Archived: Dr Ezekiel Alawale Also known as Lenton Medical Centre

Updated 29 November 2016

Dr Ezekiel Alawale’s practice is also known as Lenton Medical Centre and is run by a single handed GP (male). The practice is part of the NHS Nottingham City clinical commissioning group (CCG) and the practice holds a personal medical services (PMS) contract. PMS contracts are locally agreed between the CCG or NHS England and a GP practice. The practice is also contracted to provide a number of enhanced services, which aim to provide patients with greater access to care and treatment on site.

Dr Ezekiel Alawale is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures and treatment of disease, disorder or injury.

The practice had a patient list size of 2144 at the time of inspection. The practice population is culturally diverse with a significant proportion of patients from black and minority ethnic groups. This includes patients from Asian, African and Eastern European backgrounds. The common languages spoken are English, Urdu and Punjabi. Patients have access to interpreters and some staff are bi-lingual. The level of deprivation within the practice population is above the national average (fourth most deprived decile).

The GP is supported by a part-time nurse, healthcare assistant and two part time-locum nurses. The non-clinical team comprises of the practice manager, an assistant practice manager and three receptionists. The health care assistant and the assistant practice manager also undertake reception duties. Dr Ezekiel Alawale is a teaching practice facilitating learning opportunities for medical students in year one and two. At the time of our inspection there were no students.

The practice is open from: 8.30am to 6.30pm on Monday, Tuesday, Wednesday and Friday; and 8.30am to 1.30pm on Thursdays. Extended opening hours are available on Tuesday evenings between 6.30pm and 7.30pm; and 8.30am to 12.30pm on Saturday.

The out of hour’s service is provided by Nottingham Emergency Medical Services and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

We previously inspected Dr Ezekiel Alawale’s practice on:

• 13 November 2013 based on the outcome based methodology and all five standards inspected were found compliant.

• 20 and 22 October 2015 based on the new general practice inspection methodology. The practice was awarded an overall rating of inadequate and placed in special measures in March 2016 for a period of six months.

Updated 29 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Dr Ezekiel Alawale on 15 September 2016. Overall the practice is rated as good.

We found improvements had been made since the previous inspection of October 2015 when the practice had been rated as inadequate and was placed into Special Measures.

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

• Significant improvements had been made to the systems and processes in place which were highlighted following our October 2015 inspection. This included arrangements for delivering safe care and treatment, staffing and improved governance.
• There was an open and transparent approach to safety and an effective system in place for reporting, recording and analysing significant events.
• Risks to patients were assessed and mostly well managed through an on-going review programme to ensure patients and staff were kept safe. This included recruitment checks, health and safety, and medicines management.
• However, a notice of deficiencies had been issued by the Nottinghamshire fire and rescue service in respect of fire safety contraventions found following their March and June 2016 visits; and a remedial notice had also been issued by the Nottingham City Clinical Commissioning Group (CCG). The two agencies will follow-up compliance in line with their enforcement framework and contractual agreements respectively. The practice had agreed to voluntary restrictions which included all patient and staff activities being undertaken on the ground floor.
• Staff delivered care and treatment in line with evidence based guidance and local guidelines. The use of clinical audits contributed to improved patient care and outcomes.
• The practice could demonstrate that they had made significant improvement in the Quality Outcomes Framework achievement because they had strengthened their recall system for inviting patients for health reviews.
• Staff were supported with an induction, training, appraisal and supervision to cover the scope of their roles and meet their professional development needs.
• The care of patients with complex health needs and / or living in vulnerable circumstances was co-ordinated with the wider multi-disciplinary team to deliver an integrated and responsive service.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available and easy to understand.
• There was a clear leadership structure and staff felt supported by management.
• Governance and performance management arrangements had been proactively reviewed to ensure improvements were sustained. This included the management of records, implementation of policies, administration of the practice and monitoring the overall service provision.

The areas where the provider must make improvement are:

• Ensure fire safety measures continue to be regularly reviewed and embedded to demonstrate compliance with the fire safety regulations.

The areas where the provider should make improvement are:

• The practice should continue to make efforts to identify and support carers within their patient population (including carers from black and ethnic minority community).

• Ensure clear guidance is shared with staff regarding procedures for disposing uncollected prescriptions and the GP has clinical oversight to enable the monitoring of patients’ compliance with prescribed medicines

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 November 2016

The practice is rated as good for the care of people with long-term conditions.

• The 2015/16 data supplied by the practice showed improved performance for clinical indicators related to long term conditions such as diabetes, coronary heart disease, and vital checks for cholesterol and blood pressure. This data had not been externally verified and published.

• Recall systems had been strengthened to ensure patients attended for their health reviews or were followed up if they did not attend.

• The GP had the lead role in chronic disease management and they worked with multi-disciplinary teams (including specialist nurses) to offer integrated care for patients with most complex needs.

• Patients at high risk of hospital admission were identified, their health needs were reviewed and care plans were put in place to support them in the community.

• Longer appointments and home visits were available when needed to ensure the health and medicines needs of patients were met.

Updated 29 November 2016

The practice is rated as good for the care of families, children and young people.

• Immunisation rates were relatively high for all standard childhood immunisations when compared to the local averages.

• The practice worked with health visitors to follow up children who did not attend for immunisations and those at risk of abuse or deteriorating health.

• A range of flexible appointments were offered for this population group. This included same day appointments for children under the age of five, urgent appointments to accommodate children who were unwell and appointments outside of school hours.

• Staff had a good understanding of safeguarding children and families; and a range of information was available for patients including support for victims experiencing domestic violence.

• The GP undertook an audit of children and young people with a high number of accident and emergency (A&E) attendances. Follow-up action including review of patient’s health needs had taken place with evidence of reduced attendances.

Updated 29 November 2016

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

• Patients aged 75 years and over had a named GP to provide continuity of care.

• Influenza, pneumococcal and shingles vaccinations were offered in accordance with national guidance.

• The practice offered personalised care to meet the needs of older people. This included booking hospital transport and / or appointments, as well as supporting patients whose first language was not English with understanding information related to their care.

• The practice offered good access for older people and this included same day appointments and home visits for urgent medical needs and / or routine health reviews.

• The practice staff worked effectively with multi-disciplinary teams to identify patients at risk of hospital admission, deteriorating health needs and social isolation to ensure their needs were met. This included joint working arrangements with the care coordinator, social workers, the community matron and district nurses.

• Practice supplied data for 2015/16 (yet to be externally verified and published) showed patient outcomes for conditions commonly found in older people had improved or had been maintained since our October 2015 inspection. This included management of osteoporosis, heart failure and rheumatoid arthritis.

• Care and treatment of older people reflected current evidence-based practice. For example the “falls and bones” specialist nurse facilitated a monthly clinic at the practice. Patients at risk of osteoporosis were identified and referred to secondary care for further examinations.

Updated 29 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered online services and this included booking appointments, ordering of repeat prescriptions and access to summarised care records.

• The practice also offered the electronic prescribing service (EPS) which enabled the GP to send prescriptions electronically to a pharmacy of the patient’s choice.

• Text messaging was used to confirm and cancel appointments, issue reminders and share health promotion information.

• Telephone consultations were offered and extended hours services were offered one evening per week (6.30pm to 7.30pm on a Tuesday) and on a Saturday morning (8.30am to 12.30pm) to facilitate appointments for working age patients.

• A range of health promotion literature and screening that reflects the needs for this age group was accessible to patients. This included travel vaccinations, advice on weight management, smoking cessation and NHS health checks.

• Significant efforts had been made by the practice team to promote national cancer screening programmes despite low uptake rates by patients. The practice supplied data for 2015/16 showed the uptake for the cervical screening programme in the last five years was 80%. This data was yet to be verified externally and published.

Updated 29 November 2016

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

• Staff had a good understanding of how to support patients with mental health needs and dementia; and had completed relevant training.

Practice supplied data for 2015/16 showed:

• Five out of six patients (83%) diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was an 8% increase compared to the 2014/15 published data which reflected a 75% achievement.

• Nine out of ten people (90%) experiencing poor mental health had received an annual physical health check and had a care plan in place. This was a 51.5% increase compared to the 2014/15 published data which reflected a 38.5% achievement.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. This included the crisis and home treatment team, early psychosis treatment team and referrals were made to services offering talking therapies and counselling

• Resources about how to access various support groups and voluntary organisations were available for patients experiencing poor mental health and dementia.

• 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.

Updated 29 November 2016

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, staff liaised with the multi-disciplinary team to ensure vulnerable patients had the appropriate health and social care support in place and appropriate referrals were made to other organisations.

• The practice held a register of patients living in vulnerable circumstances including those patients receiving end of life care and patients with a learning disability.

• Six out of 10 eligible patients with a learning disability had received their health check in the last 12 months; and care plans were in place.

• The practice offered longer appointments for the review of patient’s health needs with their carer.

• The practice had identified 1% of the practice list as carers and informed them about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. They were also aware of their duty to report safeguarding concerns to the GP safeguarding lead and / or external agencies to ensure patients were protected from further abuse.