Dr T Abela & Partners

Updated 5 December 2017

Dr T Abela & Partners, also known as Chafford Hundred Medical Centre is situated in Chafford Hundred, Essex. The practice registers patients who live in the town of Chafford Hundred. The practice provides GP services to approximately 16,000 patients.

The practice is commissioned by the Thurrock Clinical Commissioning Group and it holds a General Medical Services (GMS) contract with NHS. This contract outlines the core responsibilities of the practice in meeting the needs of its patients through the services it provides.

The practice population has higher number of children aged five to18 years compared to the England average and fewer patients aged over 65 years. Economic deprivation levels affecting children and older people are significantly lower than average, as are unemployment levels. The life expectancy of male patients is higher than the CCG average by three years. The life expectancy of female patients is higher than the CCG average by two years. There are fewer patients on the practice’s list that have long standing health conditions.

The practice is governed by a partnership that consists of three male GPs and two female GPs. The partnership is supported by one salaried doctor. There is also a nurse practitioner, three practice nurses and a healthcare assistant employed. Administrative support consists of a full-time practice manager, a practice administrator, a head receptionist, an IT manager, IT assistant and secretary. There is also a number of part-time reception staff.

The practice is open 8.30am until 6pm every day except Thursday, when it is closed from 11am. It is also closed on the weekends. On a Thursday afternoon, the practice is closed and the duty doctor responds to emergency calls with the assistance of a member of the reception team. When the surgery is closed, urgent GP care is provided by Integrated Care 24, another healthcare provider.

Morning surgery times are from 8.30am until 11am. Afternoon surgeries are from 3pm until 5.20pm every day except Thursday. Patients can make pre-bookable appointments at the Health Hub located at Thurrock Community Hospital from 9.15am until 12.30pm on a Saturday and Sunday and also on a Wednesday evening.

Updated 5 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr T Abela & Partners on 20 February 2017. The overall rating for the practice was good. Safe, effective, caring and well-led were rated as good and responsive was rated requires improvement. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for Dr T Abela & Partners on our website at www.cqc.org.uk.

This inspection was a focused desk-based inspection carried out on 26 October 2017 to confirm whether the practice had carried out their plan to meet the legal requirements in relation to the issues that we identified in our previous inspection on 20 February 2017. This report covers our findings in relation to those requirements since our last inspection.

Overall, the practice remains rated as good and responsive continues to be rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Feedback from the GP patient survey showed that patients continued to experience difficulty in accessing appointments.
• Changes had been made to the appointment system with a view to improving feedback.
• The patient participation group were yet to meet this year. A meeting had been scheduled to take place in November 2017.
• The practice advertised the patient participation group meeting on its website in in the waiting room with a view to attracting new members.
• The practice had identified 57 patients as carers. This amounted to 0.4% of the practice list.

The practice should:

• Continue to identify and support patients who are carers.
• Continue to encourage the development of an active patient participation group.
• Monitor, review and improve patient satisfaction with regards to access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2017

The provider had resolved the concerns identified under the effective and well-led domains which had been identified at our inspection on 5 May 2016. The improvements applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Nursing staff had training and lead roles in chronic disease management. Patients at risk of hospital admission were identified as a priority.
• 75% of patients with diabetes had a blood pressure reading within a given range. This was in line with the CCG average of 75% and England average of 78%.
• The percentage of patients with COPD who had received a review in the last year was 88%. This was in line with the national average of 90%.
• 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.
• Improvements had been made and there were now systems in place to ensure safe prescribing of high-risk medicines, including those that were commonly used by people with long-term conditions.
• Although patients continued to indicate that they could not see a preferred GP to ensure continuity of care, action had been taken to improve this.

Updated 20 April 2017

The provider had resolved the concerns identified under the effective and well-led domains which had been identified at our inspection on 5 May 2016. The improvements applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Immunisation rates were above average for all standard childhood immunisations. For children under two, vaccination rates were 95% to 98% as compared to the national expected coverage of 90%.
• There was joint working with school nurses and health visitors through regular multi-disciplinary meetings. The health visitor and midwife held weekly clinics at the practice which promoted the ongoing sharing of information.
• 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.
• The practice had a policy never to refuse or postpone a child appointment. Patients with children that we spoke with confirmed this.

Updated 20 April 2017

The provider had resolved the concerns identified under the effective and well-led domains which had been identified at our inspection on 5 May 2016. The improvements applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Annual health checks were available to patients over 75.
• Joint injections were available for elderly patients living with osteoarthritis.
• Home visits were available for flu vaccinations and chronic disease reviews.
• Improvements had been made and there were now systems in place to ensure safe prescribing of high-risk medicines, including those that were commonly used by older people.
• There were regular meetings with other healthcare professionals to discuss frail patients

Updated 20 April 2017

The provider had resolved the concerns identified under the effective and well-led domains which had been identified at our inspection on 5 May 2016. The improvements applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• There was a daily triage service whereby patients could speak to a GP on the phone about their health concerns.
• Although patients indicated that there was difficulty getting through to the practice on the telephone, appointments could be made on-line.
• Text reminders advised patients of their appointment time. Repeat medicines could be obtained online.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the previous 5 years was 85% which was in line with the CCG average of 80% and national average of 82%

• The practice had identified that a majority of their patients were of working age, being 66%. Therefore, they were proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

Updated 20 April 2017

The provider had resolved the concerns identified under the effective and well-led domains which had been identified at our inspection on 5 May 2016. The improvements applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Patients experiencing poor mental health could be referred or self-refer for support via the Therapy for You service.
• Performance for mental health related indicators was in line with the national average. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan was 92%. This was comparable to the CCG average of 84% and England average of 88%.
• 93% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months which was comparable to the CCG and England average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 20 April 2017

The provider had resolved the concerns identified under the effective and well-led domains which had been identified at our inspection on 5 May 2016. The improvements applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
• The practice had identified 54 patients as carers. Although this was six more than at our previous inspection, this continued to be less than 0.5% of the practice list. The practice believed the register of carers was low as they had a younger practice population, as there were means of identifying carers.
• There were 12 patients on the learning disabilities register and seven had received a health check in the current year ending 1 April 2017. Since our last inspection, the practice had commissioned support to review and rectify the register of patients with learning disabilities.
• 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.