Dr J Israel's Practice Also known as The Vale Medical Centre

Updated 28 July 2016

Dr J Israel’s Practice (also known as The Vale Medical Practice) operates from one site in Lewisham. It is one of 41 GP practices in the Lewisham Clinical Commissioning Group (CCG) area. There are approximately 11,200 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery, and treatment of disease, disorder or injury.

The practice has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include childhood vaccination and immunisation, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations, learning disabilities, minor surgery, online access, patient participation, remote care monitoring, risk profiling and case management, rotavirus and shingles immunisation and unplanned admissions.

The practice has a higher than average population of female and male patients aged from birth to nine years and from 25 to 49 years. Deprivation affecting children and adults is above the national average amongst patients registered at the practice.

The clinical team includes a male lead GP, four female and three female salaried GPs. The GPs work a total of 46 sessions per week. There are two female salaried practice nurses, and a health care assistant. The clinical team is supported by a practice manager, an assistant practice manager, five reception/administrative staff and a secretary.

The practice is currently open between 8.00am and 6.30pm Monday to Friday and is closed on bank holidays and weekends. It offers extended hours from 6.30pm to 7.30pm on Tuesdays, Wednesdays and Thursdays. Appointments are available from 8.00am to 11.40pm and from 2.00pm to 6.20pm on Mondays, 8.30am to 11.50 and 2.00pm to 7.20 on Tuesdays, Wednesdays and Thursdays, and from 8.40am to 12.20pm and 2.00pm to 5.50pm on Fridays. There are two treatment rooms and seven consulting rooms on the ground floor.

There is wheelchair access and baby changing facilities. There is car parking available outside the premises, including disabled parking.

The practice has opted out of providing out-of-hours (OOH) services and directs patients needing care outside of normal opening hours to a contracted out-of-hours service.

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr J Israel on 21 April 2016. 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, and staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mostly below average in 2014/2015 for several health indicators, but the practice had addressed this and made some improvements in 2015/2016.

• 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. Improvements were made to the quality of care as a result of complaints.
• The majority of patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Ensure QOF performance is continuously monitored and improvements are made.

• Ensure translation services are advertised in the waiting area, in a format patients can understand.

• Ensure there is a policy for safeguarding adults.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 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.

• Performance for diabetes related indicators was below average. For example, 67% of patients with diabetes had well-controlled blood sugar in the previous 12 months (national average 78%). The practice had carried out its own analysis in 2015/2016 which showed performance had increased to 84% in 2015/2016.

• All patients with a long term condition had a named GP, a personalised care plan, and most had received a structured annual review to check their health and medicines needs were being met.

• Performance for asthma related indicators was average; 72% of patients with asthma had an asthma review in the previous 12 months (national average 75%).

• Performance for indicators related to chronic obstructive pulmonary disease was below average; 79% of patients with chronic obstructive pulmonary disease had a review of their care in the previous 12 months (national average 90%). The practice had carried out its own analysis in 2015/2016 which showed performance had increased to 80% in 2015/2016.

• Longer appointments and home visits were available when needed. The practice encouraged patients with long term conditions to make use of their in-house massage service to aid their mental and physical well-being.

• 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 28 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.

• 85% of women aged between 25 and 64 years received a cervical screening test in the previous five years. This was in line with 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.

Updated 28 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 by GPs, and the practice’s community nurse who was able to perform a variety of services including phlebotomy for these patients.

• Home visits were scheduled to coincide with patients’ medicine reviews, but the practice also responded to home visit requests from patients.

• Urgent appointments were available for those with enhanced needs.

• The practice hosted regular multi-disciplinary meetings attended by social workers, district burses and palliative care nurses.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example, 79% of patients with hypertension had well controlled blood pressure in the previous 12 months. This was in line with the national average of 84%.

Updated 28 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.

• 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 an in-house phlebotomy service and 24 hour blood pressure monitoring to reduce the need for patients to visit local hospitals.

• Extended hours opening and daily telephone consultations were available for patients who could not attend the practice during normal working hours.

• There was accessible health promotion material available throughout the practice.

Updated 28 July 2016

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

• 57% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was significantly below the national average of 84% but the practice had carried out its own analysis in 2015/2016 which showed an increase to 74% in 2015/2016.
• 78% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their records. This was below the national average of 88% but the practice had carried out its own analysis in 2015/2016 which showed an increase to 98% in 2015/2016.

• The practice provided care for patients in local care homes for people with poor mental health and learning difficulties.

• 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 28 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 and for carers.

• The practice told us homeless people were able to register as patients to receive on-going care at the practice. They also provided care to women from a local women’s refuge home for vulnerable women and children with complex health and social needs.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.