Dr James Lawrie

Updated 3 July 2017

Dr James Lawrie, also known as the Royal Docks Medical Practice is situated on the ground floor of the Royal Docks Medical Centre and is within NHS Newham Clinical Commissioning Group (CCG). It provides services to approximately 9,150 patients under a Personal Medical Services (PMS) contract and is roughly two minutes’ walk from Cyprus DLR station. The practice has step free access, a disabled toilet, and a hearing loop on reception. It provides a full range of enhanced services including diabetes, extended hours, and NHS health checks. It is registered with the Care Quality Commission to carry on the regulated activities of Maternity and midwifery services, Family planning services, Surgical procedures, Treatment of disease, disorder or injury, and Diagnostic and screening procedures.

The staff team at the practice includes the full time male lead GP working nine sessions per week, one part time salaried male GPs (working six sessions per week), five part time salaried female GPs (two working six sessions per week, one working four sessions per week, and two working five sessions per week) and two full time female practice nurses. There is one part time female psychologist working two sessions per week, a full time practice manager, and a team of reception and administrative staff (working a mix of part time hours). The practice is a teaching and training practice and has two GP registrars, one male and one female (one full time and one working at 0.8% of full time equivalent). The practice very rarely uses locum GPs and several GPs who trained at the practice had stayed on to work there as salaried GPs.

The practice core opening time is from 8am to 6.30pm every week day. It has extended opening every week day until 7.00pm except Thursday when it is open until 9.30pm, and on Saturdays from 9.00am to 12.30pm for working patients who cannot attend during normal opening hours. GP and nurse appointments are available from 8.30am to 12.30pm and from 1.50pm to 7.00pm every weekday evening except Thursdays when they are available until 8.30pm. Saturday GP appointments are between 9.00am and 12.30pm. The practice offers further extended opening through a hub network of local practices every weekday until 9.30pm. Pre-bookable appointments are available including online in advance. Home visits, telephone appointments and urgent appointments are available for people that need them. Patients telephoning out of hours are transferred automatically to the local out of hours provider.

The information published by Public Health England rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The practice has large groups of Bengali and Eastern European patients and a high proportion of student patients on its list due to being in very close proximity to the University of East London campus. It has a lower percentage than the national average of people aged over 65 years (4% compared to 17%).

Updated 3 July 2017

Letter from the Chief Inspector of General Practice

The practice is rated good overall and good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 18 February 2016. The overall rating for the practice was good. However, a breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us evidence and actions detailing what they would do to meet the legal requirements. We conducted a focused inspection on 12 June 2017 to check that the provider had followed their plans and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 18 February 2016 we found the following area where the practice must improve:

• Ensure a system for production of Patient Specific Directions (PSDs) to enable nurses to administer specific injectable medicines such as vitamin B12, Depo-Provera and Yellow Fever vaccinations as required.

Our previous report also highlighted the following areas where the practice should improve:

• Consider increasing the frequency of basic life support training for non-clinical staff.
• Implement robust arrangements to assess and manage processes such as the cold chain, and recruitment procedure and all necessary pre-employment checks for all staff.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 12 June 2017 we found:

• Appropriate PSDs were in place to enable nurses to administer specific injectable medicines in line with legislation.
• Effective arrangements were in place to ensure staff pre-employment checks and basic life support (BLS) training.

• There were systems to maintain the cold chain for safe storage of refrigerated medicines. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 2016

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.
• Longer appointments and home visits were available when needed.
• 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.
• Performance for diabetes related indicators was comparable to CCG and national averages at 80%, (CCG average 87%, and national average of 90%)
• The practice had two GPs and a Nurse trained in diabetes and able to initiate insulin and “GLP1” medicines for diabetic patients.
• The percentage of patients with hypertension having regular blood pressure tests was comparable to CCG and national averages at 76% (CCG average and national average both 84%)
• Dr James Lawrie had co-led a local project for young people (16-25 years) with diabetes which resulted in several positive outcomes for this group, for example the development of a Newham based peer-support group for young people with diabetes.

Updated 15 June 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 relatively high for all standard childhood immunisations.
• The percentage of patients with asthma who had an asthma review in the preceding 12 months was 76% compared to 75% nationally.
• 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.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to 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 had a specially trained female GP and offered a full range of contraceptive services including contraceptive advice, contraceptive pills, Depo-Provera injection, and coils fitting and removal.

Updated 15 June 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.
• The practice undertook its own visits for older people for continuity of care out of hours.
• The practice held monthly meetings with a local hospice to discuss care for patients at the end of life.
• The practice had run practice based small chronic pain classes with a clinical psychologist.

Updated 15 June 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 on site physiotherapy every Thursday evening and Saturday morning.
• The practice was part of a local extended hours collaborative, and patients could book to see a GP in Newham every week night until 8.30pm and or between 9.00am and 1.00pm on Saturdays.
• The practice offered an appointment based on site phlebotomy service two mornings a week from 8.30am.
• The practice had monthly meetings with the student welfare team from the University of East London to discuss students with physical, social or psychological problems.

Updated 15 June 2016

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

• 88% of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• Performance for mental health related indicators was similar to CCG and the national averages at 89% (CCG average 87%, national average 93%).
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• The practice hosted an eating disorders pilot project and held monthly meetings with the specialist eating disorder counsellor.
• The practice had employed its own counsellor and held on site psychodynamic counselling and Cognitive Behavioural Therapy (CBT).

Updated 15 June 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.
• The practice worked closely with staff at a hostel for women with learning difficulties who had suffered abuse or exploitation, and a community homes scheme for people with learning disabilities and mental health problems.
• Two GPs had completed the Royal College of General Practitioners (RCGP) opiate training to enable them to prescribe methadone for people combating opiate addiction.