Larkshall Medical Centre

Updated 6 February 2017

Larkshall Medical Centre is located in Chingford, North London. It is part of the Waltham Forest Clinical Commissioning Group. The practice has a patient list of approximately 8200. Forty five percent of patients are aged under 18 (compared to the national practice average of 44%) and 21% are 65 or older (compared to the national practice average of 20%). Fifty four percent of patients have a long-standing health condition.

The services provided by the practice include child health care, ante and post-natal care, immunisations, sexual health and contraception advice and management of long term conditions.

The staff team comprises two GP partners (one male and one female, working a total of 16 sessions a week), two male and two female sessional GPs (working a total of 14 sessions a week), two female practice nurses (working a total of four days a week), a full time practice manager secretarial and reception staff. Larkshall Medical Centre holds a Personal Medical Service (PMS) contract with NHS England. The practice is a teaching practice but does not currently have any students.

The practice’s opening hours are:

• Monday, Tuesday, Wednesday and Friday 8:00am-6:30pm
• Thursday 8:00am to 1pm
• Tuesday 7:00am-8:00am (extended hours)

Appointments are available at the following times:

• Monday, Tuesday, Wednesday and Friday 8:30am – 10:30am and 3:30pm – 5:30pm
• Thursday – 8:30am – 10:30am

In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments are also available for people that need them. When the practice was closed, patients were directed to the local out of hour’s provider. Routine weekend appointments were provided by the local GP hub.

The practice is registered to provide the following regulated activities which we inspected: family planning, maternity and midwifery services, surgical procedures, treatment of disease, disorder or injury and diagnostic and screening procedures.

The practice has not previously been inspected.

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Larkshall Medical Centre on 7 December 2016. Overall the practice is rated as good.

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

• Risks to patients were assessed and managed. However there was no log of cleaning for hand held clinical equipment such as spirometer, nebuliser and ear irrigator and no expiry dates present on the log of emergency medicines. Following the inspection, the practice provided evidence of an updated log of emergency medicines with expiry dates present.
• The practice had audited the carers list and was working on improving this and the support given to identified carers.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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 carers are identified and correctly coded on the computer system and that systems are put in place to support them.

• Produce a schedule for the cleaning of hand held clinical equipment such as spirometer, nebuliser and ear irrigator.

• Continue to review the storage of the vaccine fridges.

• Look at ways to improve patient satisfaction scores.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 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.

• Performance for diabetes associated indicators was comparable to the local and national average.

• 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.
• The practice logged all cancer referrals and had put a system in place to chase hospital appointments on behalf of patients.

Updated 6 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.

• Cervical screening data was comparable to the national average.

• All university and college students were contacted through text message to promote the meningitis vaccine.

• 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 6 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.

• Health promotion alerts were sent to patients through text messages.

• Housebound patients were routinely visited on an annual basis for flu vaccinations, medication reviews, long term conditions management and health promotion.

Updated 6 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 including text message alerts, booking appointments, ordering repeat prescriptions and viewing medical records.

• A full range of health promotion and screening was available that reflected the needs for this age group.

Updated 6 February 2017

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review was 94%, which was comparable to the CCG and national averages.

• Mental health related performance indicators were comparable to the local and national average.

• 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 offered walk in appointments for patients who were feeling distressed or presented with signs of acute mental health problems.

• 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 6 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.

• The practice offered a flu vaccination clinic in a local church hall for homeless people.

• 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.