Archived: Eastern Avenue Medical Centre

Updated 27 April 2017

Eastern Avenue Medical Centre is based at 167 Eastern Avenue, Ilford, Redbridge IG4 5AW and provides GP services under a Personal Medical Services contract. This is a contract between the GP practice and NHS England to deliver local services. The surgery is in a converted semi-detached house and has limited parking available directly in front of the building. There is step-free access from the street to all waiting areas and clinical rooms.

Eastern Avenue Medical Centre is one of a number of GP practices commissioned by Redbridge Clinical Commissioning Group (CCG). It has a practice list of 6913 registered patients. The practice is in the third least deprived group out of 10 on the national deprivation scale. The practice has a similar percentage of unemployed patients (5.3%) compared to the local average of 6.6% and national average of 5.4%.

The practice staff includes one male principal GP, two salaried male GPs, one male sessional GP and one female sessional GP. The nursing team consists of three locum practice nurses, one of whom was due to take up a full time contract following our inspection. The clinical team provided 440 appointment slots per week and a healthcare assistant provides clinical support. The administration team include a full time practice manager and a team of eight reception and administrative staff.

Appointments are available during the following hours:

Monday – 9am to 8pm

Tuesday – 9am to 8pm

Wednesday – 9am to 8pm

Thursday – 9am to 1pm

Friday – 9am to 8pm

Out of these hours, cover was provided by the NHS 111 service.

We had not previously carried out an inspection at this practice.

Updated 27 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastern Avenue Medical Centre on 6 January 2017. Overall the practice is rated as requires improvement.

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

• Staff described an effective system to report and investigate significant events and there was an up to date policy in place. However, the practice had documented no significant events in the previous two years.
• Risks to patients were assessed and well managed, including through medicines management and safeguarding processes.
• 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.
• There was evidence of multidisciplinary working to meet the complex needs of patients, including vulnerable young people and those who received palliative care. This included participating in a locality design team to implement new care pathways to reduce hospital admissions.
• Patients provided positive feedback about the caring nature of staff and said they took the time to listen to their concerns. We saw staff treated people with compassion, dignity and respect and involved them in care planning 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.
• 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.
• There was no central record of which members of staff had a DBS check and the practice had not completed risk assessments to identify if non-clinical staff needed a DBS check.

The areas where the provider must make improvements are:

• Ensure fire safety practices in the surgery adhere to the requirements of the Regulatory Reform (Fire Safety) Order 2005, including in staff training, evacuation policies and building safety.

• Ensure the environment is maintained to appropriate standard that ensures consistent protection from infection risk and the build-up of bacteria. This should be audited on a regular basis.

• Ensure staff who provide chaperone services are properly trained.

• Ensure all clinical staff are aware of systems in place to identify at-risk children and young people.

The areas where the provider should make improvements are:

• Ensure learning from significant events is embedded in practice processes and staff professional development.

• Implement a quality improvement programme which includes audit that staff can use to benchmark standards of practice and drive improvements. This should also be used to ensure the needs of patients with long terms conditions are met.

• Implement and maintain a carer’s register to ensure carer’s are identified and provided with structured support.

• Ensure risk assessments are in place for members of staff who are employed withoutDisclosure Barring Service clearance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 April 2017

The practice is rated as requires improvement for safe and effective and good for caring, responsive and well-led. This means the overall rating is requires improvement, which includes services for this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The principal GP ensured patients in this group had continuity of care as the nurse team was made up of regular locum staff.
• The practice maintained a disease register and ensured patients received regular reviews.
• Performance for diabetes related indicators was lower than the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 70% compared to the CCG average of 79% and the national averages of 78%. In addition the percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 67% compared with the CCG average of 74% and national average of 80%.
• Patients in this group 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, a named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Staff restricted prescriptions for high-risk medicines, such as psychotropic medicines, to monthly quantities. This meant a GP could review each patient regularly.

Updated 27 April 2017

The practice is rated as requires improvement for safe and effective and good for caring, responsive and well-led. This means the overall rating is requires improvement, which includes services for this population group.

• The practice scored 8.8 out of 10 for standard childhood immunisations up to the age of two and achieved the national target of 90% in one out of four NHS England sub-indicators.
• The practice’s uptake for the cervical screening programme was 70% which was comparable to the CCG average of 78% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Baby clinics were offered at six weeks prior to birth and six weeks after birth.
• Staff conducted a two-weekly audit of babies who had missed a scheduled immunisation and contacted their parents to encourage them to attend.
• The practice participated in a health promotion programme for obese children and for children with mental health needs.
• We saw positive examples of joint working with midwives and health visitors.
• The practice provided sexual health advice and screening for young people and were due to implement chlamydia screening for the under 25s in February 2017.

Updated 27 April 2017

The practice is rated as requires improvement for safe and effective and good for caring, responsive and well-led. This means the overall rating is requires improvement, which includes services for this population group.

• 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 complex needs.
• Staff had established an unplanned admission avoidance scheme that involved proactively referring patients to a community treatment team aimed at reducing unplanned hospital readmissions. The practice also liaised with an integrated care management matron to help patients remain healthy at home and in the community rather than have to attend hospital.
• The practice invited all patients over 75 years to attend an annual health check and also offered patients an annual medication review and home flu vaccinations.
• The practice provided a same-day prescription service for elderly patients, which meant they did not need to give the usual two days’ notice.

Updated 27 April 2017

The practice is rated as requires improvement for safe and effective and good for caring, responsive and well-led. This means the overall rating is requires improvement, which includes services for this population group.

• 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 range of health promotion and screening that reflected the needs of this age group, including electronic prescribing and sexual health.
• The practice offered daily extended hours to 7.30pm.
• The patient representative group was actively promoting recruitment to this age group to improve their representation at practice development meetings.
• The practice provided temporary registration for students including access to urgent appointments and sexual health screening.

Updated 27 April 2017

The practice is rated as requires improvement for safe and effective and good for caring, responsive and well-led. This means the overall rating is requires improvement, which includes services for this population group.

• 71% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%. The practice had exception reported 4% compared to the national average of 13%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice offered a dementia screening service that enabled patients to access specialist care and carried out advance care planning for these patients.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 27 April 2017

The practice is rated as requires improvement for safe and effective and good for caring, responsive and well-led. This means the overall rating is requires improvement, which includes services for this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, those over 75 years of age living alone and those with a learning disability.
• The practice offered longer appointments and an annual health check 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.
• Patients who were considered vulnerable were given same day appointments.