Dr Winston Solomon Also known as St Clement's Surgery

Updated 16 November 2017

Dr Winston Solomon, also known as St Clement’s Surgery, is located in Ilford in outer north east London. It is part of the NHS Redbridge Clinical Commissioning Group (CCG).

The practice population comes from across the age range, with somewhat higher numbers of children and working-age people registered at the practice. The practice location is average in terms of levels of deprivation. The practice has approximately 3,700 registered patients. The practice provider stated that around eighty per cent of practice’s patients are of Asian origin and most of them are Muslims.

Services are provided by Dr Winston Solomon under a General Medical Services (GMS) contract with NHS England.

The practice is in a refurbished residential property. Patient areas on the ground floor include a reception area, a practice manager’s office, a consulting room and a treatment room in which minor surgery is carried out. The ground floor is wheelchair accessible and there is a disabled toilet. There are a further two consulting rooms on the first floor.

Dr Winston Solomon is a teaching practice for medical students.

Four GPs (two male and two female) work at the practice. Overall the practice provides 20 GP sessions each week. There is also a practice nurse, a pharmacist and a health care assistant working at the practice. The clinical staff are supported by a team of reception, administrative, and secretarial staff headed up by a full time practice manager.

The practice’s opening times are

• 9.00am to 6.30pm on Monday, Wednesday, Thursday and Friday.

• 9.00am to 8.30pm on Tuesday.

Patients are directed to an out of hours GP service outside these times.

The doctors’ clinic times are:

• 9.30am to 12.30pm and 3.30pm to 6.00pm on Monday, Wednesday, Thursday and Friday.

• 9.30am to 12.30pm and 3.30pm to 8.20pm on Tuesday.

Dr Winston Solomon is registered with the Care Quality Commission to carry on the following regulated activities: Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures, and Treatment of disease, disorder or injury.

We previously carried out an announced comprehensive inspection at Dr Winston Solomon on 20 December 2016. The overall rating for the practice at that time was ‘requires improvement’. We identified concerns related to the key questions of whether the practice was ‘safe’, ‘effective’ and ‘well-led’. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Winston Solomon on our website at www.cqc.org.uk.

This inspection was undertaken to follow up on the concerns identified in December 2016 and was an announced, comprehensive inspection on 16 October 2017.

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Winston Solomon on 20 December 2016. The overall rating for the practice was ‘requires improvement’. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Winston Solomon on our website at www.cqc.org.uk.

This inspection was undertaken to follow up on the concerns identified in December 2016 and was an announced comprehensive inspection on 16 October 2017. Overall the practice is now rated as ‘good’.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence-based guidance. Staff had been trained to implement the guidance; they had the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and their GPs involved them in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they could 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 the management team. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The provider had acted to improve the quality of the service by responding to the concerns raised by CQC at the previous inspection in December 2016. For example, the provider had taken action to ensure the safe management of medicines and implemented a new, diabetes clinic to improve the quality of care for some patients.

We saw one area of outstanding practice:

• The practice had made a commitment to improve outcomes for patients with diabetes. There was a weekly, diabetes-care clinic led by a GP with a special interest in diabetes; new patient education materials had been developed, and additional staff training had been arranged. This had successfully improved outcomes for all of the diabetic patients who had attended the clinic. This was demonstrated through a 2-cycle audit showing that patients attending the clinic had improved blood sugar readings; HbA1c levels showed an average reduction of 23 mmol/mol with the largest, single reduction in any patient being 49 mmol/mol.

The areas where the provider should make improvements are:

• Review arrangements for minimising risks relating to the management of the premises.

• Monitor patient feedback from all sources, including results from the national GP patient survey, to drive improvements in patients’ experiences of engaging with the provider.

• Check that recent changes lead to increases in the number of carers identified and supported by the practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2017

The practice is rated as outstanding for the care of people with long-term conditions.

• Performance for diabetes related indicators had historically been lower than the national average. For example, in 2016/17, 68% of patients with diabetes had recorded acceptable average blood pressure reading, which was comparable to the CCG average (68%) but lower than the national average of 78%. The practice had taken action to address these issues. A diabetes specialist clinic had been introduced in February 2017 and had concentrated on those patients at highest risk. All of the patients attending the clinic showed improved blood sugar control after four months. The practice had also developed new, patient education materials and arranged for in-house diabetes care training for all staff.

• Nursing and pharmacy staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

• The practice had audited their exception reporting rates for atrial fibrillation and heart failure. This had identified reasons for reporting each patient as an exception and the practice demonstrated that they continued to monitor outcomes for each patient.

Updated 16 November 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 16 November 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the practice had a system to ensure that they shared information around medicines management with hospitals and local care homes.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, the provider hosted weekly yoga sessions for older patients and also organised, with input from the Patient Participation Group (PPG), tea parties to engage older patients who were at risk of social isolation.

Updated 16 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.

• 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.

Updated 16 November 2017

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

• The practice carried out advance care planning for patients living with dementia.

• < >85% of patients with a serious mental health condition had had a care plan review within the past 12 months, which is comparable to the national average.

  The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice had recently improved access to brief, mental health advice through liaising closely with the local Improving Access to Psychological Therapies (IAPT) service.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 November 2017

The practice is rated as good 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, travellers and those with a learning disability.

• End-of-life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.