You are here

Dr Asma Moghal Good Also known as Becontree Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 21 April 2017

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Asma Moghal practice, Becontree Medical centre on 11 March 2016. The overall rating for the practice was requires improvement and the practice therefore needed to be re-inspected within six months after the report was published. The full comprehensive report published on 27 May 2016 can be found by selecting the ‘all reports’ link for Dr Asma Moghal on our website at www.cqc.org.uk.

This inspection was undertaken following the period of six months and was an announced comprehensive inspection on 17 November 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 11 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings 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 and the practice had acted upon the findings of our previous inspection in relation to patient safety.
  • 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.
  • 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.
  • The majority of 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 in a purpose-built building and was well equipped to treat patients and meet their needs.
  • There was a leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Continue to review system to identify carers in the practice.
  • Make patient information leaflets available in other languages spoken by patients in the practice.
  • Ensure patients are aware that translation services are available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 April 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received mandatory training relevant to their roles including infection control, which they had not received in the last inspection.
  • The practice had adequate arrangements to respond to emergencies and major incidents.
  • The practice had acted upon the findings of the previous inspection and had made significant improvements and changes to keep people safe, including carrying out DBS checks for staff who chaperoned, implementing infection control protocols and monthly infection control audits.

Effective

Good

Updated 21 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were compared to the national average.
  • In the previous inspection knowledge of and reference to national guidelines or medical alerts were inconsistent. In this inspection we found staff were aware of current evidence based guidance and there was an audit for medical alerts.
  • In the previous inspection, the practice had not carried out any completed audits. In this inspection the practice had completed a two cycle clinical audit demonstrating quality improvement to patient outcomes.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 21 April 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice similar to others for several aspects of care. For example, 91% of patients said the GP was good at listening to them compared with the CCG average of 81% and the national average of 89%.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Information for patients about the services available was accessible, however all patient information leaflets were in English and therefore did not cater for non-English speaking patients.
  • The practice had a system to identify patients who were carers however they had identified a relatively small number of carers.

Responsive

Good

Updated 21 April 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. They offered a family planning service as they had identified 15% of their patient population were females aged 20 to 49 years old.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Half of the patients we spoke with 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.
  • In our previous inspection we found that the practice did not have systems in place for handling complaints. On this follow up inspection we saw information about how to complain was available and evidence from nine examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders and the practice carried out an annual audit of all the complaints received.

Well-led

Good

Updated 21 April 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour. In five examples we reviewed we saw evidence the practice complied with these requirements.
  • The practice management team encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient reference group.
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
Checks on specific services

People with long term conditions

Good

Updated 21 April 2017

The practice had resolved the concerns for safety, effective, responsive and well-led identified at our inspection on 11 March 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was similar to the CCG and national averages. For example, 68% of patients on the diabetes register had had a recorded blood glucose level of 64mmol/mol or less in the preceding 12 months compared to CCG average of 72% and national average of 78%.
  • 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.
  • 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.

Families, children and young people

Good

Updated 21 April 2017

The practice had resolved the concerns for safety, effective, responsive and well-led identified at our inspection on 11 March 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. The practice is rated as good for the care of families, children and young people.

  • The practice’s uptake for the cervical screening programme was 83%, which was comparable with the CCG average of 80% and the national average of 81%.
  • 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 comparable to national averages 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 worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Older people

Good

Updated 21 April 2017

The practice had resolved the concerns for safety, effective, responsive and well-led identified at our inspection on 11 March 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. 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 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.

Working age people (including those recently retired and students)

Good

Updated 21 April 2017

The practice had resolved the concerns for safety, effective, responsive and well-led identified at our inspection on 11 March 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. The practice is rated as good for the care of working age people (including those recently retired and students).

  • The practice offered extended hours between 6.30pm and 8.00pm three days a week with the practice nurse and between 6.30pm and 7pm once a week with a GP.
  • The practice was proactive in offering online services and electronic prescription service as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice offered telephone consultations to all patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 April 2017

The practice had resolved the concerns for safety, effective, responsive and well-led identified at our inspection on 11 March 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Performance for mental health related indicators was similar to the CCG and national averages. For example, 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their records in the preceding 12 months, compared to the CCG average of 89% and national average of 88%.
  • Performance for dementia related indicators was similar to the CCG and national averages. For example, 82% of patients diagnosed with dementia had had a face-to-face care review in the preceding 12 months compared to the CCG and national averages of 84%.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 21 April 2017

The practice had resolved the concerns for safety, effective, responsive and well-led identified at our inspection on 11 March 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this. 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.
  • The practice offered longer appointments for patients with a learning disability. The practice gave a bypass contact telephone number, which allowed vulnerable people to call the surgery when they needed.
  • 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 in normal working hours and out of hours.
  • All clinical staff could demonstrate they had completed relevant training for adult safeguarding in the past three years.