 3.30pm to 6pm.

Appointments include home visits, telephone consultations and online pre-bookable appointments. Urgent appointments are available for patients who need them. The practice offers extended hours on a Monday 6.30pm to 9pm, Friday 7pm to 9pm and Saturday 9am to 1pm. Patients telephoning when the practice is closed are transferred automatically to the local out-of-hours service provider.

The information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The practice area has a relatively high population of people whose working status is unemployed at 14% compared to 4% nationally, and a lower percentage of people over 65 years of age at 8% compared to 17% nationally.

Updated 9 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Greengate Medical Centre on 14 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for the Greengate Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken and was an announced comprehensive inspection on 3 October 2017. Overall the practice is now 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.
• The practice was 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 one area of outstanding practice:

The practice had undertaken initiatives and staff training to engage compassionately and effectively with patients from specific groups including those with English as a second language, from the Roma community, homeless patients, and lesbian, gay, bisexual and transgender (LGBT) patients. Patient’s uptake of important preventative breast and bowel cancer screening had improved significantly following practice staff engagement work for patients with English as a second language and were comparatively higher than average as a result.

However, there were areas of practice where the provider needs to make improvements.

The provider should:

• Review fire escape arrangements for people with a mobility impairment.
• Continue to monitor and take action to improve patient feedback including GP Patient survey results and regarding telephone access and appointments.
• Monitor and ensure good uptake rates for health checks for people with a learning disability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 November 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.
• 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.
• Performance for diabetes related indicators was similar to national averages. For example, the percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c (blood sugar level) was 64 mmol/mol or less in the preceding 12 months was 66%, compared to the CCG average of 72% and the national average of 78%.
• The percentage of patients with hypertension having regular blood pressure tests was 85% compared to the CCG average of 82% and the national average of 83%.
• The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 91% compared to the CCG average of 87% and the national average of 90%
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• 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 9 November 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.
• The practice had online appointment booking and prescription requests.
• The practice offered NHS health checks for patients aged 40–74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.
• Telephone consultations with clinicians were available to meet the needs of this population group.

Updated 9 November 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 such as social services adult social care teams.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, healthy eating and anti-coagulation therapy for patients with atrial fibrillation.

Updated 9 November 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.
• The practice had online appointment booking and prescription requests.
• The practice offered NHS health checks for patients aged 40–74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.
• Telephone consultations with clinicians were available to meet the needs of this population group.

Updated 9 November 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.
• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 81% and the national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, by ensuring annual health checks.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice had identified 75 patients on its register with a mental health condition, 25 (95%) of these patients had a comprehensive, agreed care plan documented in the record, in the preceding 12 months.
• 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 9 November 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.
• 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.
• The practice had 20 patients on the register with a learning disability, 6 (30%) of these patients had received an annual health check in the last 6 months. This figure was 69% at our previous inspection. However, there were 6 months remaining in the current reporting year for this figure to increase.
• The practice had taken action to best understand and reduce barriers to patient care for  several specific groups of patients, some that may have been vulnerable or harder to reach such as patients from specific groups including those with English as a second language, from the Roma community, sex workers, homeless patients, and lesbian, gay, bisexual and transgender (LGBT) patients.