First 4 Health Group - Stratford Village Surgery

Updated 14 June 2017

The Stratford Village Surgery provides services to approximately 9,000 patients under a Personal Medical Services (PMS) contract.

The practice shares management and human resources teams with two other East London based practices. (i) Leytonstone Medical Centre, 157 Leytonstone Rd, London. E15 1LH and (ii) E12 Health, 1st Floor, The Centre, 30 Church Road, London, E12 6AQ. All three practices operate as part of the First 4 Health Group http://www.first4healthgroup.co.uk/ and are situated within the NHS Newham Clinical Commissioning Group. They have separate lists of patients and are registered as separate locations with the Care Quality Commission.

The Stratford Village Surgery provides a full range of enhanced services including extended hours, sexual health, and child and travel immunisations including Yellow Fever. The practice is registered with the Care Quality Commission to carry on the regulated activities of Maternity and midwifery services, Family planning services, Treatment of disease, disorder or injury, and Diagnostic and screening procedures.

The staff team at the practice include three GP partners (one full time female working eight sessions per week, and two male (one working two sessions and the other one session per week), six salaried GPs, (five female, three working five sessions per week, one working seven sessions per week, and one working two sessions per week, and one male working seven sessions per week), two part time practice nurses one male and one female (one working 30 hours and the other eight hours per week), two female health care assistants (one working 20 hours and the other 15 hours per week), and a team of management, reception and administrative staff all working a mixture of full and part time hours. The practice has developed its IT systems to provide online and digital services for patients including via an app, it is part of a hub of practices providing integrated extended hours access for patients in Newham. The practice offices are mostly paperless.

The practice is located within a converted residential property and has four floors, including a basement area and lift access to upper floors. It is open 8am to 6.30pm Monday to Friday. Appointments are from 9am to 11.50am and 1.00pm to 6.20pm daily. Extended hours are provided on site by the Newham GP Co-op and are available on Monday and Thursday from 6.30 to 8.30pm, and every Saturday from 9am to 1pm. In addition, pre-bookable appointments, home visits, telephone appointments, and urgent appointments are available for people that need them.

The Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. It has a lower percentage than the national average of people aged above 65 years (6% compared to 17% nationally). 

Updated 14 June 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 20 April 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 24 May 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 20 April 2016 we found the following area where the practice must improve:

• Implement robust arrangements for child protection.

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

• Undertake quality improvement initiatives to monitor and improve outcomes for patients.
• Ensure all staff are appropriately trained in basic life support.
• Review the system for identifying patients who are carers.
• Consider how to ensure patients with a hearing disability can be communicated with.
• Ensure that its child protection IT system and policy remain up to date and robust.
• Seek to understand and address low GP patient survey results of patients feeling treated with care and concern for both nurses and GPs.
• Engage with patients to understand and address difficulties in making an appointment.
• Look at how it can improve aspects of clinical performance for people experiencing poor mental health.

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 24 May 2017 we found:

• Arrangements for child protection were current and effective.
• The practice had undertaken quality improvement activity including completed audits such as to lower rates of inadequate cervical screening tests and to ensure rapid follow up for patients requiring cancer screening or treatment.
• Clinical and non-clinical staff were trained in basic life support.
• Arrangements for identifying patients who are carers and communication for patients with a hearing disability had been reviewed and were appropriate.
• GP patient survey results scores had improved for patients feeling treated with care and concern for nurses and GPs and being able to get an appointment and were comparable to local and national averages.
• 2015-2016 clinical performance data for people experiencing poor mental health showed the practice was performing in line with local and national averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 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.
• Performance for diabetes related indicators was comparable with the CCG and national averages over all at 86% compared to the CCG average of 87% and the national average of 89%
• The percentage of patients with hypertension having regular blood pressure tests was 86%, which was comparable with the CCG average of 84% and national average of 84%
• 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.

Updated 14 June 2017

Updated 8 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 percentage of patients with rheumatoid arthritis, on the register, who had had a face-to-face annual review in the preceding 12 months was 91% which was the same as CCG and national averages.
• The practice nurses provided home visits to deliver routine checks for older housebound patients with chronic diseases.
• The practice had a system to identify palliative care patients and reviewed them monthly at multidisciplinary meetings.

Updated 8 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 had identified that it had a high proportion of working age women on its list and hosted a weekly consultant led gynaecology clinic, provided contraceptive services such as oral contraceptives, depot injections and IUCD (coil) implantation and removal, and breast health awareness sessions on site.
• 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 hosted physiotherapy and consultant led musculoskeletal clinics once per week.

Updated 8 June 2016

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

• 76% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%
• 2014-2015 data showed that performance for mental health related indicators was 75%, which was comparable to the CCG average at 87% and below the national average of 93%; however, 2015-2016 data showed the practice had improved and was performing in line with both local and national averages.
• 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 and had held a support group for men with mental health problems
• 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 8 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, 81% of these patients had received an annual health check.
• 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. For example it referred homeless people and travellers to a local specialist service.
• 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.