London Fields Medical Centre

Updated 8 January 2018

London Fields Medical Centre is located in the London Borough of Hackney, East London. The practice has a patient list of approximately 10,400. Thirty four percent of patients are aged under 18 (compared to the national practice average of 15%) and 9% are 65 or older (compared to the national practice average of 17%). Forty five percent of patients have a long-standing health condition.

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 GP partners (three male and one female, three working one whole time equivalent (WTE) and one working 0.75 WTE), three salaried GPs (two female and one male with two working 0.75 WTE and one working 0.25 WTE), a male and female GP registrar (both working 0.8 WTE), two full time female practice nurses, a practice manager, assistant practice manager, secretarial and administrative staff. London Fields Medical Centre holds a General Medical Service (GMS) contract with NHS England.

The practice’s opening hours in which appointments are available are:

Monday 8:30am to 12pm and 1pm to 6:30pm

Tuesday 8:30am to 12pm and 1pm to 6:30pm

Wednesday 8:30am to 12pm and 1pm to 6:30pm

Thursday 8:30am to 12pm and 2pm to 4.30pm

Friday 8:30am to 12pm and 1pm to 6:30pm

Extended hours opening is offered on:

Tuesday 7am to 8am

Weekend appointments are available to patients of the practice via the local GP Confederation hub.

In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments are also available for people that needed them.

Outside these times, cover is provided by an out of hour’s provider.

The practice is a training practice.

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 and maternity and midwifery services.

The practice was previously inspected on 12 May 2016 and was rated good overall.

Updated 8 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection May 2016. Overall rated – 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 comprehensive inspection at London Fields Medical Centre on 6 December 2017 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.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However we found that non-clinical staff had not received formal safeguarding training. Evidence that this training had now been completed was provided following the inspection.

• 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 said that they were involved in their care and decisions about their treatment.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• 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 requirement of the duty of candour.

The areas where the provider should make improvements are:

• Review training provision to ensure that staff undertake appropriate training relevant to their role including safeguarding training.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 July 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.

• The percentage of patients in whom the last IFCC-HbA1c was 64 mmol/mol or less was 86% compared the CCG average of 79% and the national average of 77%. The percentage of patients that had a foot examination and risk classification recorded was 92% compared to the CCG average of 96% and national average of 88%. 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 18 July 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.

• 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 79%, which was comparable to the CCG average of 81% and the national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 18 July 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 older people have care plans which are regularly reviewed.

• The practice provided a frail home visiting service for those patients that were housebound. This was an extra service to the routine house visits.

• The practice met on a monthly basis with local services such as community matron, district nurse and social worker to discuss older patients of concern.

Updated 18 July 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.

• Early morning appointments were available on a Tuesday and Thursday.

• The practice operated a dedicated telephone advice line for two hour each day and a call back system for any patients that wanted to speak to a GP.

• The practice was proactive in offering online services including booking appointments, ordering repeat prescriptions and viewing limited data on the patient records.

• The practice offered a full range of health promotion and screening that reflects the needs for this age group. This included Chlamydia and HIV screening if appropriate.

Updated 18 July 2016

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

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  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 18 July 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 other health care professionals in the case management of vulnerable patients.

• The practice ran a dedicated Turkish clinic for those patients who did not speak English. A Turkish speaking advocate was available to attend consultations at the patient’s request.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Non-clinical staff had not undertaken mental capacity act training

• 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.