Background to this inspection
Updated
14 January 2016
Dr Altafuddin Ahmed (also known as Newham Medical Centre) is located in Newham, East London. The practice has a patient list of approximately 5,500. Twenty one percent of patients are aged under 18 (compared to the national practice average of 14.8%) and 6.2% are 65 or older (compared to the national practice average of 17%). Fifty nine percent of patients have a long- standing health condition, whilst 16% have carer responsibilities.
The services provided by the practice include child health care, ante and post natal care, immunisations, sexual health and contraception advice and management of long term conditions.
The staff team comprises one male senior GP (9 sessions per week), male salaried GP (8 sessions per week), male salaried GP (6 sessions per week), female long term GP locum (3 sessions per week), male long term GP locum (1 session per week), two practice nurses (one female, one male), health care assistant (female), business manager, practice manager and administrative/reception staff.
The practice holds a Personal Medical Service (PMS) contract with NHS England. This is a locally agreed alternative to the standard General Medical Service (GMS) contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.
The practice’s opening hours are:
Appointments are available at the following times:
Extended hours opening was not provided at the practice but we were told that it worked with ten GP surgeries in the borough as part of an extended hours directed enhanced service; enabling patients to access extended hours appointments from these sites as follows:
Outside of these times, cover is provided by an out of hours provider.
The practice is registered to provide the following regulated activities which we inspected: treatment of disease, disorder or injury; diagnostic and screening procedures; family planning; and maternity and midwifery services.
CQC (Registration) Regulations 2009 require registration of all regulated activities carried on by the provider. During our visit we found that the provider had been carrying on the regulated activity of surgical procedures (namely joint injections, incisions and warts removal) without registration. The regulated activities that require registration with CQC are set out in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider must register for this regulated activity.
Updated
14 January 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Altafuddin Ahmed (also known as Newham Medical Centre) on 24 September 2015. Overall the practice is rated as good.
We inspected this location in August 2014 as part as part of our new inspection programme to test our approach going forward. We did not rate the practice at that time but identified concerns regarding significant events reporting, staff recruitment and systems for actioning blood test results.
The inspection which took place on 24 September 2015 was therefore a comprehensive inspection to check whether the provider was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.
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 the skills, knowledge and experience to deliver effective care and treatment.
- All the patients we spoke with told us said they were treated with compassion, dignity and respect; although this did not align with patient survey results at practice or national level. The practice demonstrated how it had acted on survey results which were below CCG and national averages regarding dignity and respect shown by staff.
- Information about services and how to complain was available and easy to understand.
- Some patients fed back that it was difficult to get through to the practice by phone and to make an appointment. The practice demonstrated how it had acted on these concerns (for example by recruiting more administrative staff to answer the phones at peak times and by recruiting two salaried GPs).
- 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:
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Review national patient survey results on the extent to which tests and treatments were explained and the extent to which patients were involved in decisions about their care and treatment; and see where improvements can be made as these results were below local and national averages.
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Review systems for ensuring that patients with a learning disability receive annual health reviews.
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Undertake a review of performance on dementia related indicators given that this area was below CCG and national averages.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
People with long term conditions
Updated
14 January 2016
The practice is rated as good for the care of people with long-term conditions.
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Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
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Performance for diabetes related indicators was 97.7% which was above the CCG average by 1.3% and below the national average by 1.2%.
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Longer appointments and home visits were available when needed.
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All patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
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Patients we spoke with from this population group were positive about the care they received.
Families, children and young people
Updated
14 January 2016
The practice is rated as good for the care of families, children and young people.
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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 for all standard childhood immunisations were comparable to local and national averages.
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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.
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The practice’s uptake for the cervical screening programme was 81% which was comparable to the national average.
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Appointments were available outside of school hours and the premises were suitable for children and babies.
Updated
14 January 2016
The practice is rated as good for the care of older people.
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A register of all patients over 75 was kept and they had a named GP.
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The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
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Patients we spoke with from this population group were positive about the care they received.
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Performance for dementia related indicators was 76.9% which was below the CCG average by 15% and below the national average by 16.5%.
Working age people (including those recently retired and students)
Updated
14 January 2016
The practice is rated as good for the care of working-age people (including those recently retired and students).
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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.
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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.
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Late evening and weekend appointments were offered.
People experiencing poor mental health (including people with dementia)
Updated
14 January 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
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73% percentage of patients diagnosed with dementia had had their care reviewed in a face-to-face review in the preceding 12 months
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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 with the 86% national average.
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The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
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The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
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It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
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Staff had a good understanding of how to support people with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
14 January 2016
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
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The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
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Twenty seven patients were on the practice’s list of patients with a learning disability but only one patient had had a health review in the last 12 months. We were told that all patients would be reviewed by March 2016.
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The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
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It had systems in place to refer vulnerable patients to support groups and voluntary organisations.
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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.