Fencepiece Road Medical Centre

Updated 19 March 2018

Fencepiece Road Medical Centre is situated at 83 Fencepiece Road, Hainault, Ilford, IG6 2NB. The practice operates from a converted semi-detached residential property and is Disability Discrimination Act (DDA) compliant. For example, there is step-free access, an automatic door, accessible toilet and a dedicated disabled parking bay at the front of the surgery. The practice has access to three consulting rooms on the ground floor. The first floor is for staff only and is accessed via stairs.

The practice provides NHS primary care services to approximately 6,000 patients living in Hainault through a Personal Medical Services (PMS) contract (an alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract). The practice is part of NHS Redbridge Clinical Commissioning Group (CCG) which consists of 46 GP practices.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services and family planning.

The practice provides a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract) including extended hours and learning disability health checks.

The practice staff comprises of two female GP partners (totalling 13 sessions per week), a male GP Partner (8 sessions per week), a female salaried GP (8 sessions), a locum practice nurse (25 hours per week), a phlebotomist (25 hours per week) a full time practice manager and four reception staff.

The practice reception and telephone lines are open from 8am and 6.30pm Monday to Friday.

Appointments are available from 8am to 12 noon and from 3pm to 6.30pm.

Extended surgery hours are offered on Tuesday and Friday from 6.30pm to 8pm.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111. Patients can also access appointments through hub practices within Redbridge as part of the Prime Minister’s Challenge Fund (the Challenge Fund was set up nationally in 2013 to stimulate innovative ways to improve access to primary care services).

Appointments can be booked online, some being available the next day. Urgent appointments are also available for patients who need them. The practice has opted out of providing an out-of-hours service. Patients telephoning when the practice is closed are transferred automatically to the local out-of-hours service provider.

The practice had a lower percentage of patients aged over 65 years than the national average (10% compared to 17%), a comparable percentage of unemployed patients (5%) and a lower percentage of patients with a long standing health condition (44% compared to 54%).

The registered practice population is predominantly white (63%) with Black, Asian and Minority Ethnic groups making up the remaining 37%. Information published by Public Health England rates the level of deprivation within the practice population group as six on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.

A GP Partner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Updated 19 March 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 19 May 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced inspection at Fencepiece Road Medical Centre on 18 January 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Consider introducing a system to record the actions and outcomes of MHRA and patient safety alerts.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them and more carers are identified.
• Consider ways in which the uptake for cervical screening can be increased so as to bring it in line with the 80% coverage target for the national screening programme.
• Review the results from the July 2017 annual national GP patient survey and consider ways in which patients’ satisfaction as regards how they could access care and treatment could be increased so as to make it more comparable to national averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 August 2016

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

• Chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 87% (national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 91% (national average 94%).
• 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 15 August 2016

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 good for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 85%, which was above 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.
• The practice provided a family planning, long-acting reversible contraceptive and sexual advice clinic for its patients and was the sexual health hub for the locality.
• CCG data showed the practice had exceeded all practices in the borough for Chlamydia screening for March 2015 to April 2016 and had received an award.
• The practice had baby changing facilities and a room for breast feeding.

Updated 15 August 2016

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.
• All patients over 75 had a named GP.
• Patients who were on the avoidable admissions register and integrated care programme were given a separate number to call to enable them to get through to the practice quickly and by-pass the main line.
• The PPG had worked with the practice and had planned a ‘keep well at winter’ health promotion event at the surgery to assist elderly patients apply for winter fuel grants and keep warm and healthy during the winter months.

Updated 15 August 2016

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 as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered a ‘Commuter’s Clinic’ on Monday from 7.30am to 8am, Tuesday from 6.30pm to 8.00pm and on Thursday from 6.30pm to 7.30pm for working patients who could not attend during normal opening hours.

Updated 15 August 2016

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 above the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 93% (national average 88%).
• 85% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, which is comparable to the national average of 84%.
• 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 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 15 August 2016

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.
• 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 and 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.