The Ross Practice

Updated 10 March 2016

The practice was established in 1955 in the garage of Dr Ross’ house. The practice has since moved twice and two of the current partners joined the practice in the mid-1980s. The practice is based in a leased building with another GP practice and various health professionals from South East Partnership Trust (SEPT).

The current patient list size of the practice is 9706. There are six GP partners, two female and four male and two female salaried GPs. There are two female practice nurses and two female health care assistants (HCAs).

From time to time the practice is involved in training medical students and also offers a work experience programme to sixth form students considering applying to medical school. Students are only present with consent of the patient and sixth form students are never present for any examinations. At the time of our inspection there were no students at the practice.

The practice is open between 8.30am and 6.30pm Monday to Friday. Appointments are from 8.45am to 11.30am and 3.30pm to 5.30pm daily. There is a pre-bookable weekend GP/Nurse/HCA service which is based within the building in the neighbouring practice. The practice is part of PELC, a London based on-call service which uses the services of some local GP’s. Patients with an urgent problem outside normal practice hours are directed to PELC via the practice number. Patients are asked to attend the emergency centre or, if necessary, a home visit would be arranged. The PELC service begins at 6.30pm each evening.

Approximately 95% of the practice population are white British, with the remainder of patients mainly Polish, Italian and Chinese. The practice area has high levels of unemployment, housing issues and patients experiencing poor mental health. There is a mixed level of income related deprivation within the area, with children more likely to be affected by income deprivation.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ross Practice on 15 December 2015. 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 the skills, knowledge and experience to deliver effective care and treatment, however not all staff had received dedicated infection control and prevention training.
• 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.
• Patients said there was a delay if they wanted to make an appointment with a named GP. Urgent appointments were 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 practice obtained and acted upon feedback from the ‘Friends of the Ross Practice’ group. The ‘friends’ group supported the practice by raising money to buy equipment for the practice to use to benefit the patients. The practice was in the process of forming a PPG.
• There was limited awareness of Duty of Candour, however the provider had plans to improve this awareness and staff we spoke with told us that they would highlight any concerns they had regarding service provision.

The area where the provider should make improvements is:

• Ensure that any references accepted verbally are documented and the paperwork kept in the relevant staff member’s personnel file.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

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

• Nationally reported data showed that outcomes for patients for long-term conditions were comparable with other practices nationally. For example, numbers of patients with long-term conditions, such as diabetes receiving appropriate reviews were slightly higher than the national average.
• Home visits were available when needed.
• Where the practice was able to provide or source a service for their patients, to avoid them having to make a trip to the local hospital, they did this.
• Sign posting information for support groups was evident in the reception area.
• The practice offered annual birthday recalls where the patient’s records were looked at and any reviews, tests or checks were completed at the same time.

Updated 10 March 2016

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

• There was a dedicated room with a baby changing station; this room also had chairs so if a mother wished to breastfeed in private she could do so. There was sufficient space for siblings to be in the room too.
• There was a child friendly area at the back of the waiting room. Some of the consulting rooms had elements in them that would put young children at ease, such as cuddly toys and cartoon characters.
• The practice area had a higher level of income deprivation affecting children than the England average. 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 high for all standard childhood immunisations.
• Nationally reported data showed that outcomes for patients for uptake of cervical smears were comparable with other practices nationally.
• We saw evidence of joint working with midwives and health visitors in the form of regular meetings to discuss patients.   

Updated 10 March 2016

The practice is rated as good for the care of older people.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable or higher than other practices nationally. For example, the practice offered patients aged 65 and older a flu vaccination, and performed higher than the national average for uptake of this vaccination.
• The practice had plans to engage with other practices in the CCG, with above average outcomes for this patient group, to improve the services that they offered to older people.
• A room was made available to a visiting phlebotomy service, so patients could choose to have blood tests done at the practice instead of at the local hospital.
• The practice offered annual birthday recalls where the patient’s records were looked at and any reviews, tests or checks were completed at the same time.
• A room was made available for a monthly drop in hearing aid repair service for all Harlow patients (not just those registered with the service).

Updated 10 March 2016

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

• The practice made available urgent appointment slots at the end of clinic.
• Patients could have a telephone consultation if a face to face consultation was not required.
• A room was made available to a visiting phlebotomy service, so patients could choose to have blood tests done at the practice instead of at the local hospital.
• 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 pre-bookable weekend service that was based in the GP practice next door but within the same building.

Updated 10 March 2016

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

• 82.43% of people diagnosed with Dementia had had their care reviewed in a face to face meeting in the last 12 months.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice held a register of patients experiencing poor mental health. The staff were aware of patients within this group and were able to recognise and refer appropriately when increased support was needed.
• The practice felt they could improve the standard of care they offered to people experiencing poor mental health, including seeking guidance on best practice from other practices in the CCG who had very good outcomes for this group of patients.

Updated 10 March 2016

The practice is rated as good for the care of people who 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.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told 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.
•  There were policies or arrangements to allow people with no fixed address to register or be seen at the practice. The practice encouraged word of mouth referrals. Patients were signposted to a local hostel.
• There was a gypsy community in the practice area from time to time, which the practice told us they had built a rapport with.
• The practice had many hard to reach communities within its practice boundaries and looked at personalised solutions to overcome barriers to treatment. For example, if the being in the surgery building made a patient uncomfortable the practice would look at ways to overcome this. Strategies used in the past by the practice included varying the time of appointment, the method of entering the building and the location.
• One of the GP's role was to spend time with patients with complex needs. We were given an example where the GP spent several visits familiarising the patient to them prior to providing any treatment or examination, in order for the GP to build a relationship with the patient and be able to provide a better outcome for that patient.