Archived: Straight Road Doctors Surgery

Updated 10 April 2018

Straight Road Doctors Surgery provides GP primary care services to approximately 2,400 people living in the Harold Hill neighbourhood of the London Borough of Havering. The practice is in an area that is the third most deprived decile. The practice’s age and gender profile is largely in line with national averages, with a slightly higher population of 40 to 50 year olds.

The practice is run by two GP partners, one male and one female, both of whom work part time to provide a combined total of nine sessions per week. The practice provides GP services to two local nursing homes and provides an additional two sessions per week for this. There are two nurse prescribers and one practice nurse, all of whom work part time with a combined full time equivalent of 0.5, a business manager and a practice manager. There are also two receptionists and two administration staff. The practice is registered with the CQC as a partnership.

The practice is open between 8:30am and 1pm and 4:30pm to 6:30pm Monday to Friday. Appointments are from 9am to 11am and 5pm to 6:30pm Monday to Friday. Extended surgery hours for pre-bookable appointments are available on a Monday between 6:30pm to 8pm. The locally agreed out of hours provider covers calls made to the practice and directs patients when the practice is closed.

The practice operates under 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) , and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These are: Childhood Vaccination and Immunisation Scheme, Extended Hours Access, Facilitating Timely Diagnosis and Support for People with Dementia, Influenza and Pneumococcal Immunisations, Minor Surgery, Patient Participation, Rotavirus and Shingles Immunisation and Improving Patient Access Online.

The practice is registered with the Care Quality Commission to carry out the regulated activities of diagnostic and screening procedures, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury from one location.

Updated 10 April 2018

We carried out a desk based inspection of Straight Road Doctors Surgery on 12 April 2017. The overall rating for the practice was good with a rating of requires improvement for being caring. The full comprehensive report published in June 2017 can be found by selecting the ‘all reports’ link for Straight Road Doctors Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused follow up inspection carried out on 7 March 2018 to confirm that the practice had carried out their plan to make improvements on the areas that we identified in our previous inspection on 12 April 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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Overall the practice is still rated as good.

Our key findings were as follows:

• Results of the most recent GP patient survey showed improvement in how patients rated the practice in most aspects of care.

• The practice had improved its processes for identifying patients who were carers and had identified 1% of its patient population as such.

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However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

Continue to work on improving patient satisfaction with services provided.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 16 June 2017

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.
• Outcomes for patients with long term conditions were in line with national averages. For instance, the percentage of patients with diabetes whose blood sugar was well controlled was 83% compared to the national average of 78%. The percentage of patients with chronic obstructive pulmonary disease (COPD) who had a review undertaken including an assessment of breathlessness was 98% compared to the national average of 90%.
• 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 16 June 2017

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. 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.
• The practice’s uptake for the cervical screening programme was 70%, which was lower than the CCG average of 77% and the national average of 74%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided confidential sexual health advice and chlamydia screening to younger people.
• The practice provided child health surveillance and six week check-ups, and offered health education to young parents.

Updated 16 June 2017

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• GPs used a risk stratification tool designed to identify patients at highest risk of attending A&E or being admitted to hospital, and also to enable the GPs to have peer to peer discussions regarding patients with similar health concerns
• The practice provided a health check to all registered patients over the age of 75 years as part of the Everyone Counts Health Initiative.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with national averages. For instance, patients with hypertension whose blood pressure was well controlled was 84% which was the same as the national average.
• The practice was participating in a CCG pilot scheme in which the practice was aligned to two local nursing homes. The practice had created two extra sessions per week which were exclusively reserved for residents in the nursing homes and this had improved continuity of care for these patients.

Updated 16 June 2017

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 reflected the needs for this age group.

• The practice offered a ‘Commuter’s Clinic’ on a Tuesday evening until 8:00pm for working patients who could not attend during normal opening hours.

• Each GP session included a number of telephone consultation slots for patients who were unable to attend in person or who were unsure if their condition required a visit to the surgery.

• The practice was part of a local co-operative and this meant it could offer appointments until 10:00pm on weekday evenings and between 8:00am and 8:00pm on Saturdays.

• Health checks for patients aged 40 to 74 and cardiovascular risk assessments were undertaken opportunistically and by invitation.

Updated 16 June 2017

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

• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive agreed care plan documented in the record was 90%, the national average was also 90%.
• 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.
• Patients experiencing mental health conditions could book longer appointments.

Updated 16 June 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.
• The practice had a flexible approach to appointments for patients who were hard to reach for immunisations, annual reviews and long term condition management and would undertake a number of aspects of patient care during any appointment a patient attended.
• 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.
• 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.
• Translation services were available for patients who did not have English as a first language but information about this was not readily available to patients.