Mission Medical Practice

Updated 18 July 2016

Mission Medical Practice is located at 208 Cambridge Heath Road, London E2 9LS on the first floor of what was previously Bethnal Green Hospital. The practice is accessible by lift and stairs. The clinical area is split into two wings, the north wing consisting of 15 consulting rooms and the south wing consisting of six nurse consulting rooms. The practice provides NHS primary care services to approximately 11,200 patients living in the Bethnal Green area through a General Medical Services (GMS) contract (a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice is part of NHS Tower Hamlets Clinical Commissioning Group (CCG) which consists of 36 GP practices split into eight networks. Mission Medical Practice is in network one which comprises of five local practices.

The practice population is in the second most deprived decile in England. People living in more deprived areas tend to have a greater need for health services.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services; and family planning. Prior to our inspection the practice told us they were undertaking minor surgical procedures. However, they were not registered for the regulated activity of surgical procedures. Since the inspection the practice has added the regulated activity to its registration.

The practice staff comprises of four male and five female GP partners (totalling 46 clinical sessions per week), two female salaried GPs (totalling nine clinical sessions per week) and two registrars (totalling 11 sessions per week). The clinical team is supported by four practice nurses of which one was a non-medical independent prescriber and four healthcare assistants. The administration team consists of a full-time practice manager, 10 receptionists, a wellbeing networker, a secretary and a summariser.

The practice is a training and a teaching practice.

The practice premises are open from 8.30am to 6.30pm every week day expect Thursday when the practice closes at 1pm. Extended hours are provided on Saturday morning from 8.30am to 12 noon.

The practice provides a range of services including childhood immunisations, chronic disease management, smoking cessation, sexual health, cervical smears and travel advice and immunisations.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111. Patients can also access appointments out of hours through several hub practices within Tower Hamlets between 6.30pm and 8pm on weekdays and 8am to 8pm on weekends as part of the Prime Minister’s Challenge Fund (the Challenge Fund was set up nationally in 2013 to stimulate innovative ways to improve access to primary care services).

Updated 18 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mission Medical Practice on 31 March 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 with the exception of the absence of an automated external defibrillator for use in medical emergencies. Shortly after the inspection, the practice provided evidence that one had been ordered.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had 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.
• Patients said they were able to get an appointment, but not always with their preferred GP. Urgent appointments were available on the 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 patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice had been undertaking minor surgical procedures but had not registered with CQC the regulated activity of surgical procedures. Since the inspection the practice has added the regulated activity to its registration.

We saw one area of outstanding practice:

The practice recognised that many patients attending the surgery had non-medical conditions and identified the need to effectively utilise the social prescribing initiative, which is a means of connecting patients with social, emotional or practical needs to a range of local, non-clinical services in the voluntary and community sector. It achieved this by creating a role for a dedicated member of the team to support patients with complex health needs and signpost them to the appropriate community services. We saw several examples of very positive outcomes and improved wellbeing for patients who had been suffering depression and social isolation and the practice reported some reduction in the use of conventional health services such as A&E attendance and GP appointments as a result.

The areas where the provider should make improvement are:

• Ensure all staff are trained on the use of the recently acquired automated external defibrillator (AED) and ensure the device is included in a schedule for electrical and medical equipment checks in line with guidance.
• Record and implement actions identified from the infection control audit.
• Ensure there is an effective system to track blank prescriptions through the practice in line with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 July 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.
• Performance for diabetes related indicators was similar to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 81% (national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 97% (national average 94%).
• The practice attended network multi-disciplinary team meeting with a consultant diabetologist to discuss the management of patients with complex or uncontrolled diabetes.
• 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 18 July 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 A&E attendances.
• The practice followed-up on all non-attendance of children at GP and secondary care appointments to ensure children were not missing essential health reviews.
• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was comparable to the national average (practice 74%, national 75%).
• The practice actively referred into MEND (a childhood obesity initiative aimed to help children become fitter, healthier and happier whilst having fun) and MEND Mums (a post-natal weight management programme).
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%.
• 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 and health visitors.

Updated 18 July 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.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice referred patients to LinkAge Plus (a free outreach service for the over 50s living in Tower Hamlets with the aim to help older people achieve a better quality of life, improve well-being and overcome social isolation within the community by providing activities and an outreach service).
• Patients who were on the avoidable admissions register and integrated care programme were given a separate number to call to enable them to get through to the practice quickly and by-pass the main phone line.

Updated 18 July 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 held an extended hours clinic on Saturday from 8.30am to 12 noon and out-of-hours appointments were available through several hub practices in the CCG area.
• The practice was proactive in offering on-line services and patients could book and cancel appointments, request repeat prescriptions and update personal information through the practice website.

Updated 18 July 2016

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 comparable to the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 87% (national average 88%).
• The percentage of patients diagnosed with dementia who had had their care reviewed in a face-to-face meeting in the last 12 months was 73%, which was below the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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. Some of the staff had trained in dementia awareness.

Updated 18 July 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 those with a learning disability. Some of the staff had been trained in learning disability awareness.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.
• A benefit advisor held a weekly session at the practice to assist patients.
• The practice had written information and links on the practice website to direct carers to various avenues of support. The practice had identified and recorded 1.5% of the practice list as carers.
• The practice ran a weekly substance misuse clinic for patients on methadone and a weekly morning clinic on-site at a local hostel providing temporary accommodation for single homeless men and women with alcohol dependence.