Archived: All Saints Practice

Updated 9 November 2017

All Saints Practice provides primary medical services to approximately 6700 patients through an alternative personal medical services contract (APMS) for Tower Hamlets CCG. (APMS is one of the three contracting routes that have been available to enable commissioning of primary medical services) It is located in a purpose built building at 21 Newby Place, Poplar London, E14 0EY. All Saints practice operates regulated activities from one location and is registered with the Care Quality Commission to provide;

• Treatment of disease, disorder and injury.

• Family planning.

• Maternity and midwifery.

• Diagnostic and screening procedures.

• Surgical procedures.

The practice is run by Hurley Clinical Partnership who provides centralised clinical governance, managerial, finance and training across all sites Hurley Partnership Practices including All Saints Practice. Services are provided to patients from a purpose built facility in Poplar, Tower Hamlets on a busy high road and is managed and maintained by Community Health Partnerships (CHP). The purpose built facility accommodates another Gough Walk Practice and various other healthcare services operate from this site. The reception area is shared between the two practices. The practice is accessible via public transportation and parking facilities are available at the rear of the practice.

Based on data available from Public Health England (PHE), the practice is located in one of the most deprived areas. The level of deprivation within the practice population group is rated as one on a scale of one to 10. Level one represents the highest levels of deprivation. Compared to the national average the practice has a higher proportion of patients between 20 and 40 and lower proportions of patients over 40 years of age. Data obtained from the (2011) census showed that there are a high percentage of patients from Bangladeshi background and other minority groups living in Tower Hamlets.

The medical team is made up of a lead GP (male) working six clinical and two management sessions a week. The salaried GP (female) works two sessions a week but was on maternity leave at the time of the inspection. There are three locum GPs (two male, one female) from the Hurley Medical Bank who cover 25 sessions per week and a full-time nurse independent prescriber (female), full-time practice nurse (female) and a part time health care assistant (female). The clinical team are supported by a practice manager, receptionists and various administrative staff.

The practice is open Mondays to Saturdays; the phone lines are open from 8:00am to 6:30pm. Monday to Friday the practice is open between 8am and 8pm and on a Saturday 9am to 5pm. GP appointments are available from 8am to 8pm Monday to Friday and from 9am to 5pm on Saturdays.

Same day appointments are triaged by a GP, and an appointment is booked if deemed urgent. The out of hours service is provided by Tower Hamlets Out of Hours GP service and can be accessed by ringing the practice’s telephone after 6:30pm where the call is then diverted or the patient can telephone directly using the local rate telephone number which is on the practice website and in the practice leaflet.

Updated 9 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at All Saints Practice on 28 November 2016. The overall rating for the practice was Inadequate and the practice was placed in special measures for a period of six months.

Some of the issues found were;

• There was no formal system in place for managing patient safety alerts.

• There were no arrangements in place to assure the safe management of medicines such as vaccines are followed in accordance with practice’s cold chain policy.

• The practice did not ensure that significant events were investigated thoroughly and recorded in accordance with the practice’s significant event policy.

• Risks to patients were not always assessed and well managed; the practice did not risk assess the absence of certain emergency medicines for e.g. GTN spray/ tablets.

The full comprehensive report on the 28 November 2016 inspection can be found by selecting the ‘all reports’ link for All Saints Practice on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 1 September 2017. Overall the practice is now rated as Requires Improvement.

Our key findings were as follows:

• Staff understood their responsibility to formally report incidents, near misses and concerns; we saw evidence that significant events were recorded and investigated in a timely way, discussed at clinical and practice meetings and learning was shared.

• The practice had a number of policies and procedures to govern activity, for example there was a cold chain policy, which had set escalations as a significant event including to the provider for the Hurley Clinical Partnership and NHS England.

• Risks to patients were assessed and well managed.

• There was a system in place for highlighting, monitoring and cascading patient safety alerts; however staff were not always aware of current evidence based guidance, such as NICE.

• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Patients informed us that they were treated with compassion, dignity and respect. However they stated that the lack of enough GPs made it difficult to feel involved in decisions about their care and treatment, as well as finding it difficult to make appointments.

• Information about services and how to complain was available and easy to understand.

• The practice offered early morning and late evening appointment to meet the needs of the local population. Patients were also able to make appointments online.

• 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.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, in particular in relation to NICE guidelines

• Continue to develop an ongoing programme that demonstrates continuous quality improvements to patient care in a range of clinical areas. This may include clinical audit.

• Although the results are improving the practice should continue to assess, monitor and improve the access to and satisfaction with appointments in view of the low patient survey results.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 November 2017

The provider is rated as requires improvement for effective, responsive and well-led, and good for safe and caring. The evidence which led to these ratings affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice nurse offered a chronic disease clinic every Wednesday.

• Nationally reported data showed that outcomes for patients with long term conditions were in line or above CCG and national averages. For example, the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 76% compared to the CCG of 82% and national average of 78%.This was achieved with an exception rate of 4% which was the same as the CCG average and lower than the national average of 9%.

• Electronic care plans for patients were populated with a clinical oversight and MDT meetings arranged opportunistically.

• Longer appointments and home visits were available when patients needed them.

• The practice worked closely with the district nursing team who served as both a formal and informal early warning system.

• 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, however, actions from these meetings were not always noted on the patients notes.

Updated 9 November 2017

The provider is rated as requires improvement for effective, responsive and well-led, and good for safe and caring. The evidence which led to these ratings affected all patients including this population group.

• The practice’s had a risk register for both adults and children deemed vulnerable, this was regularly updated

• Immunisation rates for the standard childhood immunisations were in line with local CCG and national averages. For example, childhood immunisations rates for under two year olds ranged from 82% to 92% and five year olds from 85% to 91% for the practice. This was in line with the CCG averages of 88% to 91% and national averages of 88% to 94%.

• Appointments were available outside of school hours and any child under five presenting as an urgent patient would be seen on the same day.

• There was a baby changing area as well as a room available if a mother wanted to breastfeed in private.

• The practice held a weekly baby clinic.

Updated 9 November 2017

The provider is rated as requires improvement for effective, responsive and well-led, and good for safe and caring. The evidence which led to these ratings affected all patients including this population group.

• The practice offered home visits with the duty doctor.

• The practice took part in the complex care plan admissions avoidance, which is an incentive scheme to identify the top 5% of patients who were most at risk of avoidable unplanned admissions. These patients all had alerts on their medical records which highlighted their vulnerability to the reception staff.

• There were accessible facilities available and the practice had an elevator to access treatment rooms on first floor.

• Every patient over 75 had an allocated GP and extended appointments were allocated when required.

• The practice carried out an end of life planning audit to improve patient care.

Updated 9 November 2017

The provider is rated as requires improvement for effective, responsive and well-led, and good for safe and caring. The evidence which led to these ratings affected all patients including this population group.

• The practice was open 6 days per week. Monday to Friday 8am to 8pm and Saturday 9am to 5pm.

• There was online access to book appointments, online consultations and patients could request repeat prescriptions through the practice website.

• The practice uptake for the cervical screening programme was 72%, in line with both the CCG and national averages of 78% and 81% respectively. However this was achieved with an exception rate of 15%, compared to the CCG average of 9% and national average of 7%.

• The practice encouraged new patients to register which could be done online or visiting the practice in person.

• Patients aged 40–74 had access to appropriate health assessments and checks that were followed up where abnormalities or risk factors were identified.

Updated 9 November 2017

The provider is rated as requires improvement for effective, responsive and well-led, and good for safe and caring. The evidence which led to these ratings affected all patients including this population group.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 Months was 91% which was comparable to the CCG average of 90% and national average of 89%. This had been achieved with an exception rate of 0% compared to the local CCG average of 5% and national average of 10%.

• The practice regularly worked with multi-disciplinary teams in caring for people experiencing poor mental health, including those with dementia.

• The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Patients had access following referral to a dedicated psychologist based within the practice.

• 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.

• The lead GP at the practice undertook two clinical sessions per week at a local care home for patients with a diagnosis of dementia.

Updated 9 November 2017

The provider is rated as requires improvement for effective, responsive and well-led, and good for safe and caring. The evidence which led to these ratings affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• The practice offered longer appointments for patients with a learning disability.

• Annual reviews were arranged and carried out centrally within the network of practices.

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