Archived: Barkingside Medical Centre

Updated 28 January 2016

Barkingside Medical Centre is in Barkingside in the London Borough of Redbridge. It is one of the 47 member GP practices of Redbridge Clinical Commissioning Group.

The practice serves a predominantly White (45.8%) and Asian / Asian British (41.4%) population. A further 7.5% of the local population identifies itself as Black / African / Caribbean / Black British; 2.4% as Mixed / Multiple Ethnic Groups; and 2.8% as Other. The practice has approximately 5,400 registered patients. The practice is located in the seventh less deprived decile of areas in England. At 81 years, male life expectancy is a little above the England average of 79 years. At 83 years, female is the same as the England average.

Services are provided by Barkingside Medical Centre, which is a registered partnership of Dr Undinti David Shubhaker and Dr Varaha Vijay Konathala, under a Personal Medical Services (PMS) contract with NHS England. Dr Shubhaker plans to retire on 31 December 2015 and the practice will relocate then to new premises. Dr Shubhaker has not worked as a GP at the practice since July 2015. The practice has since then experienced considerable change. All the GPs other than Dr Konathala, and most of the non clinical staff were recruited to the practice during this time. New systems are being put in place, for example the practice is changing the patient record system it uses, and the practice has been looking for new premises. On 05 November 2015 Redbridge CCG announced the new location for the practice and confirmed that the practice would not be closing. We advised the practice on the processes for cancelling the current provider’s registration with CQC, and on registering the new provider and the new location.

The practice opening times are:

Monday to Wednesday and Friday – 7.30am to 7.30pm

Thursday – 7.30am to 12.00 noon

Routine appointments are available at the following times:

Monday to Wednesday and Friday - 7.30am to 12.00 noon and 2.00pm to 7.30pm

Thursday – 7.30am to 12.00 noon.

Clinical services are provided by two male and three female GPs and a Practice Nurse. The male GPs include Dr Konathala (40 hours per week) and a long term GP locum (12 hours). The female GPs include one salaried GP (18 hours) and two long term GP locums (ten hours and eight hours). Patients have access to a male or female GP at every clinical session. The Practice Nurse sees patients Monday to Wednesday (22 hours). Non clinical staff include a part time Practice Manager and a team of six part time secretarial, administrative and reception staff.

Patients are cared for by an external out of hours GP service when the practice is closed.

Barkingside Medical Centre is registered with the Care Quality Commission to carry on the following regulated activities at 700 Cranbrook Road, Barkingside, Ilford, Essex IG6 1HP: Treatment of disease, disorder or injury; Diagnostic and screening procedures; and Maternity and midwifery services.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barkingside Medical Centre on 11 November 2015. Overall the practice is rated as requires improvement.

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

• The practice had faced considerably uncertainty since the senior partner announced in June 2015 their intention to retire from general practice at the end of the year and that the practice was required to vacate the premises. This uncertainty was ended on 05 November 2015 when the CCG confirmed the practice would not close and that a new location for the practice had been found. The new premises would be provided by NHS Property Services.

• Data showed patient outcomes were low for the locality. Although some audits had been carried out, few were completed audits and there was little evidence that audits were driving improvement in performance to improve patient outcomes.

• Among the patient records we reviewed of eight patients chosen at random we saw instances of inadequate recording of history and examination, inadequate recording of a working diagnosis or no diagnosis recorded, inadequate clinical management, and pathology results that appeared not to have been acted on. We also saw instances of accepted clinical guidelines not being followed. NHS England were advised of our concerns.

• There was an open and transparent approach to safety and a system was in place for reporting and recording significant events. The provider however did not have policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.

• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks. Fire, legionella and control of substances hazardous to health (COSHH) risk assessments were not in place. The provider was aware of these shortfalls in their current premises which they would be vacating at the end of December 2015.

• National GP survey results published in July 2015 showed comparatively few patients felt they were treated with care and concern.

• Information about services and how to complain was available and easy to understand.

• The practice had worked hard to improve the responsiveness of the service and there was anecdotal evidence on the day of our inspection that patients were finding easier to make an appointment to see a GP. However, there was no formal evidence that the practice had improved on its below average results in the national GP survey in this area.

• Urgent appointments were available on the day they were requested.

• There was a clear leadership structure and staff felt supported by management. However capacity and capability to run the practice and ensure high quality care was stretched.

• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure systems are in place to monitor and improve patient outcomes and the performance of the practice.

• Ensure processes are in place so that national guidelines are used to secure consistent, high quality, evidence based care for patients

• Ensure recruitment arrangements include all necessary employment checks for all staff and that information in relation to each person working for the service as specified in Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 is available for staff who joined the practice after 01 April 2013.

• Ensure patient records fully document the care and treatment that has been provided.

In addition the provider should:

• Put in place policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.

Put arrangements in place so that patients can book appointments and order repeat prescriptions online.

We carried out an announced comprehensive inspection at Barkingside Medical Centre on 11 November 2015. Overall the practice is rated as requires improvement.

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

• The practice had faced considerably uncertainty since the senior partner announced in June 2015 their intention to retire from general practice at the end of the year and that the practice was required to vacate the premises. This uncertainty was ended on 05 November 2015 when the CCG confirmed the practice would not close and that a new location for the practice had been found. The new premises would be provided by NHS Property Services.

• Data showed patient outcomes were low for the locality. Although some audits had been carried out, few were completed audits and there was little evidence that audits were driving improvement in performance to improve patient outcomes.

• Among the patient records we reviewed of eight patients chosen at random we saw instances of inadequate recording of history and examination, inadequate recording of a working diagnosis or no diagnosis recorded, inadequate clinical management, and pathology results that appeared not to have been acted on. We also saw instances of accepted clinical guidelines not being followed. NHS England were advised of our concerns.

• There was an open and transparent approach to safety and a system was in place for reporting and recording significant events. The provider however did not have policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.

• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks. Fire, legionella and control of substances hazardous to health (COSHH) risk assessments were not in place. The provider was aware of these shortfalls in their current premises which they would be vacating at the end of December 2015.

• National GP survey results published in July 2015 showed comparatively few patients felt they were treated with care and concern.

• Information about services and how to complain was available and easy to understand.

• The practice had worked hard to improve the responsiveness of the service and there was anecdotal evidence on the day of our inspection that patients were finding easier to make an appointment to see a GP. However, there was no formal evidence that the practice had improved on its below average results in the national GP survey in this area.

• Urgent appointments were available on the day they were requested.

• There was a clear leadership structure and staff felt supported by management. However capacity and capability to run the practice and ensure high quality care was stretched.

• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure systems are in place to monitor and improve patient outcomes and the performance of the practice.

• Ensure processes are in place so that national guidelines are used to secure consistent, high quality, evidence based care for patients

• Ensure recruitment arrangements include all necessary employment checks for all staff and that information in relation to each person working for the service as specified in Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 is available for staff who joined the practice after 01 April 2013.

• Ensure patient records fully document the care and treatment that has been provided.

In addition the provider should:

• Put in place policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.
• Put arrangements in place so that patients can book appointments and order repeat prescriptions online.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

The provider was rated as requires improvement for providing safe, effective, caring, responsive and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• The practice nurse had the lead role in managing patients with diabetes and there had been an improvement in the outcomes for these patients in 2014/15. However the practice continued to perform below CCG and national averages for some glucose and cholesterol control indicators.

• Patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met, however this was currently the GP partner which was not sustainable.

For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 January 2016

The provider was rated as requires improvement for providing safe, effective, caring, responsive and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• The practice maintained a register of children considered to be at risk by social services. However the patient record system was not used to flag this to a GP attending to one of these children.

• 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 cervical screening rate for the practice was comparable to the national average (80.27% and 81.83 % respectively)

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

Updated 28 January 2016

The provider was rated as requires improvement for providing safe, effective, caring, responsive and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 28 January 2016

The provider was rated as requires improvement for providing safe, effective, caring, responsive and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• The needs of the working age population, those recently retired and students had been identified and the practice was adjusting the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Although the practice offered extended opening hours for appointments four days a week, patients could not book appointments or order repeat prescriptions online.

Health promotion advice was offered and the uptake of health screening was comparable with CCG and national averages.

Updated 28 January 2016

The provider was rated as requires improvement for providing safe, effective, caring, responsive and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• The practice was able to identify patients

• While outcomes for patients with mental health problems were comparable with national averages there had been a sharp decline in the percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in 2014/15, from 77.78% in 2013/14 to 22.22% in 2014/15.

Updated 28 January 2016

The provider was rated as requires improvement for providing safe, effective, caring, responsive and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• It offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

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.