The Care Quality Commission
  • Doctor
  • GP practice

Laburnum Health Centre

Overall: Requires improvement read more about inspection ratings

Althorne Way, Dagenham, Essex, RM10 7DF (020) 8517 0222

Provided and run by:
Laburnum Health Centre

All Inspections

27 July and 17 August 2022

During a routine inspection

We carried out an announced comprehensive inspection at Laburnum Health Centre on 17 July and 17 August 2022. Overall, the practice is rated as Requires Improvement.

Safe - requires improvement.

Effective -requires improvement.

Caring – good.

Responsive - requires improvement.

Well-led - requires improvement.

Following our previous inspection on 6 April 2022, the practice was rated as requires improvement for providing a responsive service.

This was because:-

  • Patients still could not always access care and treatment in a timely way.
  • Complaints were not always used to improve the quality of care.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Laburnum Health Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from the previous inspection.

How we carried out the inspection.

This included:

  • Conducting staff interviews.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • What we found when we inspected.
  • Information from our ongoing monitoring of data about services.
  • Information from the provider, patients, the public and other organisations.

We found that:

We rated safe as requires improvement because:

  • The systems to assess, monitor and manage, safeguarding, medicines, risks to patient safety, significant events and information to deliver safe care and treatment were not always effective.

We rated effective as requires improvement because:

  • Patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation.

We rated responsive as requires improvement because:

  • Patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation.

We rated well-led as requires improvement because:

  • There was no emphasis on the safety and wellbeing of staff.
  • Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
  • The overall governance arrangements were sometimes ineffective.

We rated caring as good because:

  • The national GP survey provided positive results.

We found two breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services.

6 April 2022

During an inspection looking at part of the service

We carried out an announced review at Laburnum Health Centre on 6 April 2022. Following our previous inspection on 9 September 2019 and 22 April 2021, the practice was rated as good overall and for all key questions, except for responsive which was rated as requires improvement at both inspections.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Laburnum Health Centre on our website at www.cqc.org.uk.

Why we carried out this review

This inspection was a focused review of information without undertaking a site visit to follow up on the responsive key question. We based our judgement of the quality of care at this service on a combination of:

• what we found when we carried out our review;

• information from our ongoing monitoring of data about services

• information from the provider, patients, the public and other organisations.

Our findings

The practice is rated as Good overall; however, we have continued to rate the practice as Requires Improvement for providing responsive services because we found that:

  • Although the practice had sought to improve access, evidence demonstrated that patients still could not always access care and treatment in a timely way.
  • The practice’s 2021 GP Patient Survey results remained below local and national averages for all the questions relating to access.
  • Feedback from patients continued to indicate significant difficulties with access to the practice and access to home visits.
  • Complaints were not always used to improve the quality of care.

These areas affected all population groups, so we rated all population groups as requires improvement for providing responsive services.

We found breaches of regulations. The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. This includes driving improvement in the quality of the experience of people using the service; in particular acting on feedback and complaints.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

22 April 2021

During an inspection looking at part of the service

We carried out an announced review of Laburnum Health Centre on 22 April 2021.

Following our previous inspection on 9 September 2019, the practice was rated as good overall and for all key questions, except for responsive which was rated as requires improvement.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Laburnum Health Centre on our website at www.cqc.org.uk.

This was a focused review of information (without undertaking a site visit) to follow up on the responsive key question.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we carried out our review;
  • information from our ongoing monitoring of data about services; and
  • information from the provider, patients, the public and other organisations.

We have rated the practice as good overall.

We rated the practice as requires improvement for providing responsive services because:

  • Although the practice had made changes to its appointment system and sought to improve access, evidence demonstrated that patients still could not always access care and treatment in a timely way.
  • The practice’s 2020 GP Patient Survey results remained below national averages for some questions relating to access, and patient feedback relating to telephone access and types of appointment offered demonstrated a year on year downward trajectory.
  • Feedback from patients indicated difficulties with telephone access in particular.

These areas affected all population groups, so we rated all population groups as requires improvement for providing responsive services.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

09/09/2019

During an inspection looking at part of the service

We carried out an inspection of this service on 9 September 2019 following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions: Effective, Responsive and Well-led.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: Safe and Caring.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and requires improvement for all population groups. This was because the issues relating to appointment availability affected all population groups.

We found that:

  • Patients received effective care and treatment that met their needs.
  • The practice did not always organise and deliver services to meet patients’ needs.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review and improve the level of exception reporting.
  • Continue to review and improve performance in childhood immunisations and cervical screening.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

18 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Laburnum Health Centre on 18 October 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 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 were able to make an appointment when they needed one, 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:

  • Consider keeping the full complement of emergency medicines in one central location that staff all have ready access to.
  • Formalise the risk assessment supporting the decision not to take any medicines on home visits.
  • Put systems in place to maintain a supply of oxygen masks and defibrillator pads for children at the practice.
  • Consider further ways of meeting the needs of patients with long term conditions given the high exception reporting rates compared to local and national averages.
  • Consider further ways of improving the uptake of cervical screening given the high exception reporting rate compared to local and national averages.
  • Review arrangements for the identification and support of carers amongst the practice patient list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

13 August 2014

During an inspection looking at part of the service

We did not speak to patients on this occasion. At our previous inspection on 25 April 2014, we were concerned that privacy and dignity was not always maintained in the reception area. We were also concerned about the management of patients on Methotrexate and found that complaints were not always handled in a timely manner.

On this visit, we observed staff patient interaction within the reception area and found that confidentiality was maintained. Posters had been put up to ensure that people could request for a private room to discuss confidential issues. There had been three complaints since our last visit. All three had been acknowledged and responded to in a timely manner. Staff showed us the way they managed patients on methotrexate, this was done by checking that blood tests had been completed before issuing repeat prescriptions

25 April 2014

During an inspection in response to concerns

We spoke to 11 patients, collected 12 response cards and reviewed comments made by patients in a local survey. We spoke to patients with chronic conditions such as asthma, diabetes and some who were on warfarin. They told us that the nurses were good at explaining things at their check -up. One person said 'the warfarin clinic is very good." Another said 'staff are helpful. They always try to help especially with explaining why I need to take all my tablets."

We found that there was information displayed relating to opening times and other health care conditions. We observed staff at reception and noted instances where confidentiality of patients was not always maintained.

We spoke to clinical staff who told us how they accessed, referred and ordered further investigations such as scans using an electronic patient record system. We looked at 12 patient consultation records and found that staff consistently assessed and recorded treatment, and advice given.

We found that medications were stored and handled appropriately. The electronic prescription service was working well and there was an established warfarin clinic.

Clinical and non -clinical staff told us they worked well with other professionals such as the district nurse and palliative care nurse. We saw minutes and action plans which verified that joint working meetings took place.

We found that the complaints system and the system for monitoring patients on methotrexate, needed to be improved.