Enter and view: The Loxford Practice

This Healthwatch Redbridge Enter and View report summarises a visit to The Loxford Practice in Ilford on 25 January 2017, approximately five months after new provider AT Medics took over management of the practice following an inadequate CQC rating in 2016. The visit aimed to assess whether patient experience had improved and whether the practice had implemented the Accessible Information Standard for patients with communication needs. 

The practice served approximately 15,479 registered patients and offered a wide range of services, including chronic disease reviews, immunisations, health checks, referrals, smoking cessation services and a telephone triage system. The practice reported providing around 200 GP appointments and 106 nurse appointments each day. 

Healthwatch found that the premises were generally modern, clean and physically accessible. The building had automatic doors, accessible parking spaces and consultation rooms on the ground floor. Signage directing patients around the building was generally clear, although some signs, toilet signage and consultation room numbers were considered too small. Certain accessibility features, such as hearing loop signs and complaints information, were also difficult to locate or read.

The review identified a number of issues relating to accessible communication. Although staff recorded patients' communication needs on their records and had attended Accessible Information Standard workshops, Healthwatch found gaps in staff knowledge and training. A hearing loop system was available but was not functioning during the visit because it had been unplugged, and some staff were unsure how to operate it. The practice was also still developing accessible materials such as large-print and easy-read information. 

Patient feedback highlighted significant concerns about access to appointments. Most patients found it difficult to get through on the telephone, and nine out of ten said it was difficult or very difficult to obtain an appointment with a GP. Although three-quarters of patients were aware of online booking, only a minority found it easy to use. Patients generally found nurse appointments easier to obtain than doctor appointments. 

Waiting times were another area of concern. While just over half of patients reported waiting less than two weeks for a GP appointment, many still experienced delays, and one in five reported waiting more than 45 minutes after their appointment time to be seen. Every patient interviewed stated that they had been unable to obtain an emergency appointment when needed, and only a third said they had been signposted to alternative services such as NHS 111, GP hubs or A&E. 

Patient views on clinical care were mixed but generally positive. Three-quarters of respondents rated care from GPs as good or excellent, while six in ten rated nursing care positively. Some patients felt clinicians only addressed one problem per consultation, struggled to obtain referrals, or felt there was a lack of personal care. Others commented that the service had improved considerably since the change in provider. 

Reception services received mixed feedback. Some patients described reception staff as helpful and friendly, while others felt they could be abrupt, inconsistent or unhelpful. However, several patients acknowledged recent improvements in staff attitudes and communication.

Awareness of complaints procedures was low. Only 17% of patients interviewed knew how to make a complaint, and the complaints information displayed in the practice was considered difficult to find and not available in accessible formats. Patients with communication impairments also reported not being asked about their specific needs. 

Healthwatch concluded that while patients recognised improvements since the previous provider left, there were still significant issues around appointment availability, telephone access, communication, accessibility and patient information. The report recommended improving signage, making complaints information more accessible, providing additional disability-awareness training, ensuring all staff could use hearing loops correctly, improving telephone access, reducing appointment waiting times, and strengthening signposting to alternative services when appointments were unavailable. 

The practice responded positively, outlining actions already taken or planned, including larger signs, improved hearing loop signage, staff training, promotion of online services, monitoring of telephone performance, better identification of patients with communication needs, and ongoing work to develop accessible information resources.