4 August 2014
During a routine inspection
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.