Archived: Dr Mathew K L Chang Also known as Stratford Health Centre

Updated 8 May 2017

Stratford Health Centre is located in, East London. Dr Anil Shah had recently taken over as lead GP in December 2016 following the retirement of Dr Matthew Chang. The practice was located in an old cinema building on one of the main streets in Stratford. The building was modified to provide suitable accommodation for a GP surgery. The practice was part of the Newham Clinical Commissioning Group (CCG).

The practice provides primary care services to 6600 patients. 33% of patients on the list were aged 18 or younger compared with the national average of 21%. The number of people over the age of 65 was 4.2% compared to the national average of 17%. The majority of the practices patients were aged 20 to 44 years of age. The proportion of elderly and children and young people aged 0-19 was less than the England average.

There is one full time lead GP, five long term locums and one salaried GP. There are three male and two female GPs. There are three part time practice nurses, a nurse practitioner and two healthcare assistants. The practice has appointed two salaried GPs who will be joining the practice early in 2017.

The lead GP was retiring and there had been uncertainly about who would be leading the practice. The new lead GP was announced announcement a few weeks before our inspection. Staff had been updating the practice’s policies, which reflected the change.

The practice is not a training or teaching practice for GPs but provides training for practice nurses.

The practice is open from 8.30am until 6.30pm each day from Monday to Friday and from 12.30pm until 3.00pm on Saturdays. Appointments were available from 8.30am until 6.30pm

Updated 8 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stratford Health Centre on 15 December 2016.  Overall, the practice is rated as good.

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

• The practice analysed any incidents which occurred and identified the lessons learned.

• The practice participated in a monthly multi-disciplinary team meeting (MDT) pilot in Newham CCG. Colleagues from community services met with staff from the practice to discuss patients with multiple comorbidities and recurrent hospital admissions.

• The practice’s computer system highlighted when a child was on the child protection register.

• The information needed to plan and deliver care and treatment was available to relevant staff in a timely and accessible way through the practice’s patient record system and their intranet system.

• The practice had adopted Patient Group Directions (PGDs) to allow nurses to administer medicines in line with legislation.

• The practice carried out appropriate recruitment checks for staff prior to employment.

• Staff had received chaperone training and we saw posters in the waiting area informing patients that they could ask for a chaperone. All staff within the practice had received checks with the Disclosure and Barring service.

• The practice offered appointments each day Monday to Friday from 8.30am until 6.30pm in the evening. The last three appointments were kept for families to access appointments after school and for patients who worked. The practice was open on Saturday afternoons for patients who were unable to attend during the week.

• The practice worked with the Patient Participation Group to develop the practice.

The areas where the provider should make improvement are:

• Ensure the recommendations from the 2014 infection control audit are all fully implemented.

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

• The practice should keep written records of verbal as well as written complaints

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 May 2017

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

• The practice manager, nurses and healthcare assistants managed the chronic disease registers and patient recall process.

• There were longer appointments for reviewing patients with long term conditions.

• Patients were usually reviewed every six months to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with community nurses and social care colleagues to provide multidisciplinary care.

• The practice contributed to a quality improvement programme developed by the CCG which increased the range and level of monitoring for patients with long term conditions. The programme also supported patients to manage their own care for example diabetic self monitoring blood glucose testing strips.

Updated 8 May 2017

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

• Young people who were unable to attend during practice opening hours were able to access evening and weekend booked appointment service through GP Cooperative.

• The practice provided same day consultation for children and families. Children were given priority appointments in evening clinics after school.

• The practice provided antenatal and postnatal care and contraceptive services.

• Mothers were able to feed their baby in a room within the practice.

• Young people were offered contraception advice and were referred to sexual health clinics

• Chlamydia screening was available.

• The practice worked with the local with the local health visiting team to ensure children’s vaccinations were up to date. The practice’s uptake for the cervical screening programme was 81%, which was the same as the CCG average of 81% and the national average of 82%. 

• Childhood immunisation rates were below the national standard of 90% for three out of four vaccinations for two year olds. The number of children who had received the second dose of their measles, mumps and rubella vaccination at the age of five was 81% compared with 77% in the CCG and 88% nationally.

Updated 8 May 2017

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

• The practice monitored the health of older patients to prevent and detect any health problems such as visual impairment, hearing, mobility, memory or cardiovascular problems.  Health checks for the over 75s were offered together with flu vaccinations.

• There was a register for carers and the practice organised quarterly carers meetings.  Carers were offered flu and other vaccinations.

• High risk patients who were discharged from hospital were followed up to avoid further admissions and cared for alongside community colleagues according to an agreed care plan.  

• Social needs were identified and discussed with colleagues from the community and social services multi disciplinary meetings if necessary.

• The practice developed end of life care plans with patients and their families. These were put in place and recorded on the practice’s clinical system. Information about patient’s end of life plans were shared for example with the ambulance service

Updated 8 May 2017

The practice is rated as good for the care of working age people

• The practice was aware of the needs of the working age population and had adjusted the services provided to ensure patients could access care when they needed it.

• Patients could book an appointment on Saturday afternoons if they found it difficult to attend during the working week.

• The practice was aware of the needs of the working age population and had adjusted the services provided to ensure patients could access care when they needed it.

• Patients could also book online appointments and had access to online prescriptions

• Appointment slots at the end of the day were held for patients who worked during the day and needed an urgent appointment.

• The practice provided a full range of health promotion and screening, to meet the needs for this age group.

Updated 8 May 2017

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

• Patients experiencing poor mental health had their physical health needs reviewed annually.

• Practice staff worked closely with the local community mental health team to access advice and support for patients

• Patients with mental health conditions were referred to adult psychological therapies (IAPT services for counselling or cognitive behaviour therapy. 

• Practice staff discussed referred patients with the community mental health team during practice meetings to identify any deterioration and discuss appropriate management and referral for specialist intervention.

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable with the CCG average of 87% and the national average of 84%.   The percentage of patients with a mental health condition who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 57% compared with 84% in the CCG and 88% nationally.

• 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 informed patients experiencing poor mental health about how to access support groups and voluntary organisations.

Updated 8 May 2017

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

• Patients with a learning disability were invited for an annual health check.

• Staff were trained to identify safeguarding concerns and report these to the safeguarding authorities.

• The practice organised interpreters for patients who did not have English as their first language.  

• Carers’ details were recorded on the practice system to ensure they were offered for flu vaccinations and other support.

• The practice met monthly with other health and social care professionals in the case management of vulnerable patients