Archived: Aldersbrook Medical Centre

Updated 1 March 2017

Aldersbrook Medical Centre provides primary medical services in Redbridge to approximately 3830 patients and is a member of NHS Redbridge Clinical Commissioning Group (CCG).

The practice population is in the fifth least deprived decile in England. It has less than CCG and national average representation of income deprived children. The practice had surveyed the ethnicity of the practice population and had determined that 65% of patients described themselves as white, 14% Asian, 2% black and 19% as having mixed or other ethnicity.

The practice operates from a converted residential property with all patient facilities on the ground floor that is wheelchair accessible. There are offices for administrative and management staff on the ground and first floors. Both floors are accessed via stairs.

The practice operates under an Alternative Provider Medical Services (APMS) contract (an APMS contract allows NHS England to contract with organisations to provide primary medical care services) and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract). The enhanced services it provides are: meningitis immunisation; alcohol brief intervention; facilitating timely diagnosis and support for people with dementia; influenza and pneumococcal immunisations; patient participation; rotavirus and shingles immunisation; and unplanned admissions.

The practice team at the surgery is made up of one full- time permanent male GP, and two part-time female locum GPs. The doctors provide 18 clinical sessions per week. The nursing team consists of one part-time female nurse prescriber, and one time female health care assistant. There are seven administrative, reception and clerical staff including a part-time practice manager.

The practice is open between 8.00am and 6.30pm Monday to Friday. Appointments are from 8.00am to 11.00am, and from 2.30pm to 6.30pm daily. Extended surgery hours are offered from 7.30am until 8.00am Monday to Wednesday and Friday. The practice does not open on a weekend. The practice belongs to a GP hub which has appointments until 10.00pm on weekdays, with weekend appointments also available. The practice has opted out of providing out of hours (OOH) services to their own patients when it is closed and directs patients to the OOH provider for NHS Redbridge CCG.

Aldersbrook Medical Centre is registered with the Care Quality Commission as part of Malling Health (UK) Limited to provide the regulated activities of maternity and midwifery services; diagnostic and screening procedures; treatment of disease, disorder or injury; surgical procedures; family planning.

This practice has not previously been inspected by CQC.

Updated 1 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Aldersbrook Medical Centre on 16 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Results of the national GP patient survey showed that the practice was performing below local and national averages in some areas.
• Some patients said they did not find it easy to make an appointment with a GP but there was continuity of care, with urgent appointments available the same day.
• The practice had identified less than 1% of patients as having caring responsibilities.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 sought feedback from staff and patients.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Continue to monitor and work to improve patient outcomes in QOF (Quality and Outcomes Framework) to improve patient outcomes.

• Review the cleaning arrangements of the practice to ensure they are sufficient to maintain appropriate standards of cleanliness and hygiene.

• Review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to all.

• Continue to take action to improve the availability of appointments in response to patient feedback.

• Display the practice mission statement so that staff and patients are aware of the practice’ overarching purpose.

• Monitor quality and outcomes framework (QOF) exception reporting and work to improve patient outcomes in QOF.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 March 2017

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.

• Performance for diabetes related indicators was similar to the national average. For example, 77% of patients with diabetes had well controlled blood sugar readings in the preceding 12 months compared to a CCG average of 70% and a national average of 78%.

• Longer appointments and home visits were available when needed.

• All these 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 1 March 2017

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 had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 79% and the national average of 82%.

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

Updated 1 March 2017

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

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

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

• If families had suffered bereavement, their usual GP contacted them to offer condolences and to signpost them to local support groups.

Updated 1 March 2017

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 had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Extended hours appointments were available four mornings a week for the benefit of patients who could not attend during working hours.

Updated 1 March 2017

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

• 75% of patients diagnosed with dementia had received a care review in a face-to-face review in the preceding 12 months which was below the CCG average of 83% and the national average of 84%.

  • Performance for mental health related indicators was varied in comparison to the national average. For example :

    • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan documented in their record, in the preceding 12 months, compared to a CCG average of 90% and a national average of 88%.

    • 75% of patients diagnosed with dementia had received a care review in a face-to-face review in the preceding 12 months compared to a CCG average of 83% and a national average of 84%.

    • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had had their alcohol consumption recorded in the preceding 12 months compared to a CCG average of 91% and a national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 1 March 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.

• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.