Archived: DMC Healthcare1

Updated 19 February 2015

DMC Healthcare group runs GP practices and walk-in centres in London and the south east of England. DMC Healthcare 1 is part of this group and is a GP surgery with four female salaried GPs including the lead clinician, pharmacist, junior pharmacist, nurse prescriber, practice nurse, and two healthcare assistants. It is located in a building shared with four other practices, walk in centre, pharmacy and other community healthcare facilities. One of the practices is another DMC Healthcare GP surgery and all the staff, facilities and equipment are shared with this practice.

DMC Healthcare 1 offers a number of services such as family planning and travel advice and immunisations. They hold several specialist clinics including smoking cessation and hypertension.

The practice provides primary care for over 1300 patients within the Stratford area of east London. The practice has 60% Asian and 40% black and minority ethnic patients who are predominantly female. Two thirds of the patients are over 40 years old.

DMC Healthcare 1 has opted out of providing out of hours services to their own patients.

Updated 19 February 2015

DMC Healthcare 1 provides primary medical care and a range of services including hypertension, diabetes, and child health and baby immunisations clinics to 1,300 people in the Stratford area of east London. It is open 9am to 6.30pm on Monday to Friday with the exception of Tuesday when the practice is open until 7.30pm. Outside of these times, an out of hour’s service is available run by Newham GP Cooperative.

The main concerns identified prior to the inspection were that there was a lower than average number of medication reviews for patients on repeat medicines and a national GP survey carried out by an independent organisation in 2013 noted that the practice was among the worst for being able to get through to the surgery by telephone.  A positive aspect was that GPs were better than average at explaining tests and treatments to patients.

We carried out an announced inspection on 4 August 2014. The inspection took place over one day and the inspection team comprised a CQC Lead Inspector, GP specialist advisor, CQC inspector, practice management specialist, and Expert by Experience.  Before the inspection we talked to Newham Clinical Commissioning Group (CCG) and three health professionals in the community who dealt with patients from the practice. We talked to three patients who belonged to the Patient Participation Group (PPG) at the practice. We reviewed information from patient surveys of the practice.

On the day of the inspection we observed staff talking to patients and spoke to three patients in the waiting area. We spoke to the practice manager, two GPs including the clinical lead, pharmacist, health care assistant and three reception/administration staff. We reviewed practice management and staff files, and 21 comment cards which patients had posted on the reception desk.

The practice shared equipment and staff with another GP practice situated within Vicarage Lane Health Centre. Some facilities were shared with other health services within the premises.

The provider was in breach of regulations related to:

• assessing and monitoring the quality of service provision
• management of medicines
• supporting workers

Care was planned and delivered effectively and patients underwent regular monitoring and medicines reviews when necessary. Clinical audits were carried out and information resulting from them used to improve patient outcomes. Staff worked with multidisciplinary teams to coordinate care for patients.

Patients were positive about their care and treatment and felt they were treated with dignity and respect by staff. They also felt staff involved them in their own care and explained things to them. However, the telephone system had been a problem for over five years and meant patients could not reasonably contact the practice by telephone. Patients often had to attend the surgery in person to make an appointment. Although staff had tried to resolve this issue with senior management there was no action plan, with timescales in place, to improve the situation.

Governance arrangements were clear and staff knew who was the responsible lead for each area. Most staff felt supported and able to develop although some staff felt undervalued. Not all staff had received training in safeguarding and basic life support.

We found the practice had safe systems in place for reporting and recording incidents. Staff understood their role and the processes for reporting incidents that affected patient’s safety. Learning and improvement had resulted from significant incidents. However, the emergency kit contained adrenaline which was out of date. 

Older People

The practice responded to the needs of older patients and those over the age of 75 had a named GP. Doctors worked with other healthcare professionals to coordinate care plans for older patients at risk of emergency hospital admissions.

People with long-term conditions

The practice supported patients with long term conditions. Dedicated clinics and annual reviews were available for patients with long term conditions.

Mothers, babies, children and young people

Regular child health surveillance clinics and maternity services were offered to this group of patients. Young patients under the age of 16 years were offered health checks.

The working-age population and those recently retired

The practice responded to the needs of working people by offering and appointments from 9am to 6.30pm on Mondays to Fridays with extended hours on a Tuesday evening until 7.30pm.

People in vulnerable circumstances who may have poor access to primary care

There were no barriers to accessing care for this group of patients. Clinical staff worked closely with other community services to support patients who misused drugs and alcohol.

People experiencing poor mental health

Doctors coordinated care of this group of patients with the Mental Health Community team which was located in the building. Patients with poor mental health had annual reviews and health checks.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework (QOF) data, this relates to the most recent information available to the CQC at that time.

Updated 19 February 2015

The practice supported patients with long term conditions. Dedicated clinics were available for patients with hypertension, asthma and diabetes. All patients with heart disease received an annual review and were offered a referral to health trainers for healthy lifestyle advice.

GPs used a risk tool for patients with long term conditions such as diabetes. Multidisciplinary team meetings with other community healthcare professionals were held throughout the year and doctors shared careplans to facilitate coordinated care for patients and prevent admissions to hospital.

Updated 19 February 2015

Child health surveillance clinics were held to monitor child development and administer vaccination and immunisations for new born babies, one year olds and pre-school children.

The child safeguarding lead attended safeguarding meetings with multidisciplinary teams to share information and improve the safety of vulnerable children. They used the practice database to highlight vulnerable children and their families so that all staff would have access to up to date information.

The practice had a teenager confidentiality policy and staff and recorded when they had assessed a patient under the terms of the Gillick competency. Under 16 year olds, who had not been into the practice recently, were regularly contacted to offer them a health check.

Updated 19 February 2015

The practice responded to the needs of older people. All patients over the age of 75 years had a named GP. We saw evidence that the practice worked with multidisciplinary teams to discuss strategies and care plans for older patients at risk of emergency hospital admissions. Older people who had not been in contact with the surgery recently were contacted to ask how the practice could help with their health needs. Home visits were offered to those who were housebound or too ill to attend the surgery.

Although there was a vulnerable adults’ policy and procedure in place, not all staff had received training in this area.

Updated 19 February 2015

The practice responded to the needs of working people by offering appointments from 9am to 6.30pm Monday to Friday with the exception of Tuesday night when the practice had appointments until 7.30pm. Patients found appointment times convenient. Patients could email the practice, but there was no online appointment booking. Repeat prescription requests were  available for those patients who found it difficult to access the practice by telephone or in person.

Patients were offered vascular risk assessments so that preventative measures could be taken for those found to be at high risk of developing cardiovascular disease (CVD).

Updated 19 February 2015

The practice responded to the needs of patients experiencing poor mental health. They had employed a pharmacist to help carrying out depression assessments on patients.

The GPs worked closely with the Mental Health Community team which was located in the building. Patients with poor mental health had annual reviews and health checks. Doctors monitored those patients who took lithium.

Updated 19 February 2015

There were no barriers to accessing the practice for patients such as those who were homeless or who did not have the correct information such as ID/proof of address in order to register as patients with the practice.

The pharmacist and GPs at the practice worked closely with the Newham Drug and Alcohol Service to support vulnerable patients such as those who misused drugs and alcohol.

Carers for vulnerable patients were registered on the database so that all staff had access to that information when a patient attended the practice. Staff were aware of the principles of the Mental Capacity Act 2005 and understood they needed to obtain patient consent.

Although there was a vulnerable adults policy and procedure in place not all staff had received training in the safeguarding of vulnerable adults.