Archived: Billet Lane Medical Practice

Updated 2 October 2017

Billet Lane Surgery is located in Hornchurch in the London Borough of Havering. The practice holds a Primary Medical Services contract (an agreement between NHS England and primary practices for delivering general medical services). The practice provides enhanced services for example, adult and child immunisations, extended hours and facilitating timely diagnosis and support for people with dementia.

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

The practice had approximately 4,000 registered patients at the time of our inspection.

The staff team at the practice includes two full time partner GP’s (one male and one female) working eight sessions each per week. The practice clinical team also includes one part time female practice nurse who works five sessions per week. The practice has nine staff in its administrative team; including a practice manager. All staff work a mix of full time and part time hours.

The practice’s opening hours are:

Monday           8.30am – 7.30pm

Tuesday          8.30am – 6.30pm

Wednesday     8.30am – 6.30pm

Thursday         8.30am – 6.30pm

Friday              8.30am – 6.30pm

Saturday         Closed

Sunday           Closed

The practice’s appointment are available from:

                        Morning                       Afternoon

Monday       9.00am - 12pm          4.00pm – 7.20pm

Tuesday      9.00am – 12pm         3.00pm - 5.30pm

Wednesday 9.00am – 12pm         3.00pm - 5.30pm

Thursday     9.00am – 12pm         3.00pm – 5.30pm

Friday          9.00am – 12pm         3.00pm - 5.30pm

Saturday     Closed

Sunday       Closed

Telephones are answered between 8:30am and 6:30pm daily. Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to six weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

Urgent appointments are available each day and GPs also complete telephone consultations and home visits for patients. In addition, patients at the practice have access to two local hub practices who provide additional access for patients living in Havering (part of a CCG wide initiative) who require an appointment 6.30pm and 10.00pm Monday to Friday and 9.00am and 5.00pm on Saturdays and 12pm and 4.00pm Sundays. There is also an out of hour’s service provided to cover the practice when it is closed. If patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on their circumstances. Information on the out-of-hours service is provided to patients on the practice leaflet as well as through posters and leaflets available at the practice.

The practice provides a wide range of services including clinics for diabetes, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

The most recent information published by Public Health England rates the level of deprivation within the practice population group as nine on a scale of one to ten. Level one represents the very highest levels of deprivation and level ten the lowest.

Updated 2 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Billet Lane Medical Practice on 14 September 2016. The overall rating for the practice was requires improvement as safe, caring and well led were rated requires improvement and effective and responsive were rated as good. The full comprehensive report on the 14 September 2016 inspection can be found by selecting the 'all reports' link for Billet Lane Medical Practice on our website at www.cqc.org.uk.

This follow up inspection was undertaken as an announced comprehensive inspection on 23 August 2017. Overall the practice is now rated as Good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Arrangements for managing medicines (obtaining, prescribing, recording, handling, storing, security and disposal) were safe; including systems for ensuring that medicines reviews and repeat authorisation functions were undertaken in accordance with recognised guidelines. In addition, the practice ensured that PGD’s (Patient Group Directions) were reviewed, signed and authorised for all locum nurses.
• The practice had reviewed storage arrangements for emergency medicines to allow staff to easily access them in an emergency.

• The practice had established a process for monitoring the use of prescription pads.

• Recruitment checks were now being undertaken for all locum clinicians.
• Staff appraisals had taken place to ensure staff had the appropriate skills and training to do their jobs. Learning and development needs were being identified, planned and supported.
• Feedback from patients about their care was consistently positive.
• Carers were being identified and recorded to enable carers to receive appropriate support.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice website had been developed to help share information about the practice and the services it provides.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. For example, policies and procedures and business continuity arrangements were up to date and in line with practice arrangements and published best practice guidelines.

However, there were also areas of practice where the provider should make improvements.

The provider should:

• Review their fire safety policy to ensure Fire wardens are identified andappropriately trained.
• Continue to review access to the practice via telephone so that patients can make timely appointments and arrange to speak to a GP or nurse.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 2 October 2017

The practice is rated as good for the care of people with long-term conditions.

• Patients at risk of hospital admission were identified as a priority.

• Seventy six per cent of patients with diabetes had well controlled blood sugar levels compared the CCG average of 70% and the national average of 78%. The exception reporting rate for this indicator was 3% which was lower than the CCG average of 15% and national average of 13%. The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 87% (82% in 2014/15) compared to the CCG average of 76% and a national average of 78%.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All 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 2 October 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

  Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 2 October 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.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 2 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations 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, extended opening hours and Saturday appointments via the local hub.

• 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 2 October 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.

• Data showed that 76% of patients with dementia had had their care reviewed in a face to face interview within the past twelve months compared to 82% locally and 84% nationally.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Eight one percent of patients with schizophrenia, bipolar affective disorder and other psychoses (sixteen patients) had a comprehensive, agreed care plan documented in the record compared to 91% locally and 89% nationally.

• 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 2 October 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.