Tredegar Practice

Updated 13 April 2017

Tredegar Practice is in Bow in east London. It is one of the 36 member GP practices in NHS Tower Hamlets Clinical Commissioning Group (CCG). It is also one of the five practices forming the Bow Health Network (BHN) Community Interest Company. The aim of the BHN is to work together with partner constituents and local stakeholders to engage and provide high quality, holistic and integrated care to the patients whilst maintaining individual practice autonomy.

The practice is located in the second more deprived decile of areas in England. At 77 years, male life expectancy is lower than the England average of 79 years. At 82 years, female life expectancy is lower than the England average of 83 years. Data from the 2011 census shows the three largest ethnic groups in Tower Hamlets (White British, Bangladeshi and White Other) make up some 78% of the practice’s catchment area. The provider told us that the local population was growing rapidly and that its demography was changing, placing new and increasing demands on the practice.

The practice has approximately 4,500 registered patients. It has many more patients in the 25 to 39 years age ranges than England average, and fewer in the other age ranges than the England average, with the exception of patients in the nought to four years age range, which is similar to the England average. Services are provided by Tredegar Practice under a General Medical Services (GMS) contract with NHS England.

The practice is in purpose built premises and patient areas are wheelchair accessible. There are four clinical rooms and an interview / phlebotomy room.

The practice teaches medical students and is taking part in the Tower Hamlets CCG Open Doors scheme which provides education and clinical mentoring for nurses and health care assistants employed by general practice in the borough.

The two GP partners and two salaried GPs work at the practice on a part time basis. Together they make up the equivalent of two whole time staff (WTE). Patients have access to female and male GPs. There are two nurses, who together make up 1.4 WTE staff, and a part time healthcare assistant (0.7 WTE). The clinical staff are supported by a team of administrative and receptionist staff headed up by a practice manager (0.44 WTE), an assistant practice manager (one WTE), and a reception manager (0.64 WTE).

The practice’s opening times are:

• 7.50am to 12.30pm and 2.00pm to 7.00pm on Monday and Tuesday.

• 8.00am to 12.30pm and 2.00pm to 6.30pm on Wednesday

• 8.00am to 12.30pm on Thursday.

• 7.50am to 12.30pm and 2.00pm to 7.00pm on Friday.

Patients are directed to an out of hours GP service outside these times.

Tredegar Practice is registered with the Care Quality Commission to carry on the following regulated activities at  35 St Stephens Road, London E3 5JD: Diagnostic and screening procedures, Family planning, Maternity and midwifery services, and Treatment of disease, disorder or injury.

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tredegar Practice on 05 January 2017. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and managed.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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.
• 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 and complied with the requirements of the duty of candour.

The area where the provider should make improvement is:

• Strengthen security arrangements for storing the prescription pad kept in the visit bag.

• Continue to review and monitor performance in relation to COPD (chronic obstructive pulmonary disease) and childhood immunisations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2017

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

• Nursing staff lead roles in chronic disease management were becoming established following changes in the nursing team and increased nursing capacity. This was having a positive effect on outcomes for patients, for example, 91% of patients with COPD had had their annual review at 25 October 2016. This compared with 54% of patients in the whole of 2015-16 (national average 90%).

• Patients at risk of hospital admission were identified as a priority.

• Performance against clinical targets for patients with diabetes was comparable to national averages.

• The practice hosted the diabetes and cardiovascular disease specialist nurse clinics for the network.

• Longer appointments and home visits were available when needed.

• 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.

• A person-centred care planning approach to organising enhanced treatment and care for patients with long term conditions and complex and multiple needs was well established as part of an integrated care local enhanced service.

Updated 13 April 2017

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. This included regular liaison with the health visitor service.

• The practice was on track to meet childhood immunisation rates targets in 2016-17. For example 80% of children aged 2 had received all their immunisations at 15 December 2016. The provider had changed how the baby clinic was run as part of the plan to improve childhood immunisation rates, some of which had been below target for two year olds in 2015-16 (87% compared with the target of 90%).

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. The practice was ‘You’re Welcome’ accredited which means it was meeting the Department of Health quality criteria for young people friendly health services.

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

• We saw positive examples of joint working with midwives and health visitors. Midwives held a weekly clinic at the practice and the baby clinic held every two weeks at the practice included a GP, nurse and health visitor to provide families with one-stop services.

• The percentage of eligible women having the cervical screening test was comparable to the local and national averages.

Updated 13 April 2017

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

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

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

• A person-centred care planning approach to organising enhanced treatment and care for patients with complex and multiple needs was well established, as part of an integrated care local enhanced service.

• The patient’s integrated care plan record was shared between the GP, hospital and social services with their consent to aid coordination of health and care services and understanding of the patient’s wishes.

Updated 13 April 2017

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 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.

• It provided phlebotomy, spirometry and 24 hour blood pressure monitoring to increase patients’ access to these tests.

Updated 13 April 2017

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

• One hundred per cent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months in 2015-16, which was above the CCG average of 91% and the national average of 84%. The practice had 15 patients with dementia and reported no exceptions compared with the CCG and national average exception reporting rates, both at eight per cent. Exception reporting is the removal of patients from QOF calculations where, for example, patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.

• Patients with dementia were included in the integrated care local enhanced service.

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

• Eighty nine per cent of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months, which was the same as the CCG and national averages. The practice recognised the need to improve the recording of these patients’ alcohol consumption, which was 62% of patients 2015-16 (CCG average of 90%, national average 89%), and had started to review performance against this indicator in its weekly performance monitoring meetings.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.

• Patients could access the clinical psychologist and the community mental health team at the practice.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

Updated 13 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 frail patients with complex needs, those receiving palliative care, those at risk of avoidable admission to hospital and those with a learning disability.

• The practice offered longer appointments for patients where needed, for example those with a learning disability.

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

• The practice took part in the shared care scheme for people with drug addiction problems.

• 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.