Archived: Orient Practice Also known as Forest Community Health

Updated 5 April 2017

The Orient Practice is managed by Forest Community Health Limited and is located in a purpose built building with one other practice and other community services such as phlebotomy within a residential area of Waltham Forest. The practice is a part of Waltham Forest Clinical Commissioning Group (CCG) and up until August 2016 was also a walk-in centre.

There are 8,586 patients registered with the practice, 2% of which are aged over 60. Eight five percent of the practice population is in paid work or full time education, which is higher than the CCG average of 65% and the national average of 62%. The practice has a large number of patients of eastern European decent and 38% of patients do not have English as a first language and require an interpreter. The practice also has 42 registered homeless patients.

The practice is managed by a board which is made from three companies and has one male GP Director, two male and one female salaried GPs, and nine regular sessional GP’s who carry out a total of 17 sessions per week, one female practice nurse and one regular locum nurse carrying out six sessions per week, two health care assistants and one independent prescribing practice pharmacist. There is one practice manager, one assistant practice manager and nine reception/administration staff members.

The practice operates under an Alternative Provider Medical Services (APMS) (a locally negotiated contract open to both NHS practices and voluntary sector or private providers e.g. many walk-in centres) contract which ends on 31 March 2017; the practice is currently out to tender by the CCG.

The practice is open Monday to Friday between 8am and 8pm and Saturday between 8am to 1pm. Phone lines are open from 8am, appointments run concurrently throughout each day. The locally agreed out of hours provider covers calls made to the practice whilst it is closed.

The Orient Practice operates regulated activities from one location and is registered with the Care Quality commission to provide maternity and midwifery services, treatment of disease, disorder or injury and diagnostic and screening procedures.

Updated 5 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orient Practice on 17 January 2017. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Audits were single cycle; changes were made as a result but improvements were not monitored.
• Patients rated the practice below local and national averages for several aspects of care.
• The practice had identified less than 1% of the patient list as a carer.
• 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.
• There were weekly reviews of patient consultation notes and referrals leaving the practice to monitor consistency and that guidelines were followed and learning was shared.
• The practice’s QOF and exception reporting results were comparable with the CCG and national averages.
• 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 and extended hours appointments available each 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 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 practice system for identifying and recording patient carers to ensure that adequate support is provided to them.

• Review the quality improvement programme, including clinical audits and re-audits to monitor improvement to patient outcomes.

• Work to improve the GP patient satisfaction scores.

• Continue to work to improve patient uptake of breast and bowel screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 April 2017

The practice is rated as requires improvement for providing effective and caring services. The issues identified as requiring improvement overall affected all patients including this population group.

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

• 85% of patients on the diabetes register last measure of cholesterol was 5mmol/l or less, which was comparable to the CCG average of 77% and the national average of 80%.

• 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 5 April 2017

The practice is rated as requires improvement for providing effective and caring services. The issues identified as requiring improvement overall affected all patients including this population group.

• 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. Immunisation rates were relatively 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.

• 85% of women aged 25 to 64 had a record of a cervical screening test being performed in the preceding five years documented in their record, which was comparable to the CCG and national average of 82%.

• The practice offered implants and coil insertion and removals to registered patients as well as patients from local practices.

• 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 5 April 2017

The practice is rated as requires improvement for providing effective and caring services. The issues identified as requiring improvement overall affected all patients including this population group.

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

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

• All these patients had a named GP.

• Patients were offered an annual health check and influenza vaccination.

Updated 5 April 2017

The practice is rated as requires improvement for providing effective and caring services. The issues identified as requiring improvement overall affected all patients including this population group.

• 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 evening extended hours appointments five days a week and was open on a Saturday.

• Telephone consultations were available in the morning and afternoon so patients could have access before work, after work and on their breaks.

Updated 5 April 2017

The practice is rated as requires improvement for providing effective and caring services. The issues identified as requiring improvement overall affected all patients including this population group.

• 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is similar to the national average of 84%.
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented in their record in the preceding 12 months, which was similar to the national average of 89%.

• Patients were offered priority access to appointments.

• 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 5 April 2017

The practice is rated as requires improvement for providing effective and caring services. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, refugees, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice worked with homeless charities to encourage patients to register and ensure their needs were being met.

• 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 staff members had received vulnerable adults training.