Archived: The Surgery, Dr T Rahman and Dr CY Tsoi

Updated 18 April 2017

The Surgery, Dr T Rahman and Dr CY Tsoi is located on South End Road, Hornchurch and has a Branch located on Stanley Road, Hornchurch. They are both situated in converted two storey houses and close to Elm park underground station. The premises are owned by the previous partner and practice manager and they are currently in progress with a solicitor to transfer to the current partners. The practice provides NHS primary medical services to 3619 patients through a General Medical Services contract (a General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities) in the NHS Havering Clinical Commissioning Group (CCG) area.

The premises have step free access with an accessible toilet and baby changing facilities.

The practice staff includes two GP partners (male and female) working 16 sessions per week, a practice nurse (female) working three sessions per week. The practice manager works 30 hours per week, and there are administration, reception and cleaning staff working a variety of part time hours.

The practice is open from:

• Monday 9am - 1pm and 4pm - 7pm
• Tuesday 9am - 1pm and 4pm - 7pm
• Wednesday 9am - 1pm and 4pm - 7pm
• Thursday 9am - 1pm
• Friday 9am - 1pm and 4pm - 7pm

Appointments are from:

• Monday 9am - 12pm and 4pm - 6:30pm
• Tuesday 9am - 12pm and 4pm - 6:30pm
• Wednesday 9am - 12pm and 4pm - 6:30pm
• Thursday 9am - 12pm
• Friday 9am - 12pm and 4pm - 6:30pm

Extended hours appointments are offered on Mondays and Wednesdays from 6:30pm to 7pm. Out of hour’s services covered by the Partnership of East London Cooperative (PELC) who cover from 6:30pm to 10pm weekdays and 12pm to 10pm at weekends. PELC also covers telephone calls from 8am to 9am and 1pm to 2:30pm and contact whichever GP is on call for any issues. Thursday afternoon clinical GP cover arranged from 1:00pm.

The practice patient population is 77% white British with 18% over 65’s which is comparable to the national average of 17%. Information published by Public Health England rates the level of deprivation within the practice population group as eight on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

Updated 18 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery, Dr. T Rahman and Dr. CY Tsoi on 16 November 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey were above average and showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice had identified less than 1% of its practice list as carers.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs; however the nurses consulting room did not have a sink.
• 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 April 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 82% which is comparable to the CCG and national averages of 78%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

Updated 18 April 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were above average for five year olds although they were below average for two year olds for standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had posters in waiting room with information of local sexual health and contraceptive clinics.

Updated 18 April 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. These patients were discussed at six weekly Integrated Case Management (ICM) meeting with ICM co-ordinator, community matron and social worker.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 18 April 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• 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 .

• Extended hours were available on Mondays and Wednesdays from 6:30pm to 7pm for those requiring after work medical consultations with a GP.

• NHS health checks provided for early identification of chronic disease, lifestyle counselling, weight management, and physical activity referral.

Updated 18 April 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia, for example 92% of patients with mental health problems had a health check in the last year (12 out of 13 patients).

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 100% which was higher than the CCG average of 91% and the National average of 89%( this was based on 13 patients).

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 18 April 2017

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, travellers and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

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

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.