Archived: The Old Church Surgery

Updated 21 January 2016

The Old Church Surgery is located in a residential area of East London within an adapted house. The practice held a General Medical Services (GMS) contract and provided services to 4411 patients. The practice’s registered population was higher than the national average for patients aged over 85 years.

The practice has two GP partners, one male and one female, one female nurse practitioner, one female nurse, one practice manager and six reception/administration staff. The practice was a training practice.

The practice is open between 8:00am and 6:30pm Monday to Friday. Morning appointments are from 8:30am to 12pm on Monday, 7:30am to 11:00am on Tuesday and Friday, 8:30am to 11:00am on Wednesday and Thursday. Afternoon appointments are from 4:00pm and 6:00pm, with the exception of Wednesdays when the practice closed for administration work to be completed at 1:00pm. Extended hours are on a Monday from 6:30pm and 8:00pm. The practice is closed between 12:30pm and 1:30pm each day, however the phone lines remain open during this period.

When the practice is closed, patients are advised to contact the out of hours provider whom the practice has a contact with which has been agreed by NHS England.

The Old Church Surgery operates regulated activities from one location and is registered with the Care Quality Commission to provide family planning, treatment of disease, disorder and injury, diagnostic and screening procedures and maternity and midwifery services.

Updated 21 January 2016

We carried out an announced comprehensive inspection at The Old Church Surgery on 8 October 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• Risks to patients were assessed and well managed.
• The practice worked closely with other organisations and the local community in planning how services were provided to ensure that they meet people’s needs.
• The practice implemented suggestions for improvements and made changes to the way that it delivered services as a consequence of feedback from patients and from the Patient Participation Group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.
• The practice had a clear vision, which had quality and safety as a top priority. A business continuity plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• There was a clear leadership structure and staff felt supported by management.
• There was a system in place to reduce risks to patient safety for example, infection control procedures.
• The practice made good use of audits and had shared information from their audits with other practices to promote better patient outcomes.

We saw one area of outstanding practice:

The practice had a strong focus on Carers and increased its number of Carers from five to thirty five by working alongside Waltham Forest Carers to develop a Carers Pack and template, which has been adopted by local practices.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure that a face to face patient participation group is set up and regular meetings held rather than just a virtual group to enable a wider range of patients to become involved.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 January 2016

The practice is rated as good for the care of people with long-term conditions. These patients had structured annual reviews or six monthly reviews if their condition was not well controlled to check their health and medication needs were being met. Nursing staff had key roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP. For those people with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 21 January 2016

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 had priority access to appointments. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors and school nurses.

Updated 21 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, admissions avoidance and dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments and longer appointments for those with enhanced needs. The practice introduced phlebotomy clinics as a result of patient feedback suggesting that elderly patients preferred to have their bloods taken in the practice rather than an external clinic.

The practice had a strong focus on Carers and worked alongside Waltham Forest Carers to develop a Carers pack and template, which had been adopted by local practices. The practice had dedicated pages on their website for carers, providing them with information and support. Carer identification was a standing agenda item on both the practice’s palliative care and integrated care monthly meetings. The practice increased its number of carers from five to thirty five.

Updated 21 January 2016

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 offered extended hours three times a week, with both early morning and late evening appointments; there was online access to appointments and prescriptions. Telephone consultations were used for patients who were unable to attend the practice and the practice worked alongside a network of Chingford practices to offer patients appointments on Saturday and Sunday. The practice offered a full range of health promotion and screening that reflects the needs for this age group.

Updated 21 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Ninety three percent of people experiencing poor mental health had received an agreed care plan, and the practice regularly worked with multi-disciplinary teams in the case management of these patients.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 21 January 2016

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 and those with a learning disability. It had carried out annual health checks for people with a learning disability and offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Leaflets were available to provide patients with information about how to access various support groups and 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.