The Lawson Practice

Updated 10 October 2017

The Lawson Practice operates from purpose built premises at St Leonards, 85 Nuttall Street, London N1 5HZ. The practice has level access from the road to the ground floor entrance and a lift to the first floor. There are good bus and rail links close to the practice and some parking spaces for disabled people. It has a spacious ground floor waiting room which is split into two areas either side of the main reception desk. There is a glassed area where children can play, a small room / pod which patients could use independently to check their weight, height and blood pressure.

The practice provided NHS primary medical services through a General Medical Services (GMS) contract to approximately 13,500 patients in Shoreditch, north-east London. The practice is part of the NHS City and Hackney Clinical Commissioning Group (CCG) which is made up of 43 general practices. The practice is part of a GP federation within the CCG. The federation offices are above the practice.

The practice has no branch surgeries but run two other practices in the CCG. It has a high proportion of patients who are non-English speaking or whose first language is not English and a higher than average younger population but a lower than average older population. The practice is in an area with a high deprivation weighting. The Indices of Multiple Deprivation score is two.

The practice is registered with the CQC to provide the regulated activities Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

The clinical staff at the practice was made up of 16 GPs overall (six were partners). There were two male GPs, a full time nurse practitioner and three health care assistants and a clinical pharmacist. There were vacancies for one nurse and a pharmacy technician. Two GPs were on maternity leave.

It is a teaching and training practice and at the time of the inspection there were three GP registrars (trainee GPs) working there. In addition, there was a practice manager and an administrative team of 16.

The practice reception and surgery opening hours were:

Monday : Morning - 8.00am – 1.00pm and Afternoon - 1.50pm to 8.00pm

Tuesday: Morning - 8.00am – 1.00pm and Afternoon - 1.50pm to 6.30pm

Wednesday: Morning - 8.00am – 1.00pm and Afternoon - 1.50pm to 8.00pm

Thursday: Morning - 8.00am – 1.00pm and Afternoon - 1.50pm to 7.00pm

Friday: Morning - 8.00am – 1.00pm and Afternoon - 1.50pm to 6.30pm

Saturday and Sunday: Closed

Extended appointments can be made on any day when the practice is open.

If the practice is closed there is a number patients can call to obtain the Out of Hours service contact details. This is also on the practice website.

The practice was previously inspected in February 2015. All domains were rated as good and this inspection was to ensure that the practice were maintaining standards.

Updated 10 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lawson Practice on 21 August 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 and the option to use a new online service (WebGP), to communicate with a GP.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• Staff were aware of current evidence based guidance, although did not use an assistant when fitting intra-uterine contraceptive devices (IUCDs).

• The practice had lower than average rates for breast, bowel and cervical cancer screening uptake but were taking action to address this.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment, although we found that the practice had a higher than average inadequate rate for cervical smear taking and were taking action to address this.
• The practice had a quality improvement programme although most audits were one cycle.
• The practice provided three clinics a week with an in-house Turkish or Kurdish speaking interpreter / advocate.

The areas where the provider should make improvement are:

• Review the programme of clinical audits to develop continuous cycle audits with improvement after each cycle.
• Review the training needs of staff who undertake cervical cancer screening.
• Review the low screening uptake for breast, bowel and cervical cancer and how targeting of patients can be improved.
• Review the need for an assistant to be present when fitting IUCDs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 October 2017

The practice is rated as good for the care of people with long-term conditions.

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

• The practice was comparable to other practices in relation to their diabetes indicators.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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 10 October 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for premature babies and their families following discharge from hospital. For example with follow up home visits and close liaison with midwives and health visitors.

  Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 10 October 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• All patients have a named GP.

• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the multi-disciplinary team (practice staff, community nurses, psychiatry, clinical pharmacist).

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example information about diet, well-being, long term conditions.

Updated 10 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours. They also provided Saturday appointments for a travel health service at one of their other practices.

• 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.

Updated 10 October 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, a named doctor, regular liaison meetings with psychiatry and psychological services with clinics held at the surgery to facilitate close working, a depression register with bi-annual reviews and 78% of patients with severe mental health problems received an annual physical health check in the last QOF year.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice was comparable to other practices across all of their mental health indicators.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 October 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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.