E7 Health

Updated 6 June 2017

The Leytonstone Medical Centre works closely together and shares management and HR teams with two further practices (i) The Stratford Village Surgery, 50C Romford Road, London, E15 4BZ, and (ii) E12 Health, 1st Floor, The Centre, 30 Church Road, London, E12 6AQ. 

All three practices operate as part of the First 4 Health Group http://www.first4healthgroup.co.uk/ and are situated within the NHS Newham Clinical Commissioning Group. They have separate lists of patients and are registered as separate locations with the Care Quality Commission. 

The Leytonstone Medical Centre holds a General Medical Services contract (General Medical Services agreements are locally agreed contracts between NHS England and a GP practice). It provides a full range of enhanced services to approximately 4,000 patients including avoiding patients’ unplanned admissions into hospital, immunisations, and child immunisations. It is registered with the Care Quality Commission to carry on the regulated activities of Maternity and midwifery services, Family planning services, Treatment of disease, disorder or injury, and Diagnostic and screening procedures.

The staff team at the practice includes recently appointed Local Medical Director who provides clinical leadership at the practice (providing 6 sessions per week), two salaried GPs (one part time female GP providing four sessions per week and one part time male GP providing three sessions per week), two part time practice nurses (one female working nine hours and one male working six hours per week), two part time health care assistants (one working 20 hours and the other working six hours per week), an operations manager, and a team of administrative staff (working a mix of part time hours). The Leytonstone Road Medical Centre rarely uses locum GPs because the team of GPs mostly cover absences themselves. 

The practice is open from 8.30am 6.30pm every weekday and phone lines are open all day from 9.00am to 6.00pm, except Thursdays which is a half day when the practice closes at 1.00pm. Outside these hours patient calls are automatically transferred to the Newham GP CO-OP service. The practice also offers extended opening through a hub network of 22 local practices every weekday until 9.30pm and from 9.00am until 12.30pm on Saturdays. The practice has developed its IT systems to provide online and digital services for patients via an app. It is part of a hub of practices providing integrated extended hours access for patients in Newham. The practice offices are mostly paperless.  Appointments at the Leytonstone Road Medical Centre are available from 9.00am until 5.50pm every weekday except Thursday including home visits and telephone appointments. Pre-bookable appointments are available including online in advance and urgent appointments for people that need them. Patients telephoning for an out of hours appointment are directed to the deputising service when both the Leytonstone Road Medical Centre and Stratford Village Surgeries are closed.

The practice is located in one of the most deprived and diverse areas in England, it has a lower percentage than the national average of people aged over 65 years (8% compared to 17%) and a has the same percentage than the national average of people whose working status is unemployed (4%).

Updated 6 June 2017

Letter from the Chief Inspector of General Practice

The practice is rated good overall and good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 26 January 2016. The overall rating for the practice was good. However, a breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us evidence and actions detailing what they would do to meet the legal requirements. We conducted a focused inspection on 4 May 2017 to check that the provider had followed their plans and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 22 January 2016 we found the following area where the practice must improve:

• Ensure  recruitment  arrangements  include  all  necessar y pre-employment  checks  for  all  staff.

Our previous report also highlighted the following areas where the practice should improve:

• Carry out further clinical audits and re-audits to improve the quality of patient outcomes.
• Implement a system to monitor use of prescription pads. 
• Ensure Patient Group Directives (PGDs) and Patient Specific Directives (PSDs) are consistently authorised.
• Ensure all staff receive annual (BLS) training in Basic Life Support.
• Ensure Legionella water testing is carried out regularly and regular fire drills are undertaken. 

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 4 May 2017 we found:

• Arrangements were in place include  all necessary  pre-employment  checks  for  all  staff.
• The practice had undertaken several completed audits that improved patient outcomes.
• Effective systems were in place to monitor the use of prescription pads.
• All staff had received annual Basic Life Support (BLS) training.
• Staff had conducted  regular fire drills and Legionella water testing had been undertaken.

​ ​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 May 2016

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.
• The practice had identified 7% of its patients had diabetes. Performance for diabetes related indicators was 71% overall , which was below the CCG average of 87% and the national average of 89%.The latest data showed that 86% of patients with diabetes on the register had recently been seen for a foot assessment, which was comparable to the national average of 88%.
• Records we reviewed showed that full annual reviews were carried out for patients with Chronic Obstructive Pulmonary Disease (COPD), asthma and diabetes.
• Longer appointments and home visits were available when needed.
• 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.

Updated 6 May 2016

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 were on the child protection register.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Sixty-nine per cent of patients diagnosed with asthma, on the register had an asthma review in the last 12 months which was comparable to 75% nationally.
• 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.
• Eighty per cent of women aged 25-64 had a cervical screening test within the last five years which was comparable to 82% nationally.
• Appointments were available outside of school hours through the extended hours hub of local practices and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice provided oral and injectable contraceptive services in-house. For other contraceptive services patients were signposted to local family planning clinics.

Updated 6 May 2016

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

• It offered proactive, personalised care to meet the needs of the older people in its population.
• The practice had identified 92 older patients at risk of avoidable unplanned admission to hospital that had an agreed care plan, which was 2.5% of patients on the register.
• The practice had a policy to contact all older patients at risk following either an A&E attendance or emergency admission to hospital.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 6 May 2016

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.
• The provider had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was very proactive in offering online services including via an app, as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 6 May 2016

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

• 89% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in which was comparable to the national average of 88%
• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses alcohol consumption had been recorded which is comparable to the national average of 90%
• 95% of patients with physical and/or mental health conditions had a recorded smoking status in the preceding 12 months which was comparable to the national average of 94%
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.

Updated 6 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• Non-registered vulnerable patients were seen immediately as necessary.
• Staff signposted vulnerable people to local support groups, voluntary organisations and locally available services such as a CCG commissioned transitional practice for homeless people and travellers, ten minutes’ walk from the surgery.
• 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.