Archived: East Ham Medical Centre

Updated 3 November 2016

The East Ham Medical Centre is situated within NHS Newham Clinical Commissioning Group (CCG). The practice provides services to approximately 2,400 patients under a General Medical Services (GMS) contract. The practice provides a range of enhanced services including child and travel immunisations, Intrauterine Contraceptive Device (IUCD) fitting, and Diabetes Management. It is registered with the Care Quality Commission to carry on the regulated activities of Maternity and midwifery services, Family planning services, Treatment of disease, disorder or injury, and Diagnostic and screening procedures.

The staff team at the practice includes two GP partners (one female working nine sessions per week and one male working two sessions per week), a female practice nurse working six hours over two sessions per week, a newly recruited medical secretary working 34 hours per week and two reception staff (one working eight hours and the other 20 hours per week). The practice manager had left in December 2015 and a medical secretary/ health care assistant in April 2016 and the practice was in the process of recruiting replacement staff including additional practice nursing cover.

Access information we received from the practice was conflicting, including with the practice opening hour’s information slip for patients. We checked with the practice and have used the latest information received directly from them for the purposes of this report. The practice's core opening hours are from 9:00am to 1.00pm every weekday. Afternoon opening was from 4.30pm to 6.30pm Monday and Friday and 2.30pm to 6.30pm every Tuesday and Wednesday, the practice closes after morning surgery on Thursday. GP appointments are from 10:20am to 12.10pm every weekday morning. Afternoon appointments are from 4.30pm to 6.00pm Monday and Friday, 2.30pm to 6.00pm every Tuesday and Wednesday. The practice does not offer on-site extended hours; however, off site extended hours were offered every weekday until 9.30pm and on Saturday from 9.00am to 1.00pm through a network of local practices.

Patients telephoning when the practice is closed are transferred automatically to the local Newham GP Co-op out-of-hours service provider. Appointments include pre-bookable appointments, home visits, telephone consultations and urgent appointments for patients who need them.

The practice's location has a higher percentage than national average of people whose working status is unemployed (15% compared to 5% nationally), and a lower percentage of people over 65 years of age (5% compared to 17% nationally). The average life expectancy for the practice is 80 years for males (compared to 77 years within the Clinical Commissioning Group and 79 years nationally), and 82 years for females (compared to 82 years within the Clinical Commissioning Group and 83 years nationally).

We had inspected the provider on 4 February 2014 under the previous regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009 in response to concerns that one or more of the essential standards of quality and safety were not being met, and it was found be meeting all standards of quality and safety. The previous report can be found at the following link –

http://www.cqc.org.uk/sites/default/files/old_reports/1-542884805_East_Ham_Medical_Centre_INS1-1213869776_Responsive_-_Concerning_Info_04-03-2014.pdf 

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at East Ham Medical Centre on 31 May 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because a non-clinical staff member was actioning patients’ laboratory test results that were not reviewed by GPs or clinical staff.
• Systems and processes were not in place to keep patients safe. For example there was no health and safety risk assessment, fire safety risk assessment or guidance for action in the event of a fire.
• The defibrillator did not work and emergency use oxygen cylinders had either expired or were too big to move.
• The practice had not carried out safety testing of non-clinical electrical equipment and clinical equipment had no cleaning schedule in place.
• The practice had a number of policies and procedures to govern activity, but some were missing and others were insufficient or had not been implemented such as recruitment, control of substances hazardous to health (COSHH), chaperoning and induction.
• Staff understood their responsibilities to raise concerns. However, reporting systems had weaknesses and reviews and investigations had not occurred. Patients did not always receive an apology and there was no evidence of learning and communication with staff.
• Staff did not have access to current evidence based guidance or safety alerts and had not been trained to provide them with the skills, knowledge and experience to deliver safe and effective care and treatment.
• The practice had not learned lessons to make improvements following significant events or complaints because the reporting and investigation system was ineffective.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had no clear leadership and management structure, insufficient leadership knowledge and skill and limited formal governance arrangements.

The partnership that made the provider dissolved on 1 September 2016 and no longer exists. The current provider is in the process of applying to register with the CQC.

At the time of our inspection the provider was found to be in breach of Regulations 12 (Safe care and treatment), 16 Receiving and acting on complaints, 17 (Good governance), 18 (Staffing), and 19 (Fit and proper persons employed) of the Health and Social Care Act (Regulated Activities) Regulations 2014

If the provider was still registered the areas we would have set out the following list of how the provider must make improvements:

• Ensure appropriate staff qualifications, training and support and implement all necessary employment checks for all staff.
• Implement effective systems for receiving and managing complaints and seeking and recording patients consent.
• Establish systems and processes to identify and mitigate risks to patient’s safety including medicines, equipment , infection control and in the event of a medical emergency.
• Implement effective systems and processes to assess, monitor and improve quality.
• Ensure there is leadership knowledge and skill to deliver all improvements.

And the following list of areas where the provider should make improvements:

• Take action to address patient dissatisfaction indicated by the GP patient survey results and seek to improve identification of patients that are carers.
• Make arrangements to ensure appropriate monitoring of prescription pads.
• Improve information on the practice leaflet and review patients’ access to appointments.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 November 2016

The provider was rated as inadequate for safety, effectiveness, caring, responsiveness and for well-led. The issues identified as inadequate overall affected all patients including this population group.

• Longer appointments and home visits were available when needed. However, not all these patients had a personalised care plan to check that their health and care needs were being met.
• The practice could not evidence training for staff reviewing patients with long-term conditions.
• The practice did not have effective systems for information sharing and working in partnership with allied health and social care professionals.
• The practice could not demonstrate it assessed needs and delivered care in line with relevant and current evidence based standards.
• Performance for diabetes related indicators was 92% compared to CCG and national averages (CCG average 87%, national average of 89%)
• The percentage of patients with hypertension having regular blood pressure tests was 95% compared to the CCG and national averages of 84%

Updated 3 November 2016

The provider was rated as inadequate for safety, effectiveness, caring, responsiveness and for well-led. The issues identified as inadequate overall affected all patients including this population group.

• Arrangements to safeguard children were not robust and there was no child protection register.
• Non-clinical staff had not received training on safeguarding children and there was no evidence of safeguarding training for the practice nurse.
• 95% of patients diagnosed with asthma, on the register had an asthma review in the last 12 months compared to 78% within the CCG and 75% nationally.

• Childhood immunisation rates for the vaccinations given were comparable to CCG averages.
• Appointments were available outside of school hours.

Updated 3 November 2016

The provider was rated as inadequate for safety, effectiveness, caring, responsiveness and for well-led. The issues identified as inadequate overall affected all patients including this population group.

• The practice identified 50 patients that were at risk of unplanned admission into hospital such as frail elderly patients, but patients were removed from this list after six months and there was no method of follow up to ensure their wellbeing. 
• There was a register of patients over 75 years old and these patients were followed up by GPs for an annual health check.
• The practice did not have effective systems for information sharing and working in partnership with allied health and social care professionals.
• The practice could not demonstrate it assessed needs and delivered care in line with relevant and current evidence based standards.
• The percentage of patients with rheumatoid arthritis, on the register, who had had a face-to-face annual review in the preceding 12 months was 100% which is similar to 91% within the CCG and 91% nationally.

Updated 3 November 2016

The provider was rated as inadequate for safety, effectiveness, caring, responsiveness and for well-led. The issues identified as inadequate overall affected all patients including this population group.

• The age profile of patients at the practice was mainly those of working age, students and the recently retired but the services available did not fully reflect the needs of this group.
• The practice did not offer extended opening hours and it had had no website.
• The practice offered health promotion and screening that reflects the needs for this age group.
• The practice could not demonstrate it assessed needs and delivered care in line with relevant and current evidence based standards.

Updated 3 November 2016

The provider was rated as inadequate for safety, effectiveness, caring, responsiveness and for well-led. The issues identified as inadequate overall affected all patients including this population group.

• Non-clinical staff had not received training on vulnerable adults and there was no evidence of safeguarding training for the practice nurse.
• Policies were accessible to all staff but staff were unclear about who the safeguarding lead was.
• The practice could not demonstrate it assessed needs and delivered care in line with relevant and current evidence based standards.
• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 87% and the national average of 84%.
• Performance for mental health related indicators was 87%, which was comparable to the CCG average at 87% and the national average of 93%.
• The practice could not evidence outcomes of multidisciplinary (MDT) meetings with allied health and social care professionals to understand and meet the range and complexity of patients’ needs for ongoing care.

Updated 3 November 2016

The provider was rated as inadequate for safety, effectiveness, caring, responsiveness and for well-led. The issues identified as inadequate overall affected all patients including this population group.

• Staff knew how to recognise signs of abuse in vulnerable adults and children but had not been trained in safeguarding.
• Staff were aware of their responsibilities regarding information sharing but the designated safeguarding lead was unclear.
• The practice held a register of patients with a learning disability.
• Results from the national GP patient survey published in January 2016 were significantly lower for scores impacting on vulnerable people. 57% said the GP was good at listening to them, compared to the CCG average of 83% and national average of 89%.
• 65% said the GP gave them enough time (CCG average 80%, national average 87%).
• 58% said the last GP they spoke to was good at treating them with care and concern (CCG average 76%, national average 85%).