Archived: Balaam Street Practice

Updated 24 September 2015

Balaam Street Practice is situated in Plaistow in east London and is situated within NHS Newham Clinical Commissioning Group (CCG). The practice holds a Personal Medical Services contract (Primary Medical Services agreements are locally agreed contracts between NHS England and a GP practice) and provides a range of enhanced services including extending hours access, influenza and pneumococcal immunisations and remote care monitoring.

The practice is registered with the Care Quality Commission to carry on the regulated activities of Treatment of disease, disorder or injury and Diagnostic and screening procedures.

The practice had a patient list of just over 6,700 at the time of our inspection.

The staff team at the practice included two male GP partners, a female locum GP, a female practice nurse and a team of administrative staff, all working a mix of full time and part time hours.

Balaam Street Practice was not an approved training practice.

The practice was open between 08:00 am and 18.30 pm Monday to Friday. Appointments were available all day and the practice did not close during the day.

To assist patients in accessing the service there was an online booking system, text message reminders for appointments and test results. Urgent appointments were available each day and GPs also completed telephone consultations for patients. The out of hours services were provided by a local deputising service to cover the practice when it was closed.

The practice had a higher percentage than the national average of people in paid work or full time education (63% compared to 60.2%); and a higher percentage than the national average of people with health related problems in daily life (53.7% compared to 48.8%). The average male and female life expectancy for the CCG area was below the national average for males and in line with the national average for females.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Balaam Street Practice on the 2 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and well led services. It also required improvement for providing services for older people, people with long term-conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It was good for providing effective, caring and responsive services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to the availability of emergency oxygen and staff recruitment.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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 there was continuity of care, with urgent appointments available the same day.
• The practice did not hold regular governance meetings and issues were discussed at ad hoc meetings.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management.

• The practice had not proactively sought feedback from patients through its PPG.

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

Importantly the provider must:

• Ensure all clinical and non-clinical staff receives appropriate training in infection control and annual infection control audits are completed.
• Ensure all staff receives basic life support training and the practice explores ways of providing access to oxygen. The National Resuscitation Council has the view that: ‘Current resuscitation guidelines emphasise the use of oxygen, and this should be available whenever possible.’ Oxygen is considered essential in dealing with certain medical emergencies (such as acute exacerbation of asthma and other causes of hypoxaemia, which is an abnormal low level of oxygen in the blood.
• Ensure that recruitment checks have been completed for staff before the start of their employment.
• Ensure the views of patients through its PPG (A PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care) and of stakeholders about their experiences, quality of care and treatment delivered by the service are sought.

In addition the provider should:

• To exploring ways of increasing QOF performance.
• To provide equality and diversity training to its staff team.
• To hold regular staff meetings, multi-disciplinary meetings and quarterly palliative care meetings. To keep a recorded audit trail of meetings and ensure that governance issues, performance, quality and risks have been discussed.
• To provide locum GPs with a locum induction pack.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 September 2015

The practice is rated as requires improvement for the care of people with long term conditions as there were areas where it should make improvements. (LTCs). There was evidence of patients with LTCs receiving effective and responsive care. Clinical staff had the knowledge and skills to respond to the needs of patients with cardiovascular diseases, diabetes mellitus, asthma and chronic obstructive pulmonary disease (COPD).

The practice had a palliative care (end of life) register but did not hold regular internal or multidisciplinary meetings to discuss the care and support needs of patients and their families. Patients on the register were discussed with external healthcare professionals through telephone contact and patients were recalled for longer individual consultations with their GPs. Patients with suspected cancers were referred and seen within two weeks. Longer appointments were also available for patients with long-term conditions.

Updated 24 September 2015

The practice is rated as requires improvement for the care of families, children and young people as there were areas where it should make improvements. The practice was responsive to the needs of this group. There were suitable safeguarding policies and procedures in place, and staff we spoke with were aware of how to report any concerns they had. GPs were appropriately using the required codes on their electronic case management system to ensure risks to children and young people who were looked after or on child protection plans were clearly flagged and reviewed. Medical records demonstrated good liaison with partner agencies such as the police and social services. Clinical staff attended child protection case conferences and reviews where appropriate. However, we were not provided with evidence to confirm joint working with midwives, health visitors and school nurses or evidence of regular meetings taking place.

The practice offered a full range of immunisations for children, which included travel vaccines and flu vaccinations in line with current national guidance. Last year’s performance for all immunisations was above average for the Clinical Commissioning Group (CCG), and there was a clear policy for following up non-attenders by the named practice nurse. Appointments were made available outside of school hours for children and young people and we saw that premises were suitable for children and young people.

Updated 24 September 2015

The practice is rated as requires improvement for the care of older people as there were areas where it should make improvements. Older people were cared for with dignity and respect. However, older patients identified at risk of isolation were not discussed at monthly clinical meetings or multi-disciplinary meetings to monitor their care and address the support they required as necessary. The percentage of patients aged 65 who had received a flu vaccination was at 63.14% compared to the national average of 73.24% and the ratio of expected to reported prevalence of coronary heart disease (CHD) was at 43.65% compared to the national average of 52.29%.

An avoiding ‘Unplanned Admissions List’ was in place which was designed to help reduce avoidable unplanned admissions by improving services for vulnerable patients at high risk of hospital admission or re-admission. All these patients had a named GP.

Home visits were also made to older patients. There was some evidence of learning and sharing of information to help improve care delivery.

Updated 24 September 2015

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students) as there were areas where it should make improvements. 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.

Updated 24 September 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia) as there were areas where it should make improvements. The practice provided a caring and responsive service to people experiencing poor mental health. Although, the dementia diagnosis rate was in line with the national average with the practice achieving 75% compared to the national average 83.83%, we found that only 45.12% of mental health patients experiencing poor mental health had received a health check and had care plans in place in comparison to the national average of 86.09%. The practice had reviewed 75 % of its patients diagnosed with dementia in a face to face review in the preceding 12 months, compared to the national average of 83.83%.

Staff gave examples of how they responded to patients experiencing a mental health crisis, including supporting them to access emergency care and treatment. The practice worked closely with the local mental health team. All clinical staff had received training in the Mental Capacity Act 2005 and were able to demonstrate an understanding of key parts of the legislation and describe how they implemented it in their practice. The practice had a psychiatric nurse linked to the practice and who visited once every three months. A consultant psychiatrist also reviewed the list of all patients with poor mental health once a year.

Updated 24 September 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable as there were areas where it should make improvements. The practice had policies in place relating to the safeguarding of vulnerable adults and whistleblowing. Staff we spoke with were aware of their responsibilities in identifying and reporting concerns.

The practice had numerous ways of identifying patients who needed additional support. Staff told us that translation services were available for patients who did not have English as a first language. We saw notices in the reception areas informing patients this service was available.

Notices in the patient waiting room, told patients how to access a number of support groups and organisations. The practice’s computer system alerted GPs if a patient was also a carer. We were told carers could also access a support service available at the practice.