York Road Surgery

Updated 30 March 2017

York Road Surgery provides primary medical services in Ilford to approximately 7,600 patients and is part of Redbridge Clinical Commissioning Group (CCG).

The practice population is in the fourth most deprived decile in England. The percentage of children registered at the practice who are living in income deprived households is 21%, which is comparable to the CCG average of 19%. The percentage of older people registered at the practice who live in income deprived households is 30%, which is higher than the CCG average of 21%. The practice has a higher than average proportion of patients aged between 25 and 39 years and a lower than average proportion of patients aged between 15 and 24 years and aged 45 years and older.

The practice team at the surgery is made up of two male and one female GPs who are partners and two salaried GPs. In total 424 GP appointments are provided per week. The practice has two female nurses, a female assistant practitioner and two female trainee healthcare assistants. The practice team also consists of a practice manager and six receptionists.

The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8:40am and 6:30pm every week day except Thursday when they close at 12:30. Extended hours appointments are offered from 6:30pm to 7pm on Wednesdays and from 8am to 11:30am on Saturdays. In addition to appointments that can be booked in advance, urgent appointments are also available for people who needed them.

When the practice is closed patients are directed to the local out-of-hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at York Road Surgery on 29 September 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. The practice provided language translation to patients who needed it, and chaperones were available.
• Information about services and how to complain was available and easy to understand; however, complaints forms were only available on request. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said that it could be difficult to get through to the practice by phone and that there could sometimes be a wait for an appointment. However, we noted that urgent appointments were available the same day and the practice had processes in place to ensure that patients with conditions which put them at high risk of unplanned admission to hospital were able to get an emergency appointment.
• Some patients told us that appointments ran late.
• 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:

• They should make complaints forms available to patients without the need to request them from staff.
• They should continue to review the appointments system to ensure that patients are able to get an appointment when they need one and that appointments run to time.
• They should ensure that they are taking action to identify all patients with caring responsibilities so that they can be offered support.
• They should ensure that all staff are aware of the practice’s vision and strategy and their role in relation to it.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 30 March 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 related indicators were comparable to local and national averages. The proportion of diabetic patients with well controlled blood sugar was 71% compared to the CCG average of 70% 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.

Updated 30 March 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. For example, the practice had a specific confidentiality policy for patients under 18 years of age.
• The practice’s uptake for the cervical screening programme was 73%, which was comparable to the CCG average of 79% and 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 30 March 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 used a risk stratification tool in order to identify patients who were at high risk of unplanned hospital admission. Priority appointments were available for these patients.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Performance for conditions commonly found in older people were comparable to local and nation averages; for example, the percentage of patients with hypertension who had well controlled blood pressure was 81% compared to a CCG average of 82% and national average of 84%.

Updated 30 March 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. For example, they offered Saturday morning appointments for patients who were unable to attend during the week.
• 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 30 March 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 comparable to local and national averages. The practice had 11 patients diagnosed with dementia and 100% of these patients had had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 83% and national average of 84%. The practice had not excepted any patients for this indicator, compared to an exception reporting rate of 10% for the CCG and 8% nationally.
• The practice had 48 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses and 74% of these patients had had their care reviewed in a face to face meeting in the last 12 months, compared to a CCG average of 90% and national average of 88%.
• 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 developed a mental capacity assessment guidance document and checklist to ensure that all clinical staff were aware of their responsibilities under the Mental Capacity Act and that the necessary information was recorded in a consistent way.
• 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 30 March 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 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.