First 4 Health Group - Church Road Health Also known as E12 Health

Updated 20 April 2018

Church Road Health practice is situated in Manor Park in London and located within NHS Newham Clinical Commissioning Group. Church Road Health was one of the three practices of First 4 Health Group. The practice holds a Personal Medical Services contract (Primary Medical Services agreements are locally agreed contracts between NHS England and a GP practice). The practice had a patient list of just over 12,849 at the time of our inspection. In addition, the practice had accepted 1,400 patients onto the register with two days’ notice when a neighbouring practice had suspended its service in October 2017 for six weeks. More recently, the practice had agreed to register 420 patients who had not responded to correspondence from NHS England regarding the need to register with a new GP.

The practice catchment area is classed as within the group of the second most deprived areas in England. (The Index of Multiple Deprivation 2015 is the official measure of relative deprivation for small areas in England. The Index of Multiple Deprivation ranks every small are in England from one (most deprived area) to 10 (least deprived area). Approximately 84% of the people in the area are from black minority and ethnic groups. A higher than average number of patients is recorded as having long-term conditions. For example, the practice had approximately 12% of the practice population of patients with diabetes compared with the local Care Commission Group (CCG) average of 7%. The practice has a high number of children under the age of five years approximately 1141 (approximately 9% of the practice population).

The staff team at the practice included a male and female partner. Twelve GPs, (nine female and three male covering approximately 46 sessions). The nursing team included two female and one male practice nurse, five healthcare assistants. Church Road Health practice was an approved training practice for GP Registrars. Operational managers and a team of reception and administration staff supported these.

• The practice was open between 8am and 6.30pm Tuesday, Wednesday, Thursday and Friday.

• The practice offered extended hours surgeries from 8am to 8pm on a Monday and 8am to 6.30pm on a Wednesday and Saturday morning 9am to 12pm.

• Appointments were available all day and the practice did not close during the day.

• Urgent appointments were available each day and GPs completed telephone consultations for patients.

• When the practice was closed the patients are directed to the GP Co-op service who were based at the Walk-in Centre at Newham University Hospital, Glen Road, Plaistow, London E13 3NT. When the surgery was closed, the telephone is directly connected to this out-of-hours service. Or directed to the 111 service.

Updated 20 April 2018

This practice is rated as Good  overall. (Previous inspection June 2015 – Overall Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) – Good.

We carried out an announced comprehensive inspection at Church Road Health Practice on 26 January 2018. We carried out a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider met the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.At this inspection, we found:

• The practice had clear comprehensive systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff had the skills, knowledge, and experience to carry out their roles. The practice had a comprehensive appraisal and development procedure for all administration and nursing staff.

• Staff treated patients with compassion, kindness, dignity and respect.

• The practice organised and delivered services to meet patients’ needs. It took account of patients' needs and preferences.

• Leaders at all levels were visible and approachable. They had the experience, capacity and skills to deliver the practice strategy and address risks to it. They were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

• Openness, honesty and transparency were demonstrated when responding to incidents and complaints. The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

• There was a strong emphasis on the safety and well-being of all staff. The human resources manager explained that part of the personal development review looked at the staff's well-being.

• There were clear responsibilities, roles, and systems of accountability to support good governance and management.

• The practice had a computer system that enabled all staff to quickly and easily access policies, procedures and information about the practice and patients.

• The practice involved patients, the public, staff and external partners to support high-quality sustainable services.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice worked with the department of academic general practice at Queen Mary Westfield Hospital and developed a standard child safeguarding computer template for use in all GP practices in Newham CCG. The lead clinician at Church Road Health had trained other practices including over 150 practice staff in the CCG to use the system correctly and trained practices to appropriately manage safeguarding issues. Within the practice, they had developed a safeguarding team that supported quality improvement and had a whole practice approach to safeguarding. The staff reviewed the patient lists of looked after and safeguarded children. This enabled the identification of 100 children at risk who staff may not have previously identified on the child protection register. In response to the staffs findings, the practice improved staff training and the registration form for new child patients.

• The practice offered a named GP to a local home that accommodated patients with behaviours that challenged, who had a learning disability. The GPs visited the home, telephoned, or used video conferencing to assess patients. If patients visited the surgery risk assessments were in place and these included specific waiting instructions for reception. The patient’s had met the GP to reduce stress. In addition, the GP held an additional multidisciplinary meeting with the hospital team and home staff to ensure they met patients' needs. The care home staff described how the GP had worked with the staff at the home to develop a protocol for staff to follow to reduce the patient’s hospital admissions.

• Leaders had an inspiring shared purpose, and strove to deliver and motivate staff to succeed. There were high levels of satisfaction across all staff. There is a strong organisational commitment and effective action towards ensuring that there was equality and inclusion across the workforce. The practice had a comprehensive appraisal and development procedure for all administration and nursing staff, This had resulted in 26 staff progressing or moving on from the organisation and had provided payment for the course and protected time In addition, the practice had an admin/reception ‘bank’ scheme in which they offered a four-week training programme for people from the local community to get experience and basic training in what is involved in working in a GP practice.

Professor Steve Field (CBE FRCP FFPH FRCGP)Chief Inspector of General Practice

Updated 20 April 2018

Updated 20 April 2018

Updated 20 April 2018

Updated 20 April 2018

Updated 20 April 2018

Updated 20 April 2018