Newham Transitional Practice

Updated 3 November 2017

Newham Transitional Practice is located in a purpose built health centre in Newham, within a residential area and has a dedicated car park for staff and disabled patients and good transport links. The practice is a part of East London Foundation Trust (ELFT) and Newham Clinical Commissioning Group (CCG).

There are 5804 patients registered at the practice, the practice registers each patient for a year, after which the practice supports them to find a permanent practice.

The practice has four salaried GP’s, two male and two female carrying out 27 sessions per week, two nurses carrying out 13 sessions per week. One nurse who holds all her sessions outside of the practice doing outreach work in places where you would expect to find vulnerable patients to encourage them to register with a practice and have a health check. There is also a health care assistant completing nine sessions per week. The practice has one practice manager and nine reception/administration staff members.

The practice operates under an Alternative Provider Medical Services Contract (APMS) a locally negotiated contract open to both NHS practices and voluntary sector or private providers e.g. many walk-in centres.

The practice is open Monday to Friday 8:00am to 6:30pm, phones are answered from 8:00am. Appointment times were as follows:

Monday 9:00am to 12:30pm and 2:00pm to 6:00pm

Tuesday 8:30am to 11:25am and 3:00pm to 5:20pm

Wednesday 8:00am to 12:30pm and 2:00pm to 5:00pm

Thursday 8:00am to 1:00pm No clinics after 1:00pm but the practice doors are kept open

Friday 8:00am to 12:30pm and 2:00pm to 5:00pm

The out of hours provider covers calls made whilst the practice is closed.

The practice has 25% homeless patients and 27% of the practice’s patients are new to the country.

Newham Transitional Practice operates regulated activities from two locations and is registered with the Care Quality Commission to provide maternity and midwifery services, family planning, treatment of disease disorder or injury and diagnostic and screening procedures.

The branch practice address is 10 Vicarage Lane, Newham E15 4ES; this location was not visited as a part of the inspection.

Updated 3 November 2017

We carried out an announced comprehensive inspection at Newham Transitional Practice on 10 June 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 well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance both in the practice and in locations outside of the practice. 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 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 through the use of focus groups which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

One of the practice nurses held planned clinics in places such as soup kitchens and drop in centres where vulnerable patients attended and provided services which included encouraging them to register with a GP, giving prescriptions and carrying out annual reviews.

The areas where the provider should make improvement are:

• Review the system for identifying carers to enable improved support and guidance.

• Continue to look at ways to improve patient satisfaction scores with access to services.

Letter from the Chief Inspector of General Practice

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 3 November 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.

• The percentage of patients on the diabetes register with a record of foot examination and risk classification within the preceding 12 months was 90% compared with a CCG average of 89% and a national average of 88%.

• 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 3 November 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 to 64 whose notes recorded that a cervical screening examination had taken place in the preceding five years was 80% compared with a CCG and national average of 81%

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 3 November 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 held regular multidisciplinary meetings where they discussed the care of elderly patients.

Updated 3 November 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.

• Simplified and localised registration process to ensure access to care & support for people working in the sex industry.

Updated 3 November 2017

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

• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive agreed care plan documented in their record in the preceding 12 months was 79% compared with a CCG average of 84% and a 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 3 November 2017

The practice is rated as outstanding 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, people new to the country, 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 held clinics in places where vulnerable people attended.

• The practice held details of places where their vulnerable people hung out and proactively attended these places to find patients when there was a clinical need for the patient to be seen. This time was also used to register people found that did not have a GP.

• The practice had systems in place to enable vulnerable people to register with the practice easily.

• 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.