16 January 2017
Gants Hill Medical Centre provides GP primary care services to approximately 8,200 people living in Gants Hill, London Borough of Redbridge. The practice has a General Medical Services (GMS) contract for providing general practice services to the local population. General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities.
Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the very highest levels of deprivation and level ten the lowest. This information also shows that Income Deprivation Affecting Older People (IDAOPI) is 22% which is comparable to the CCG average of 21% and the national average of 16%. Income Deprivation Affecting Children (IDACI) is 14% (CCG average 19%, national average 20%).
There are currently two GP partners, one male and one female, both of whom are full time. There are two part time salaried GPs, one male and one female and three long term locum GPs, two male and one female. The practice provides a total of 33 GP sessions per week. The practice also hosts a psychological therapist.
The clinical team is completed by a practice nurse and a health care assistant, both of whom work part time. The health care assistant is also trained as a phlebotomist (Phlebotomists are specialist healthcare assistants who take blood samples from patients for testing in laboratories). There are also two practice managers, both of whom work part time, ten administrative and reception staff and one cleaner.
The practice is registered with the Care Quality Commission to provide the regulated activities of maternity and midwifery services, diagnostic and screening procedures, family planning, treatment of disease, disorder or injury and surgical procedures.
The practice is located in a two storey former residential building. Consulting rooms are located on two floors. Patients unable to access the second floor are accommodated on the ground floor.
The practice opening hours for the surgery are:
Monday 8am to 7pm
Tuesday 8am to 6:30pm
Wednesday 8am to 6:30pm
Thursday 8am to 6:30pm
Friday 8am to 7pm
Saturday 9am to 12pm
Appointments are available between 9am and 7pm on Mondays and Fridays, 9am and 6pm on Tuesdays, Wednesdays and Thursdays and 9am and 12pm on Saturdays. Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to four weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.
The practice has opted not to provide out of hours services (OOH) to patients and these were provided on the practice’s behalf by a nominated provider. The details of the how to access the OOH service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website.
The practice had not previously been inspected.
16 January 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Gants Hill Medical Centre on 17 November 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.
- 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. The practice had worked with the Patient Participation Group (PPG) to hold a health awareness and promotion event in a local community hall. GPs from the practice had taken lead roles on the day and staff from the practice had provided information and advice to visitors. This event was open to the public, was attended by a range of community health and support organisations including Age UK, Diabetes UK, Healthwatch, Macmillan Cancer Support and the British Heart Foundation, each of whom provided a stall and personnel to talk to visitors. The event was promoted by the PPG and the practice and was attended by approximately 200 members of the public.
The areas where the provider should make improvement are:
- Continue to review patient satisfaction around telephone access and overall patient recommendation and take steps to assess the impact of recent changes.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
16 January 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.
- Performance for diabetes related indicators were comparable to CCG averages but below the national average. For instance, 70% of patients had well controlled blood sugar levels (CCG average of 70%, national average 78%). The exception reporting rate for this indicator was 9% (CCG average 8%, national average 12%).
- 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.
16 January 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 74%, which was comparable to the CCG average of 78% but below the national average of 82%.
- 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.
16 January 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.
- Specific services were offered to reduce unnecessary referrals to hospitals and community services via on-site phlebotomy, extended hours and weekend hub cover.
- There were arrangements in place with local pharmacists enabling home delivery of medicines and electronic prescribing as necessary.
16 January 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.
- Extended opening hours were provided on a Saturday morning for patients who found it difficult to attend during normal office hours.
- 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.
16 January 2017
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 average. For example, 95% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record compared to the CCG average of 89% and national average of 88%. The exception reporting rate for this indicator was 11% (CCG average 6%, national average 13%).
- 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.
16 January 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 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.
- 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.