Archived: Francis Road Medical Centre

Updated 26 April 2017

Francis Road Medical Centre is situated at 94 Francis Road, Waltham Forest, London, E10 6PP. The practice operates from a converted residential property. The practice has access to three consulting rooms, two on the ground floor and one on the first floor accessed via stairs.

The practice provides NHS primary care services to approximately 4,600 patients living in the Leyton area of London through a General Medical Services (GMS) contract (a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract) The practice is part of NHS Waltham Forest Clinical Commissioning Group (CCG) which consists of 45 GP practices.

The practice population is in the fourth least deprived decile in England. The practice population of male and female patients between the age brackets 0 to 9 and 25 to 39, 30 to 34 and 35 to 39 is higher than the national averages. Of patients registered with the practice, the majority are eastern European and Asian.

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services; surgical procedures; and family planning.

The practice provides a range of services including childhood immunisations, chronic disease management, cervical smears and travel advice and immunisations.

The practice staff comprises of a female GP partner (five sessions per week), a male GP partner (six sessions per week) and a female salaried GP (five sessions per week). The GPs were supported by a practice nurse (28 hours per week), a practice manager, a deputy practice manager and administration and reception staff.

The practice reception and telephone lines are open from 9am to 1pm and 2pm to 6.30pm Monday, Tuesday, Wednesday and Friday and from 9am to 1pm on Thursday. Extended surgery hours are offered on Tuesday from 6.30pm to 8pm and on Friday from 6.30pm to 7.30pm.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111. Appointments with a GP or a practice nurse are also available on Saturday and Sunday from 9.30am to 4.30pm for routine and urgent appointments at ‘hub’ practices within Waltham Forest CCG area. The practice had leaflets in the waiting room advertising this service.

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Francis Road Medical Centre on 12 May 2016. The overall rating for the practice was requires improvement, with a rating of inadequate in safe. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. The full comprehensive report on the 12 May 2016 inspection can be found by selecting the ‘all reports’ link for Francis Road Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 31 January 2017 and 22 February 2017 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 12 May 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:

• The practice had acted upon the findings of our previous inspection in relation to patient safety. We found that risks to patients were assessed and well managed.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• 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.
• 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.

The areas where the provider should make improvement are:

• Review the significant event reporting process to ensure all significant events are captured to enable learning outcomes to be shared with all staff.
• Monitor performance in relation to the childhood immunisation programme.
• Continue to develop a programme of quality improvement to improve patient care.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 26 April 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 12 May 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 chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable with the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 86% (national average 76%) with a practice exception reporting of 11% (national 9%) and the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 71% (national average 80%) with a low practice exception reporting of 2% (national 13%).
• The practice held a register of all its pre-diabetic patients and recalled them for monitoring.
• 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 26 April 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 12 May 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.

• 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.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 81% and the national average of 81%.
• The percentage of patients with asthma, on a register (159 patients), who have had an asthma review in the preceding 12 months that includes an assessment of asthma control was 82% which was above the national average of 76% (practice exception reporting 0.6%; national 8%).
• Childhood immunisation rates for the vaccinations given to the under two year olds and five year olds were lower when compared to the national averages.
• Appointments were available outside school hours.

Updated 26 April 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 12 May 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 people in its population.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 26 April 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 12 May 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 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 offered extended opening clinics on Tuesday from 6.30pm to 8pm and on Friday from 6.30pm to 7.30pm for working patients who could not attend during normal opening hours.

Updated 26 April 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 12 May 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 above the national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 97% (36 patients) compared to the national average of 89% (practice exception reporting %; national 13%) and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 100% (36 patients) compared to the national average of 89% (practice exception reporting zero per cent; national 10%).
• The percentage of patients diagnosed with dementia who had had their care reviewed in a face-to-face meeting in the last 12 months was 94% (17 patients) compared to the national average of 84% (practice exception reporting zero per cent; national 7%).
• 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 undertaken dementia awareness training and had a good understanding of how to support patients with mental health needs and dementia.

Updated 26 April 2017

The practice had resolved the concerns for safety, effective and well-led identified at our inspection on 12 May 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 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 and 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.