The Grove Road Surgery

Updated 31 March 2017

The Grove Road Surgery is located in Tower Hamlets, East London within the NHS Tower Hamlets Clinical Commissioning Group. The practice holds a General Medical Services contract (an agreement between NHS England and general practices for delivering primary care services to local communities). The practice provides a full range of enhanced services including meningitis care provision, childhood immunisation and vaccination, dementia support, influenza and pneumococcal immunisations, learning disabilities support, minor surgery, rotavirus and shingles immunisation and unplanned admissions avoidance.

The practice is registered with the Care Quality Commission to carry on the regulated activities of surgical procedures, family planning, maternity and midwifery services, treatment of disease, disorder or injury, diagnostic and screening procedures and surgical procedures.

The practice had a patient list of 3,641 at the time of our inspection. The practice had a higher proportion of people with a long standing health conditions than the local average (54% compared to the CCG average of 45% and the national average of 54%). The practice serves a diverse multi-ethnic and multi-lingual community. At 78 years, male life expectancy is higher than the CCG average of 77 years and lower than the England average of 79 years. At 82 years, female life expectancy is in line with the CCG average of 82 years and lower than the England average of 83 years.

The practice has fewer patients aged over 60 years of age compared to an average GP practice in England. The percentage of patients under the age of 40 years is twice as high as the average GP practice in England. The surgery is based in an area with a deprivation score of three out of ten (one being the most deprived). Children and older people registered with the practice have a lower level of income deprivation compared to the local average and higher than the national average. Compared to the average GP practice in England, patients at this practice have a higher rate of unemployment.

The clinical staff team at the practice included two male GP partners, one salaried female GP, one female locum practice nurse (covering long-term leave), and one female phlebotomist. The non-clinical staff team included one practice manager and three administrative staff. There were 14 GP sessions available per week.

The practice is open between 9.00am and 6.30pm Monday to Friday, except Thursday, when the practice is open between 9.00am and 1.00pm. GP appointments are available between 9.00am and 1.00pm and between 4.00pm and 6.30pm Monday to Friday except Thursday afternoon). Extended hours appointments are available every Tuesday between 6.30pm and 8.30pm. The surgery is closed on Saturdays, Sundays and bank holidays. Urgent appointments are available each day and GPs also provide telephone consultations for patients. An out of hours service is provided for patients when the practice is closed. Patients may also access one of two local walk-in centres and one hub location. Information about the out of hours service is provided to patients through posters in the waiting area, on the practice website and the practice leaflet. Patients are automatically transferred to the out of hours provider when they ring the surgery if it is closed.

Updated 31 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grove Road Surgery on 8 November, 2016. Overall the practice is rated as good.

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

• Although patient feedback on the day of inspection was positive, patient satisfaction scores around the care they received from GPs and nurses were lower than the local and national averages.
• 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.
• 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:

• Review and monitor patient feedback to identify the low patient satisfaction results around care and treatment from GPs and nurses and take action to improve these results.

• Implement audit systems in relation to the monitoring of prescription pads in accordance with national NHS guidelines.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 31 March 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.

• Performance for hypertension related indicators was above the national average. The percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months is 150/90mmHg or less was 88% compared to the CCG average of 88% and the national average of 84%.

• Performance for diabetes related indicators was below the national average but comparable to other practices in the area. The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months was 69% compared to the CCG average of 72% and the national average of 77%.

• 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 31 March 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 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years

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

• We saw positive examples of joint working with health visitors.

Updated 31 March 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.

• The practice had monthly meetings for all their vulnerable and integrated care patients with the community health service team, social services, palliative care nurse, community physiotherapist and a nurse from the Mental Health team for older people.

Updated 31 March 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.

• The practice had a surgery pod to allow patients to attend the practice without an appointment and have their blood pressure monitored.

Updated 31 March 2017

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

• Performance for dementia related indicators was above the national average. The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 88% compared to the CCG average of 87% and the national average of 84%.

• Performance for mental health related indicators was above the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, was 95% compared to the CCG average of 83% and the national average of 88%.

• 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 31 March 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.