Brick Lane Surgery

Updated 28 November 2017

Brick Lane Surgery is located in Enfield, North London and is part of the NHS Enfield Clinical Commissioning Group (CCG). It currently holds a General Medical Service (GMS) contract (an agreement between NHS England and general practices for delivering primary medical services). The practice provides a range of enhanced services including adult and child immunisations, proactive support for people living with dementia, and identifying patients who are at high risk of avoidable unplanned admissions.

The service is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services and the treatment of disease, disorder or injury.

The practice had a patient list of approximately 4050 at the time of our inspection. There are 1247 male and 2064 female patients. The average age is 41 years old and 31% are over the age of 50 years and 17% of patients over the age over 60.

The staff team at the practice includes two GP partners (one male and one female) who provide nine clinical sessions per week and one salaried GP (female) who provides two clinical sessions per week. There are two regular locum practice nurses (both female) who provide five clinical sessions per week, and one practice nurse (female) working two days per week in total. To support the practice and patients there are a team of six administrators; including a practice manager. All staff work a mix of part time hours. In addition, in May 2017, practice leads recruited a part time clinical pharmacist (four days a week) to work at the practice in order to support ongoing safe and effective prescribing and medicines management.

The practice opens between 8.00am and 6.30pm Monday to Fridays. This is to enable patients to access a GP in an emergency from 8.00am until 9.00am and from 6.00pm and 6.30pm. Patient consultations are as follows:

                        Morning                       Afternoon

Monday             9.00am – 12.30pm     3.30pm – 8.30pm (extended hours between 6.30pm – 8.30pm)

Tuesday            9.00am – 12.30pm     3.30pm - 6.00pm

Wednesday       9.00am – 12.30pm     3.30pm – 6.00pm

Thursday           9.00am – 12.30pm     3.30pm – 6.00pm

Friday                9.00am – 12.30pm      4.00pm – 6.00pm

Saturday Closed

Sunday Closed

The practice nurse is available between 10.00am and 1.00pm and 3.00pm and 6.00pm on Tuesdays and between 10.00am and 1.00pm and 3.00pm and 6.00pm on Wednesdays.

Urgent appointments are available each day and GPs also complete telephone consultations for patients. In addition, the practice is a member of the local federated GP’s network a federation of local Enfield GP practice’s which was set up locally to provide appointments for patients at local hub practice’s between 8am and 8pm; providing additional access out of hours. There is also an-out of hour’s service provided to cover the practice when it is closed. If patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on their circumstances. Information on the out-of-hours service is provided to patients via the practice website and practice leaflet as well as through posters at the practice.

Updated 28 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brick Lane Surgery on 27 September 2017. Overall the practice is rated as good.

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

• The practice had a safe track record of learning from significant events.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• 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. However, systems for managing complaints required review.
• 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.
• 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 areas where the provider should make improvement are:

• Increase the number of identified carers in order to better support patients in managing their care and treatment.

• Review the effectiveness of the practice’s complaints system for identifying , receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 November 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.

• Performance for diabetes related indicators was above the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood sugar level is 64 mmol/mol or less in the preceding 12 months was 82% compared to a local CCG average of 73% and a national average of 78%.

• 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 28 November 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.

• 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 28 November 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.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 28 November 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 and access to evening and weekend appointments via the local hub.

• 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.

• Health Screening including structured health checks for all newly registered patients. NHS health checks for patients age 40-74 years.

Updated 28 November 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.

• Performance for dementia related indicators were similar to the national average. Ninety five per cent of patients diagnosed with dementia had had their care reviewed in the preceding 12 months compared with a local CCG average of 84% and a national average of 79%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, prompt clinical assessment and investigation with early referral to memory clinic per local pathway.

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

• Performance for mental health related indicators were below the national average. For example: 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months compared with a local CCG average of 91% and a national average of 89%.

• 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 28 November 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.