Glebelands Practice

Updated 22 November 2016

Glebelands Practice provides GP primary care services to approximately 6000 people living in Redbridge. The local area is a mixed community and there is a wide variation in the practice population, from relatively deprived to affluent and mainly young to older aged.

The practice is a training practice and is run by three GP partners. There are two male GPs and one female GP who work a total of 24 sessions per week. Other staff included two trainee GPs, a practice manager, two nurses, a health care assistant and six 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 8am to 6.30pm on Mondays to Fridays, except Thursday when they close at 12pm. They have extended hours Monday and Wednesday 6.30pm to 7.30pm and Tuesday to Friday 7.30am to 8am. The telephones were staffed throughout working hours. 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. Patients could book appointments online.

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 22 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Glebelands Practice on 13 July 2016. Overall the practice is rated as good.

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 had carried out the highest number of 40-70 health checks in the CCG locality due to the way in which they personalised each patient letter.

• 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 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.
• The practice had received a Redbridge Carers Support GP Acknowledgment Award in July 2016, in recognition of the work they carried out to support carers.

• The practice was a training practice and two of the partners were qualified trainer. At the time of our inspection there were two trainees. The GP trainers’ met with their trainees after every morning surgery. They also held weekly lunch time meetings at the practice which consultants from Whipps Cross Hospital attended on occasions.

• A systematic approach was taken in working with other organisations to improve care outcomes and tackle health inequalities. The GP were involved in various external boards and organisations, such as one GP was the chairperson of the quarterly Redbridge protected learning event (PLE).

The areas where the provider should make improvement are:

• Continue to work to identify patients who are carers so their needs can be identified and met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 November 2016

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

• The practice was pro-actively managing patients with long term conditions . The practice had clinical leads for a variety of long term conditions including diabetes, asthma and chronic obstructive pulmonary disease. Patients in these groups had a care plan and would be allocated longer appointment times when needed.

• GPs attended regular internal as well as multidisciplinary meetings with district nurses, social workers and palliative care nurses, to discuss patients and their family’s care and support needs.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. Reception staff supported clinicians in ensuring annual reviews were completed for all patients in this group. 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.

• There were monthly diabetic clinics and spirometry was provided in house.

Updated 22 November 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, they would refer families for additional support and had multidisciplinary meetings with health visitors where any safeguarding concerns would be discussed.

• We saw positive examples of appropriate action being taken and joint working with external bodies where safeguarding concerns had been identified

• 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 22 November 2016

The practice is rated as outstanding for the 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 and the HCA was the practice champion for the care of older people.
• The practice was responsive to the needs of older people, and offered double appointments, home visits and urgent appointments for those with enhanced needs

• They held an over 75’s review Clinic with twenty minute appointments every Tuesday where patients developed Care Plans.

• The practice held a ‘Fit For Fun’ Chair Aerobics 20 week course which was attended by 5-10 patients a week. At the time of our inspection the practice was in the process of training up one of their members of staff to continue offering these sessions.

• They provided a Musculoskeletal(MSK) clinic where they carried out a full assessment of patients shoulders, knees, fingers and feet, they also opportunistically discussed exercise and diet in these sessions. These appointments were 30 minutes long. We saw the practice achieved the highest reduction in hospital admissions in the borough since the clinic had been running, of 20%.

Updated 22 November 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. They offered extended appointments four mornings and two evenings a week.

• 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 22 November 2016

The practice is rated as good for the 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 24 out of 26 had been reviewed in the last 12 months.

• The practice employed their own counsellors who they would refer patients to when they had concerns. We saw of the 14 patients referred 13 had improved within the allotted six sessions.

• The practice worked closely with the CMHT to support patients with mental illness transfer from secondary care back to primary care. Patients were also referred to other services such as Improving Access to Psychological Therapy (IAPT) and MIND the mental health charity.

• 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 22 November 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 whose circumstances may make them vulnerable such as people with learning disabilities, patients with no fixed abode and those with a learning disability. Pop up alerts were placed on all computer notes to alert all members of staff of vulnerable patients, to allow reception staff to meet their specific additional needs such as double appointments and/or visual/hearing impaired needs.

• 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 these had been carried out for the six patients in the last 12 months. Extended appointments were available for patients in this group.

• The practice had a register for people with hearing and sight problems. They said patients with these conditions had an alert on their electronic record so that they could be dealt with an appropriate manner. For example, using ‘Big Word’ if necessary and to ensure they adhered to the Accessible Information Standard. (The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand with support so they can communicate effectively with health and social care services.)

• 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.