Archived: The Microfaculty Also known as Drs M E & S M Dadabhoy

Updated 26 September 2016

The Microfaculty Surgery provides GP primary care services to approximately 4600 people living in Chingford area of Waltham Forest. The local area is a mixed community and some of the practice population comes from relatively deprived backgrounds.

The practice is staffed by a lead GP and two salaried GPs, one male and two females, who work a combination of full and part time hours totalling 19 sessions per week. The practice was also a training practice and the lead GP was a qualified trainer. At the time of our inspection there were two trainees. Other staff included a practice manager, two nurses, a health care assistant and five administrative staff. The practice holds a Personal Medical Services (PMS) contract and was commissioned by NHSE London. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury, surgical procedures, family planning and maternity and midwifery services.

The practice was open between 7.30am to 6.30pm on Monday to Friday, except on Wednesday when they closed at 1pm. The telephones were staffed throughout working hours except between 1.00pm and 2.00 pm when the phones are switched to the out of hours provider. Appointment slots were available throughout the opening hours. The out of hours services are provided by an alternative provider. The details of the ‘out of hours’ service were communicated in a recorded message accessed by calling the practice when closed and details can also be found on the practice website. Longer appointments were available for patients who needed them and those with long-term conditions. This also included appointments with a named GP or nurse. Pre-bookable appointments could be booked up to two weeks in advance; urgent appointments were available for people that needed them.

The practice provided a wide range of services including clinics for diabetes, chronic obstructive pulmonary disease (COPD), contraception and child health care. The practice also provided health promotion services including a flu vaccination programme and cervical screening.

Updated 26 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Microfaculty on 14 July 2016. Overall the practice is rated as Outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they were commended and interviewed by Diabetes UK in March 2016 regarding identifying best practice that could be transferred across peers in the Waltham Forest CCG.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care was consistently positive.
• The practice implemented suggestions for improvements and made changes to the way 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.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• High standards were promoted and owned by all practice staff and teams worked together across all roles.

We saw areas of outstanding practice:

• The lead GP had created templates on the patient records system that prompted staff to get specific information, provided guidance as to what actions to take and gave specific agencies contact information in relation to concerns such as violence against women (domestic and sexual), forced marriage and honour based violence, faith based abuse, female genital mutilation, prostitution and trafficking which had been promoted by the CCG. 
• The practice took part in research projects such as East London Genes and Health. This entailed the practice collecting anonymised genetic material from people of Pakistani and Bangladeshi origin with a view to trying to rewrite the Cardiovascular Risk Tables for South Asians. Information submitted was with the full consent of patients. One hundred and eighteen participants have been recruited.

However, there were also areas of practice where the provider should make improvements:

• The practice should ensure that infection control audits are carried out annually.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 September 2016

The provider was rated as outstanding for care of people with long term conditions.

• The practice was pro-actively managing patients with long term conditions (LTC). Patients in these groups had a care plan and would be allocated longer appointment times when needed. Reception staff supported clinicians in ensuring annual reviews were completed for all patients in this group.

• The practice had the second highest proportion of people with Diabetes in Waltham Forest CCG., which was approximately 7-8% of the practice population. They were commended and interviewed by Diabetes UK in March 2016 regarding identifying best practice that could be transferred across peers in the Waltham Forest CCG.

• The practice took part in a health coaching pilot organised by the CCG through an external organisation. The aim was to assist patients with COPD and Diabetes to receive intensive Health Coaching to help them manage their health and well-being.

• The practice also promoted a structured diabetes education programme to all diabetics. The practices referral rates for diabetes outpatients was the lowest in the borough.

• The practice nurses were involved in managing patients with diabetes and performing diabetic monitoring. The practice had scored 99% on the recent QOF report for diabetes which was above the CCG average.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Services such as cardiology, urology and spirometry were provided in house to ensure continuity of care by clinicians.

Updated 26 September 2016

The provider was rated as good for 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, they had a named administrative staff member who monitored paediatric non-attenders to hospital out-patient and community services and passed this information to the safeguarding lead. 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 were recognised as individuals. The GPs demonstrated an understanding of Gillick competency and told us they promoted sexual health screening.

• The practice’s uptake for the cervical screening programme was 84%, which was above the national average of 82%.

• The practice triaged all requests for appointments on the day for children when their parent requested the child be seen for urgent medical matters, thus were able to offer appointments at mutually convenient times, for example after school, when appropriate.

Updated 26 September 2016

The provider was rated as good for care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Patients over 75 years had a named GP to co-ordinate their care.
• Patients identified as at risk of an emergency admission had their care planned.
• The practice was responsive to the needs of older people, and offered double appointments, home visits and urgent appointments for those with enhanced needs

• The practice had 278 patients over 75 and 77% had received flu vaccinations in 2015/16.

Updated 26 September 2016

The provider was rated as good for 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. They offered extended appointments on Monday evenings and Saturday mornings.

• They also had GP telephone triage for all requests for same day appointments, which enabled telephone consultations where appropriate, without patients having to take time off work.

• 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.

Updated 26 September 2016

The provider was rated as good for care of people experiencing poor mental health (including people with dementia)

• The practice had achieved 100% of the latest QOF points for patients with Dementia which was above both CCG and national averages. The practice had annual reviews for patients with dementia, which included early consideration of advance care planning. All dementia patients had a care plan which both they and carers had been involved in drafting.

• The practice had a register of patients experiencing poor mental health. These patients were invited to attend annual physical health checks and all 36 had been reviewed in the last 12 months.

• The practice worked closely with the CMHT to support patients with mental illness transfer from secondary care back to primary care. Patients with severe mental health had a shared care plan and received their depot injection from the lead GP.

• One of the GPs had a special interest in this area and was Section 12 of the Mental Health Act approved which meant they were able to assess patients and give medical recommendations for the compulsory admission of a mentally disordered person to hospital.

• 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.

• Reception staff we spoke with were aware of signs to recognise patients in crisis and to have them urgently assessed by a GP if they presented.

Updated 26 September 2016

The provider was rated as good for care of people whose circumstances may make them vulnerable

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. Pop up alerts were placed on all computer notes to alert all members of staff of vulnerable patients.

• Learning Disability patients were given care plans that met their needs. Patients with learning disabilities were invited annually for a specific review with their named GP. We saw 12 out of 14 reviews had been carried out in the last 12 months. Extended appointments were available for patients in this group.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary 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.