Archived: Sandringham Practice

Updated 31 July 2017

Sandringham Practice is located in Hackney Downs, London Borough of Hackney, North east London in a purpose built medical centre.

Sandringham Practice is located in Hackney, East London. The practice has a patient list of approximately 3,650. Twenty two percent of patients are aged under 18 (compared to the 21% national practice average) and 10% are 65 or older (compared to the national practice average of 17%). Fifty three percent of patients have a long-standing health condition and records showed that 2% of the practice’s patient list had been identified as carers.

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 four salaried GPs (two male, two female covering 22 sessions a week), two female practice nurses (equating to 8 sessions per week), practice manager, business development manager and administrative/reception staff. One of the four salaried GPs was designated as lead GP at the practice.

The practice’s opening hours are:

• Monday-Friday: 8:00am -6.30pm

• Saturday 9am-1pm

Appointments are available at the following times:

• Monday-Friday: 8:30am-12pm and 4pm-6pm

• Saturday 9am-1pm

The practice offers extended hours opening at the following times:

• Mondays and Tuesdays: 6:30pm-8pm

Outside of these times, cover is provided by an out of hours provider.

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

Since 1 December 2014, Sandringham Practice has been managed by Maclaren Perry Ltd under a temporary caretaking agreement with NHS England which terminates on 30 September 2017. Sandringham Practice is therefore currently registered as an additional location of Maclaren Perry Ltd’s CQC registration.

Updated 31 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sandringham Practice on 28 January 2016. During the inspection we identified a range of concerns including an absence of systems in place to manage risk or improve the quality of care provided to patients. (The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Sandringham Practice on our website at www.cqc.org.uk).

The practice was rated as requires improvement for providing safe, effective and well led services and was rated as good for providing caring and responsive services. Overall the practice was rated as requires improvement.

An announced comprehensive inspection was undertaken on 25 May 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• Action had been taken to improve previous governance failings and we noted that practice management and governance arrangements now facilitated the delivery of high-quality person-centred care.
• Action had been taken to improve how risks were assessed, monitored and actioned. For example, a central risk register had been introduced and we saw evidence that, with the exception of fridge temperature monitoring, risks to patients were routinely assessed and managed.
• Action had been taken to improve quality improvement. For example, clinical audit was now routinely being used to drive quality improvement.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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.

  • 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.

  • 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:

• Further investigate and take appropriate action to reduce exception reporting for the cancer clinical domain.
• Introduce a fridge temperature recording protocol to ensure that governance arrangements for recording fridge temperatures are robust.
• Consider introducing a fire evacuation plan to assist patients with mobility problems in vacating the premises.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 31 July 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Latest published data (for the period 01/04/2015 to 31/03/2016) showed that 72% of patients with diabetes had a blood sugar level which was within the required range compared to the rounded clinical commissioning group (CCG) and 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 31 July 2017

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

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

Updated 31 July 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.

• 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 31 July 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.
• 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 31 July 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.

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

• For example, the practice regularly worked with multi-disciplinary teams and GPs also routinely met with a local consultant psychiatrist in the case management of patients experiencing poor mental health, including those living with dementia.

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

• 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 31 July 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 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.

• Records showed that the practice 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.

• The practice had identified and trained a team of patients who acted as “social prescribers” to other patients who were isolated or lonely. GPs told us that these patients had a better knowledge of local third sector support networks and also spoke positively about the 30 minute appointment slots and the non-clinical options that this service offered.