Aberfeldy Practice

Updated 2 November 2016

Aberfeldy Practice is located in Tower Hamlets. The practice is in a purpose built building providing GP services to approximately 6,550 patients. Services are provided under a General Medical Services (GMS) contract with NHSE London and the practice is part of the Tower Hamlets Clinical Commissioning Group (CCG). The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of maternity and midwifery services, treatment of disease, disorder or injury, surgical procedures, family planning and diagnostic and screening procedures.

The practice is staffed by four GP partners and three salaried GPs. One of the GP partners was the Medical Director of the local GP Care Group in Tower Hamlets. There are four male GPs and three female GPs. The GPs provide 36 sessions between Mondays to Saturday. The practice employs two part time female practice nurses and one part time female healthcare assistant. There are seven administrative staff and two practice managers. The practice is an approved teaching practice, supporting undergraduate medical students.

The practice is open between 8.30am and 6.00pm Monday to Friday, with the exception of Wednesday morning, when the practice opens at 8.15am. The first Friday of every month, the practice is closed between 12.30pm and 2.30pm for a practice meeting. Appointment times are between 9.00am to 12.30am and 2.00pm to 5.30pm. The practice telephone lines are closed between 12.30pm and 1.30pm, however the practice is still open to patients. Telephone consultations with a GP are offered daily. Extended surgery hours are offered on two Saturdays every month, between 9.00am and 11.30am. Appointments can be booked in person, over the telephone or online. The out of hours services are provided by an alternative provider when the practice telephone lines are closed and after 6.00pm. The details of the service is displayed on the practice leaflet and accessed by calling the practice number.

The practice has a higher than national average population of people aged 20 to 40 years and a lower than average population of people aged 45 to 85 years and over. Approximately 30% of the practice population is between the ages of 20 to 40 years. Life expectancy for males was 76 years, which is one year lower than the CCG average of 77 years and three years less than the national average of 79 years. The female life expectancy in the practice is 82 years, which is the same as the CCG average and one year lower than the national average of 83 years.

Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.

Updated 2 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Aberfeldy Practice on 30 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. 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. For example, they had in-house phlebotomy run by the healthcare assistant daily.
• The practice worked and supported the local community. For example, the practice held a number of health promotion events at the local schools and community centres for vulnerable people.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, 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:

They proactively arranged health promotional events in the community in different settings and locations to encourage healthy lifestyle and self-care and worked with other organisations such as the health trainers to promote this. As a result of the work the practice did, their A&E attendance was 19% less than the CCG average in 2014/15 and unverified data shows that they were 15% less than the CCG average in 2015/16.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 November 2016

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.
• Performance for diabetes related indicators was similar to the national average. For example, 71% of patients with diabetes had a blood sugar level of 64 mmol/mol or less in the preceding 12 months compared to 72% for CCG average and 78% for national average.
• 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 2 November 2016

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.
• We saw the practice held two to three educational events at the local children’s centre, for parents in the local area to attend and discuss common ailments in particularly those concerning children and women’s health.
• We saw evidence that the outreach work had reduced the practices A&E attendance, which was 19% lower than the CCG average in 2014/15 and unverified data showed that they were 15% lower than the CCG average in 2015/16.
• We also saw that as a result of the ongoing educational events, the practice’s uptake for the cervical screening programme was 93%, which was better than the CCG average of 79% and the national average of 82%.
• We saw evidence as a result of the outreach work in schools and to parents that immunisation rates were 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.
• 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 2 November 2016

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.
• All patients over the age of 65 years had a personalised care plan and a named GP responsible for coordinating care for that patient.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Clinicians attended the local elder’s lunch club and offered healthcare advice about flu immunisation, healthy eating and keeping warm in the winter.

Updated 2 November 2016

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.
• The practice was proactive in offering online services including booking and cancelling appointments and electronic prescribing service.

Updated 2 November 2016

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

• Performance for dementia related indicators was better than the national average. For example, 89% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, compared to 87% for CCG average and 84% for national averages.
• Performance for mental health related indicators was better than the national average. For example, 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in their records, in the preceding 12 months compared to 83% for CCG average and 88% for national average.
• 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 2 November 2016

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 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.
• The practice worked with local community services and carried out health promotional events for vulnerable patients.
• 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.