Background to this inspection
Updated
4 July 2018
Leyton Green Neighbourhood HS is located in a residential area in east London based in a converted house. There are approximately 3700 patients registered with the practice where approximately 30% of whom do not have English as a first language and required an interpreter. The practice scored three on the index of multiple deprivation score where a score of one represents the most deprived and 10 is the least deprived.
The practice has two female GP partners and one female and two male regular locum GPs who complete a total of 13 sessions per week; there was also one female practice nurse and one female nurse prescriber who complete a total of 12 sessions per week. The practice has one practice manager and six reception/administrator staff members.
The practice is a training practice for medical students but did not have any students at the time of inspection. The practice operates under a General Medical Services 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 open Monday to Friday between 9am and 6:30pm except for Thursdays when the practice closed at 1pm. The practice also closed each day between 12:30pm and 2:30pm and extended hours appointments were not offered. Telephone calls are answered from 9am to 12:30pm and 2:30pm to 6:30pm and appointment times are as follows:
- Monday 9am to 12:15pm and 3pm to 5pm.
- Tuesday 9:30am to 12:30pm and 3pm to 6pm.
- Wednesday 9am to 11:20am and 3pm to 5:20pm.
- Thursday 9:30am to 12:20pm.
- Friday 9:30am to 12:20pm and 3:15pm to 6pm.
The locally agreed out of hours provider covers calls made to the practice when the practice is closed and the practice is a part of a local HUB, which provides GP and nurse appointments to patients on weekday evenings and weekends when the practice is closed.
Leyton Green Neighbourhood HS operates regulated activities from one location and is registered with the Care Quality Commission to provide treatment of disease, disorder or injury, diagnostic and screening procedures, maternity and midwifery services and family planning.
Updated
4 July 2018
This practice is rated as inadequate overall. (Previous inspection 11 2015 – Good)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires Improvement
Are services caring? – Good
Are services responsive? – Requires Improvement
Are services well-led? – Inadequate
We carried out an announced comprehensive inspection at Leyton Green Neighbourhood HS on 26 April 2018 as part of our inspection programme.
At this inspection we found:
- The practice did not have clear systems to manage risk so that safety incidents and significant events were less likely to recur. When incidents did happen, the practice did not effectively learn from them and improve their processes.
- The practice did not routinely review the effectiveness and appropriateness of the care it provided.
- Learning and outcomes from complaints was not shared with all relevant staff members.
- There was no evidence of quality improvement work being carried out.
- The practice did not provide appointments outside or core working hours for patients who could not attend during working hours and the practice was closed for two hours each day during lunch.
- Not all staff members had received the training required to carry out their roles effectively, for example safeguarding, infection and prevention control, fire safety and chaperone training.
- Emergency equipment was not sufficiently maintained as resuscitation equipment did not include a baby mask and had a missing valve.
- There was no documented approach to manage pathology results.
- There was no failsafe system to ensure the practice received results for all cytology samples taken.
- There were no systems to enable the process for seeking consent to be monitored appropriately.
- Home visit documentation completed by the nurse was not always comprehensive.
- Systems to ensure that electrical equipment was safe and in good working order was not effective.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- The practice had an approach for identifying and providing support to patients with caring responsibilities and had identified 2% of patients as a carer.
- Quality and Outcomes Framework achievement was in line with local and national averages.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure g good governance in accordance with the fundamental standards of care.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
The areas where the provider should make improvements are:
- Ensure all premises and equipment used by the service provider is fit for use.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice