Claremont Clinic

Updated 10 January 2017

Claremont clinic is a GP practice in Forest Gate, a town in the London Borough of Newham, to the east of London. The practice is situated within a converted, three storey, period building which is located on a main road. Consulting rooms are located on the ground and first floors of the building. The location is well served by local public transport services. Parking on the surrounding streets is generally for permit holders only, however there are public car parks within walking distance of the practice.

The practice is part of Newham Clinical Commissioning Group (CCG) and provides services under a Personal Medical Services contract (PMS) to around 8698 patients. Results from the 2011 census for the London Borough of Newham show a majority white British population as (49%) followed by those of black African ethnicity in (15%). Newham residents have lower life expectancy and higher rates of premature mortality than other Boroughs in London and the average for England as a whole. The main causes of death in Newham are cardiovascular disease, cancer and respiratory disease and the levels of diabetes are among the highest in the country. Newham is the third most deprived local authority area in England.

Clinical services are provided by four GP partners (three male, one female, 28 sessions in total per week), two salaried GPs (both female, six sessions each per week) and two practice nurses (both female). There is also one healthcare assistant (HCA) (male), a practice manager and an assistant practice manager and twelve reception/administrative staff. The practice is a teaching practice and had two GP registrars (female) at the time of our inspection.

The practice is open from 9am to 6pm Monday to Friday, except Wednesday when it opens at 8.30am and Thursday when it closes at 4.30pm. Phone lines are closed from 1pm to 3pm daily during which time calls were diverted to the GP co-operative. Consulting times are from 9am to 12pm and 4pm to 6pm Monday to Friday, except Wednesday when they start at 8.30am and Thursday when the afternoon session is from 2pm to 4.30pm. Outside of these times services are provided by the extended hours service. Appointments for this service can be booked directly and patients are seen at other local practices.

The practice is registered to provide the regulated activities services of diagnostic and screening procedures; surgical procedures; treatment of disease, disorder or injury; family planning; maternity and midwifery services from 459/463 Romford Road, Forest Gate, Newham, E7 8AB.

Claremont Clinic was not inspected under the previous inspection regime.

Updated 10 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Claremont Clinic on 7 November 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. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 and concerns.
• 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 improvement are:

• Install a hearing loop to meet the needs of patients with hearing impairment.

• Review policy of closing telephone lines from 1pm to 3pm daily to ensure patients, working patients in particular, are supported to access the practice at convenient times.

• Improve processes to identify, record and support patients who are carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 10 January 2017

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.

• Quality and Outcomes Framework (QOF) performance in 2015/16 for diabetes related indicators was 92% which was in line with the CCG average of 85% and the national average of 90%.

• 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.

• Patients who had been identified as being at risk of developing diabetes were referred to a local exercise programme run by local groups to encourage people to be more active.

• The practice was involved in local incentive and pilot schemes for the treatment and management of diabetes. They also offered insulin initiation.

• The practice nurse was respiratory trained and managed chronic obstructive pulmonary disease (COPD) and Asthma in co-ordination with the GPs. Diagnostic Spirometry testing was provided at the practice.

• An electrocardiogram (ECG) service was offered in house as well as phlebotomy for type 2 diabetic patients.

Updated 10 January 2017

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 in line with local averages for all standard childhood immunisations. The practice had dedicated members of staff who contacted patients to attend for immunisations. Where there was no response, information was shared with health visitors to follow them up.

• The practice offered regular clinics for six to eight week baby checks.

• Children and babies were prioritised for on the day appointments.

• 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 CCG average of 81% and the national average of 82% (data from 01/04/2014 to 31/03/2015).

• A range of contraceptive services were offered including implants and Intrauterine Contraceptive Devices (IUCD).

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

• A separate breast feeding room was offered.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 10 January 2017

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.

• Health checks for patients aged over 75 years were offered.

• Monthly multi disciplinary team meetings were held where vulnerable older patients were discussed and care planning was coordinated.

• The practice maintained a register of patients at risk of unplanned admissions to hospital. These patients had written personalised care plans which were shared with the wider healthcare team, with the patient’s consent.

• The practice used extended services such as Rapid Response which was a service that focused on preventing avoidable admissions to hospital and would reach eligible patients within two hours.

Updated 10 January 2017

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.

• Appointments were available at 8.30am on Wednesdays which could suit working patients. Appointments were also available at other local practices through the extended opening hours scheme. This operated from 6.30pm to 9pm Monday to Friday and Saturday from 9am to 1pm.

• Telephone consultations were available and could be booked in advance or on the day.

• Prescriptions could be sent electronically to a patient’s nominated pharmacist.

Updated 10 January 2017

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

• 96%of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 81% and the national average of 84%.

• Quality and Outcomes Framework (QOF) performance in 2015/16 for mental health related indicators was 100% which was in line with the CCG average of 87% and the national average of 93%.

• 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.

• Cognitive behavioural therapy (CBT) sessions were run twice a week at the practice. The Talking Therapies services were also promoted by the practice.

Updated 10 January 2017

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 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.