City and Hackney GP Confederation

Updated 16 June 2022

City & Hackney GP Confederation C.I.C is the registered provider of the service. The provider is registered with the CQC to carry out the regulated activities of diagnostics and screening and treatment of disease, disorder or injury from the head office which is located at:

2nd Floor, Lawson Practice

85 Nuttall Street

London

N1 5HZ

City & Hackney GP Confederation was established in 2014 and consists of 39 GP practices in the City and Hackney, which formed a community interest company. The registered patient population as at 1st April 2022 is approximately 335,739, of which 325,768 are registered in Hackney and 9,971 are registered in the City. Hackney’s boundaries are by Islington to the west, Haringey to the north, Waltham Forest to the north-east, Newham to the east, Tower Hamlets to the south-east and the City of London to the south-west.

The service responds to the current needs of the GP practices and their patients by sub-contracting to practices for services, direct service provision, primary care development/support, and representing primary care at system level.

This inspection looked specifically at the direct services which were under the scope of registration at the time of the inspection. These were:

• The extended access service, which offers patients who are registered with a City and Hackney GP practice a 15-minute, telephone, online or face to face appointment with a GP between 8am and 8pm on a Saturday, Sunday and Bank Holidays. GP practices can book patients into the service which is carried out at five locations:
• Hoxton Surgery – South West Hackney – Saturday 8am to 2pm.
• Neaman Practice – City of London – Saturday 8am to 2pm.
• Nightingale Practice – North East Hackney – Saturday 2pm to 8pm.
• Lea Surgery – South East Hackney – Sunday 8am to 2pm.
• Stamford Hill Group Practice – North East Hackney – Sunday 2pm to 8pm.

• The doorstep assessment and pulse oximetry at home service. The service was started during the pandemic, where clinical staff would visit patients who were unable to leave their homes to carry out physical observations. This was initially offered for patients with Covid-19 symptoms or who were Covid 19 positive and were housebound. This enabled GPs to monitor and treat patients in their own homes for up to 14 days and escalate to secondary care if/when appropriate. In addition, the pulse oximetry enables GPs to care for patients who had been discharged from hospital on an Enhanced Discharge Pathway.
• The doorstep assessment and pulse oximetry at home service team comprised of a Director of Nursing and, a nurse, a technician, a specialist paramedic practitioner and administration support. Supported by Corporate Development, the Covid-19 Clinical Lead City & Hackney Clinical Commissioning Group, North East London Digital First Lead & Clinical Lead for Pulse Oximetry.
• The care settings Covid 19 service which delivers Covid and flu vaccinations to residents and staff in care settings.

The provider had other services which were not under our scope of registration but were considered in the report in regard to responding to patient needs, these were: -

• Salaried GP scheme which provided newly qualified and more experienced salaried GPs with an opportunity to combine clinical sessions with funded development time to focus on areas of specialist interest or undertake work within a GP practice.
• A nursing team that offers advice regarding infection prevention and management to CQC registered and non-registered care settings.
• A smoking cessation service.

In addition, the provider holds contracts covering the following services. These contracts are delivered by the 39 practices in City & Hackney, ensuring 100% population coverage:

• Long Term Conditions
• Proactive Care: Home Visiting Service
• Proactive Care: Practice Based Service
• Duty Doctor
• End of Life Care
• Primary Care Anticoagulation
• Community Phlebotomy
• Community Wound Care
• Primary Care Mental Health Alliance (including new CYP ADHD service)
• Prostate Specific Antigen (PSA) Follow up in Primary Care
• Early Years
• Primary Care Extended Access (Neighbourhood Model)
• Latent TB
• NHS Health Checks
• Sexual & Reproductive Health
• Teledermatology

Updated 16 June 2022

This service is rated as Good overall.

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.

We carried out an announced inspection at City and Hackney GP Confederation between 10 and 24 May 2022. This was the locations first comprehensive inspection following registration with the Commission.

At this inspection we rated: -

Well- led as outstanding. This was because:

• The strategy and supporting objectives and plans were challenging and innovative, while remaining achievable. Strategies and plans were fully aligned with plans in the wider health economy, and there was a demonstrated commitment to system-wide collaboration and leadership.
• Governance arrangements are proactively reviewed and reflect best practice. A systematic approach is taken to working with other organisations to improve care outcomes.
• The leadership, governance and culture are used to drive and improve the delivery of high-quality person-centred care.
• Leaders had an inspiring shared purpose and strive to deliver and motivate staff to succeed.

Safe, effective, caring and responsive as Good. This was because:

• The services had clear systems to keep people safe and safeguarded from abuse.
• Staff had the information they needed to deliver safe care and treatment to patients.
• The service learned and made improvements when things went wrong.
• The service had a comprehensive programme of quality improvement activity and routinely received the effectiveness and appropriateness of the care provided.
• The services worked together with the GP practices of City and Hackney and secondary care to deliver effective care and treatment.
• The service obtained consent to care and treatment in line with legislation and guidance.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

The areas where the provider should make improvements are:

• Review the training matrix to ensure all training is completed and updated regularly.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care