Lower Clapton General Practice

Updated 10 April 2017

The Lower Clapton Group Practice is a teaching practice located in the London Borough of Hackney within the NHS Hackney Clinical Commissioning Group. The practice holds a General Medical Services contract (an agreement between NHS England and general practices for delivering primary care services to local communities). The practice provides a full range of enhanced services including childhood immunisation and vaccination, meningitis immunisation, alcohol support, dementia support, learning disabilities support, influenza and pneumococcal immunisations, rotavirus and shingles immunisation and unplanned admissions avoidance.

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

The practice had a patient list size of 12,459 at the time of our inspection. The practice had a higher proportion of people with a long standing health conditions than local average (48% compared to the CCG average of 45% and the national average of 54%). The practice serves a diverse community made up mostly of Turkish, Black, Asian and other non-white ethnic groups. The practice had a high proportion of young female patients. At 78 years, male life expectancy is in line with the CCG average of 78 years and the England average of 79 years. At 82 years, female life expectancy is in line with the CCG average of 82 years and the England average of 83 years.

The practice has fewer patients aged 60 years of age and older compared to an average GP practice in England. The percentage of patients under the age of 40 years of age is higher than the average GP practice in England. The surgery is based in an area with a deprivation score of two out of ten (one being the most deprived). Children and older people registered with the practice have a higher level of income deprivation compared to the local and national averages. Compared to the average GP practice in England, patients at this practice have a higher rate of unemployment.

The clinical team at the practice included six GP partners (five females and one male), eight salaried GPs (seven females and one male), three trainee GPs (two female and one male), four female practice nurses, three healthcare assistants (two female and one male) and one female clinical pharmacist. The non-clinical team at the practice one business manager and 21 administrative staff. There were 62 GP sessions available per week.

The practice is open between 8.00am and 6.45pm Monday to Friday. GP appointments are available Monday to Friday from 8.30am to 11.30am and 2.30pm to 5.30pm. Extended hours appointments are available every Monday and Thursday evening from 6.30pm to 8.00pm. The surgery is closed on Saturdays, Sundays and bank holidays. Urgent appointments are available each day and GPs also provide telephone consultations for patients. An out of hours service is provided for patients when the practice is closed. Information about the out of hours service is provided to patients through posters in the waiting area, on the practice website and the practice leaflet.

Updated 10 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lower Clapton Group Practice on 1 December, 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• Patients 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 provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice provided a frail home visiting (FHV) service visiting service where all housebound patients are visited a minimum of two visits per year, and an average of four visits per year is carried out across the whole house bound register. The purpose of this is to proactively identify physical, psychological and social needs so as to improve overall quality of life and reduce acute hospital attendances and admissions in this vulnerable group. There were 78 patients on the FHV register and over the last 12 months these proactive visits had resulted in in a total of 16 new clinical diagnoses.

The areas where the provider should make improvement are:

• Continue to take action to raise the level of patient satisfaction around contacting the practice by phone.

• Take action to ensure the complaints system is managed in a way that ensures complainants receive a written response in line with practice policy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 10 April 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.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months was 79% compared to the CCG average of 79% and the national average of 78%.

• 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.

• For patients with two or more long-term conditions, 30 minute ‘time to talk’ appointments were available as required.

Updated 10 April 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 81% compared to the CCG average of 81% and the national average of 82%.

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

• We saw positive examples of joint working with midwives and health visitors.

Updated 10 April 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.

• The practice provided a frail home visiting (FHV) service visiting service where all housebound patients are visited a minimum of two visits per year.

Updated 10 April 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 reflects the needs for this age group.

• Extended hours appointments were available until 8pm two evenings per week.

Updated 10 April 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, was 92% compared to the CCG average of 85% and the national average of 88%.

• 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 10 April 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.